Introduction to Bioethics

Preface xiii

About the Companion Website xv

Part I Setting the Scene 1

1 Science and Society 3

1.1 What’s It All About? 3

1.2 What Is Science? 5

1.2.1 Introduction: Some History (But Not Very Much) 5

1.3 Modern Science 9

1.4 Science, Ethics and Values 10

1.4.1 Introduction 10

1.4.2 Scientific Fraud 11

1.4.3 Science and Societal Values 11

1.5 Attitudes to Science 13

1.5.1 Science and the Enlightenment 13

1.5.2 Science, Modernism, Modernity and Postmodernism 14

1.5.3 Postmodernism and ‘Pseudo?]modernism’ 16

1.5.4 Public Attitudes to Science 17

Key References and Suggestions for Further Reading 21

2 Ethics and Bioethics 23

2.1 Ethics and Morals 23

2.2 The Development of Ethics 25

2.2.1 Introduction 25

2.2.2 Virtuous Greeks 25

2.2.3 Ethics and Duty 26

2.2.4 What Happens If…? 27

2.2.5 Natural Law 28

2.2.6 Moral Relativism: My View Is as Good as Yours 28

2.2.7 The Revival of Virtue 29

2.2.8 Ethics and Rights 29

2.2.9 Ethics and Religion 30

2.2.10 Ethics: A Summary 30

2.3 Making Ethical Decisions 31

2.4 Medical Ethics 33

2.5 The Growth of Bioethics 34

Key References and Suggestions for Further Reading 36

Part II Biomedical Science and Medical Technology 39

3 Life before Birth I: The New Reproductive Technologies 41

3.1 Introduction 41

3.2 Gametes Outside the Body 42

3.3 Techniques of Artificial Reproductive Medicine 43

3.3.1 Objections to Assisted Reproduction 43

3.3.2 Donor Insemination 44

3.3.3 Gamete Donation 44

3.3.4 In Vitro Fertilisation and Variations 47

3.3.5 Reception of Oocytes from Partner 50

3.4 Embryo Testing 51

3.5 Mitochondrial Donation 51

3.6 Embryo Research 54

3.7 Rights of the Unborn Child 56

3.8 Men and Women: Do We Need Both? 56

Key References and Suggestions for Further Reading 58

4 Life before Birth II: Embryos, Foetuses and Associated Issues 61

4.1 Introduction 61

4.2 The Early Human Embryo 63

4.2.1 Introduction: Embryos and Persons 63

4.2.2 Status of the Embryo: Human Life Begins at Fertilisation 64

4.2.3 Status of the Embryo: The 14?]Day Approach 65

4.3 Embryo Research 66

4.4 Screening and Diagnosis 69

4.5 Reproductive Rights 71

4.5.1 Scope of Reproductive Rights 71

4.5.2 Contraception 71

4.6 Abortion: Maternal–Foetal Conflict 72

4.7 Surrogacy 77

4.8 Artificial Wombs 78

Key References and Suggestions for Further Reading 80

5 Cloning and Stem Cells 83

5.1 Introduction 83

5.2 Frogs and Sheep 84

5.3 Genes and Clones 87

5.4 It’s Not Natural: It Should Be Banned! 87

5.5 The Ethics of Human Cloning: An Overview 91

5.6 Reproductive Cloning of Non?]human Mammals 93

5.7 Unlocking the Genetic Potential of Stem Cells 96

5.7.1 Embryonic Stem Cells 96

5.7.2 Therapeutic Potential 98

5.7.3 Embryonic Stem Cells and the Ethical Status of the Early Human Embryo 98

5.7.4 Therapeutic Cloning 101

5.7.5 Adult Stem Cells 102

5.7.6 Novel Sources of Stem Cells 103

5.8 Concluding Remarks 105

Key References and Suggestions for Further Reading 106

6 Human Genes and Genomes 109

6.1 Some History 109

6.2 Molecular Genetics and the Human Genome Project 110

6.3 Some Thoughts on Eugenics 112

6.4 Use of Human Genetic Information 113

6.4.1 Introduction 113

6.4.2 Genetic Diagnosis 114

6.4.2.1 Postnatal Diagnosis 114

6.4.2.2 Prenatal Diagnosis 115

6.4.2.3 Pre?]implantation Genetic Diagnosis 116

6.4.2.4 Saviour Siblings: A Very Special Case 118

6.4.2.5 Where Next? 119

6.4.3 Genetic Screening 120

6.4.4 The Possibility of Genetic Discrimination 124

6.4.5 Community?]Wide Genome Sequencing 125

6.4.6 Direct?]to?]Consumer Genome Analysis 127

6.4.7 The Burden of Genetic Knowledge 129

6.4.8 A Promise Unfulfilled? 130

6.5 Genetic Modification of Humans: Fact or Fiction? 131

6.5.1 Introduction 131

6.5.2 Somatic Cell Gene Therapy 131

6.5.3 Germ?]Line Gene Therapy 133

6.5.4 Genetic Enhancement and Designer Babies 135

6.5.5 Genome Editing 138

6.6 A Gene for This and a Gene for That 140

Key References and Suggestions for Further Reading 141

7 Transhumanism 143

7.1 Introduction 143

7.2 From Wooden Legs to Would?]Be Cyborgs 144

7.3 Mind and Matter 149

7.4 Stronger, Fitter, Faster, Cleverer: Biological Aspects of Transhumanism 152

7.4.1 Genetic Modification 152

7.4.2 Life Extension 153

7.4.3 Biochemical and Pharmaceutical Enhancement 154

7.5 Military Applications 156

Key References and Suggestions for Further Reading 157

8 Decisions at the End of Life: When May I Die and When Am I Dead? 159

8.1 Introduction: Four Important Examples to Inform Our Thinking 159

8.1.1 Charlotte Wyatt 159

8.1.2 Mark Sanderson 161

8.1.3 King George V 161

8.1.4 Reginald Crew 161

8.2 How Did We Get Here? 162

8.3 What Is Euthanasia? 163

8.3.1 Introduction 163

8.3.2 Euthanasia 163

8.3.3 Is Assisted Suicide Different? 164

8.4 Case for Assisted Dying 164

8.4.1 Openness 164

8.4.2 Necessity 165

8.4.3 Autonomy 165

8.5 The Arguments against Assisted Dying 166

8.5.1 Controlling Pain and Suffering 166

8.5.2 The Downside of Autonomy 166

8.6 The Debate Continues: Will the Law Ever Be Changed? 168

8.7 When Should Medical Treatment Be Withheld or Withdrawn? 172

8.7.1 Introduction 172

8.7.2 The Right to Refuse Treatment 173

8.7.3 Making Decisions for People Who Cannot Make Them for Themselves 173

8.7.4 The Liverpool Care Pathway 176

8.8 Concluding Remarks 176

Key References and Suggestions for Further Reading 177

Part III Biotechnology 179

9 Genetic Modification and Synthetic Biology 181

9.1 Introduction 181

9.2 Ethical Aspects of Genetic Modification 182

9.2.1 Introduction 182

9.2.2 Ethical Analysis of Genetic Modification 182

9.2.3 Risks Associated with Genetic Modification 183

9.2.4 Possible Misuse of Genetic Modification 186

9.3 Pharmaceuticals 187

9.4 Genetic Modification of Animals 190

9.4.1 Introduction 190

9.4.2 Scientific Background 190

9.4.3 Applications of Animal Genetic Modification 191

9.4.4 Animal GM and Animal Welfare Issues 192

9.5 Research Uses of Genetic Modification 193

9.6 Gene and Genome Editing 195

9.6.1 Introduction 195

9.6.2 The CRISPR/Cas9 Genome Editing System 196

9.7 Synthetic Biology 197

9.7.1 Introduction 197

9.7.2 What Is Synthetic Biology? 198

9.7.3 Applications of Synthetic Biology 200

9.7.4 Ethical Aspects of Synthetic Biology 201

Key References and Suggestions for Further Reading 202

10 Genetic Modification of Plants 205

10.1 Introduction and Definitions 205

10.2 Back to the Beginning 206

10.3 Basic Methodology 208

10.4 The Debate 209

10.4.1 Introduction 209

10.4.2 Conducting the Debate 210

10.4.3 The Key Issues 213

10.4.3.1 Intrinsic Objections 213

10.4.3.2 Risk 214

10.4.4 The Debate Continues 217

10.4.5 Genome Editing: A Special Case? 222

10.5 GM Crops: Is a Different Approach Possible? 223

10.6 Closing Comments: Consumer Choice 224

Key References and Suggestions for Further Reading 226

11 Genes: Some Wider Issues 229

11.1 Introduction 229

11.2 Crop GM Technology, World Trade and Global Justice 231

11.3 Gene Patenting 235

11.3.1 Gene Patents in Crop GM Technology 235

11.3.2 Gene Patents and Medical Genetics 236

11.4 Genetic Piracy 238

11.5 DNA Fingerprinting and DNA Databases 243

11.5.1 Introduction 243

11.5.2 Applications of DNA Fingerprinting 243

11.5.3 DNA Databases 245

11.6 Concluding Remarks 246

Key References and Suggestions for Further Reading 246

12 Biofuels and Bioenergy: Environmental and Ethical Aspects 249

12.1 Introduction 249

12.2 Biofuels: A Brief Survey 251

12.3 Biofuels: Ethical Issues 254

12.3.1 Introduction 254

12.3.2 Can Biofuels Be Produced without Affecting Food Production? 254

12.3.3 Is Growth of Biofuel Crops Sustainable? 258

12.3.4 Biofuel Production and Land Allocation 259

12.4 Concluding Comment 261

Key References and Suggestions for Further Reading 261

Part IV Humans and the Biosphere 263

13 Humans and Non?]human Animals 265

13.1 Introduction 265

13.2 Humankind’s Place in the Animal Kingdom 266

13.3 Human Use of Animals: An Overview 267

13.3.1 Historic and Present?]Day Perspectives 267

13.3.2 ‘Speciesism’ 270

13.4 Vivisection and the Use of Animals in Research 271

13.4.1 Definitions, Laws and Numbers 271

13.4.2 Reasons for Experimenting on Animals 272

13.4.3 All Animals Are Equal, or Are They? 274

13.5 The Ethics of Animal Research 274

13.6 Animals in Sport, Companionship, Leisure and Fashion 277

13.6.1 Sport 277

13.6.2 Companion Animals and Pets 278

13.6.3 Fashion and Fur 279

13.7 Working Animals 279

13.8 Animals for Food 280

13.9 Concluding Comments 282

Key References and Suggestions for Further Reading 283

14 The Environmental Crisis: Not Just about Climate 285

14.1 Introduction 285

14.2 Environmental Damage: It’s a Fivefold Problem 287

14.2.1 Introduction 287

14.2.2 Environmental Pollution 287

14.2.3 Environmental Degradation 290

14.2.4 Loss of Habitat and of Biodiversity 291

14.2.5 Over?]exploitation of Earth’s Resources 293

14.2.6 Pause for Reflection 294

14.3 Climate Change 295

14.3.1 Introduction 295

14.3.2 Sea Levels 297

14.3.3 How Much Can We Cope With? 298

14.3.4 Fuels and Energy Sources 299

14.3.5 Resilience 302

14.3.6 The Future 302

14.4 Valuing the Environment 305

Key References and Suggestions for Further Reading 310

15 Planet and Population 311

15.1 Introduction: The Anthropocene 311

15.2 How Many? 312

15.3 How Many Can We Feed? 313

15.3.1 Agricultural and Scientific Aspects 313

15.3.2 Social and Societal Aspects 316

15.3.3 War 317

15.4 How Many Is Too Many? 318

15.5 Water 319

15.6 Concluding Comments 321

Key References and Suggestions for Further Reading 323

Index 325