Tuija Takala

High hopes and automatic escalators: a critique of some new arguments in bioethics

Two protechnology arguments, the “hopeful principle” and the “automatic escalator”, often used in bioethics, are identified and critically analysed in this paper. It is shown that the hopeful principle is closely related to the problematic precautionary principle, and the automatic escalator argument has close affinities to the often criticised empirical slippery slope argument. The hopeful principle is shown to be really hopeless as an argument, and automatic escalator arguments often lead nowhere when critically analysed. These arguments should therefore only be used with great caution.

What is wrong with global bioethics? On the limitations of the four principles approach.

Within the latter half of the 30-year history of bioethics there has been an increasing pressure to address bioethical issues globally. Bioethics is not traditionally a theory-based enterprise, rather the focus has been problem related. With the introduction of the global perspective, theory has, however, become more important. One of the best known, probably the best known, theory of bioethics is the one presented by Tom L. Beauchamp and James F. Childress in their Principles of Biomedical Ethics in 1979. This theory is known as the “four principles” or the “Georgetown mantra” approach or “mid-level principlism.” It is the attempt to create a global framework for bioethics on the four principles—autonomy, justice, beneficence, and nonmaleficence—that I will scrutinize in this paper.

Genetic Ignorance, Moral Obligations and Social Duties

In a contribution to The Journal of Medicine and Philosophy, Professor Rosamond Rhodes argues that individuals sometimes have an obligation to know about their genetic disorders, because this is required by their status as autonomous persons. Her analysis, which is based on Kants concept of autonomy and Aristotles notion of friendship, is extended here to consequentialist concerns. These are of paramount importance if, as we believe and Professor Rhodes herself implies, the Kantian and Aristotelian doctrines can be helpful only in the sphere of private morality, not in the public realm. Better tools for assessing the right to genetic ignorance as an issue of public policy can, we contend, be found in Mills ideas concerning liberty and the prevention of harm. Our own conclusion, based on the Millian way of thinking, is that individuals probably do have the right to remain in ignorance in the cases Professor Rhodes presents as examples of a duty to know.

Genetic information, rights, and autonomy.

Rights, autonomy, privacy, and confidentialityare concepts commonly used in discussionsconcerning genetic information. When theseconcepts are thought of as denoting absolutenorms and values which cannot be overriden byother considerations, conflicts among themnaturally occur.In this paper, these and related notions areexamined in terms of the duties and obligationsmedical professionals and their clients canhave regarding genetic knowledge. It issuggested that while the prevailing idea ofautonomy is unhelpful in the analysis of theseduties, and the ensuing rights, an alternativereading of personal self-determination canprovide a firmer basis for ethical guidelinesand policies in this field.

Genetic Ignorance and Reasonable Paternalism

The question concerning an individuals rightto remain in ignorance regarding her owngenetic makeup is central to debates aboutgenetic information. Whatever is decided onthis matter has a weighty bearing on all of therelated third-party issues, such as whetherfamily members or employers should be toldabout an individuals genetic makeup. Thosearguing that no right to genetic ignoranceexists tend to argue from a viewpoint I havecalled in this paper reasonablepaternalism. It is an appealing position whichrests on widely shared intuitions on reasonablechoices, but which, in the end, smugglespaternalism back to medical practice.

The (Im) Morality of (Un) Naturalness

In discussions among nonphilosophers, the ethical argument from naturalness frequently comes up. “Of course, cloning should be banned—it is unnatural.” “Surely you cannot deny that homosexuality is unnatural (and hence it should be condemned).” “The immorality of gene technology is apparent because things like that do not happen in nature. Genes do not jump between species and crossbreeding produces infertile offspring.” Even those who come from a philosophical background can catch themselves thinking, “That is unnatural!” and finding grounds for suspicion from the thought. But what do we mean when we talk about (im)morality and (un)naturalness? What interpretations can be given to the ideas of natural and unnatural in ethical discussions? What are the implications of these interpretations? Are there good grounds for assuming that naturalness is morally better than its opposite? This paper was first presented at the Fourth International Bioethics Retreat in Paris, May 2001. I wish to thank the participants for their comments on my paper. This paper was produced as a part of the project Genes, Information, and Business , financed in 2000–2003 by the Academy of Finland.

Concepts of “person” and “liberty,” and their implications to our fading notions of autonomy

It is commonly held that respect for autonomy is one of the most important principles in medical ethics. However, there are a number of interpretations as to what that respect actually entails in practice and a number of constraints have been suggested even on our self-regarding choices. These limits are often justified in the name of autonomy. In this paper, it is argued that these different interpretations can be explained and understood by looking at the discussion from the viewpoints of positive and negative liberty and the various notions of a “person” that lay beneath. It will be shown how all the appeals to positive liberty presuppose a particular value system and are therefore problematic in multicultural societies.

Demagogues, Firefighters, and Window Dressers: Who Are We and What Should We Be?

The growing interest in bioethics has given rise to a new group of experts: experts in bioethics. They come from different walks of life and their motives, claims, and qualifications for expertise are manifold. Various academic disciplines can be said to contribute to ones status as an expert in bioethics. Studies and research in, say, philosophy, law, anthropology, history, theology, and sociology with an emphasis on bioethical matters are often thought of as suitably qualifying a person as a bioethicist. In addition to these academic qualifications there are two routes to becoming a bioethicist. I will call these the self-nomination (self-styled) and the through-work-experience routes. Self-nominated expertise is most common with medics who have strong religious or other ideological views about ethical matters. Another path to self-nominated expertise starts with strongly held ideological views with interest in bioethical matters. For this category of bioethical experts there does not have to be any institutional acknowledgment of their status; they are experts because they think they are. The other nonacademic type of expert in bioethics emerges through administrative channels. When the various ethics committees and regulatory bodies that now abound were first founded, there were no experts in bioethics to sit on these committees. People became experts by serving in these institutions for sufficiently long periods of time. This still happens with ethics committees in which just a few of the members are experts in ethics. People join the committees as experts of other fields, but are thought to have become experts through the fact that they have served on such committees.

Guest Editorial: Introduction to Philosophical Issues in Neuroethics

Neuroethics studies the ethical, social, and legal issues raised by actual or expected advances in neuroscience. The relevant fields in neuroscience include, but are not limited to, neuroimaging, cognitive neuroscience, neuropsychopharmacology, neurogenetics, and neuropsychiatry. For many, neuroethics is best understood as a subcategory of bioethics, and although not all agree, for the purposes of the present collection of articles, this definition is assumed. Although bioethics as a field of study started in the early 1970s as a normative enterprise, mainly practiced by philosophers and theologians, it has since become truly inter- and multidisciplinary, comprising also law, sociology, psychology, gender studies, disability studies, anthropology, history, and many other approaches. What we particularly wanted to do in this issue, however, was to find the most pertinent questions of neuroethics from the viewpoint of philosophy, and the call for papers was drafted accordingly.

Cloning, naturalness and personhood

Since the invention of recombinant-DNA techniques in the 1970s, the development of modern biotechnology has presented a constant challenge to our views of ourselves as natural and moral beings. Somatic cell therapies, which cure diseases only in those individuals who are actually being treated, are the least problematic form of medical genetics, as they can easily be seen as no more than a new method of doing what physicians have always done in their professional capacity, namely removing illness and relieving suffering. Germ-line gene therapy, which is expected to rectify hereditary disorders both in patients themselves and in their descendants, has been viewed with more suspicion, because more permanent changes in the human constitution over generations are involved. The project to map the human genome has also caused concern, mainly since it can be applied to eugenic purposes — for the alleged improvement of humankind. But for the last two decades the most serious moral doubts about genetics have been related to cloning or, to be more precise, to the production of children by copying the genetic makeup of living individuals.