Philosophical Reflections on Medical Ethics Also by Nafsika Athanassoulis MORALITY, MORAL LUCK AND RESPONSIBILITY Fortune’s Web THE MORAL LIFE Essays in Honour of John Cottingham (co-edited with Samantha Vice) Philosophical Reflections on Medical Ethics Edited by Nafsika Athanassoulis Lecturer in Ethics, Centre for Professional Ethics, Keele University Editorial matter, selection, introduction and chapter 8 © Nafsika Athanassoulis 2005 All remaining chapters © their respective authors 2005 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No portion of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, Saffron House, 6–10 Kirby Street, London EC1N 8TS. Any person who does any unauthorized act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The authors have asserted their rights to be identified as the authors of this work in accordance with the Copyright, Designs and Patents Act 1988. First published in hardback 2005 This paperback edition published 2010 by PALGRAVE MACMILLAN Palgrave Macmillan in the UK is an imprint of Macmillan Publishers Limited, registered in England, company number 785998, of Houndmills, Basingstoke, Hampshire RG21 6XS. Palgrave Macmillan in the US is a division of St Martin’s Press LLC, 175 Fifth Avenue, New York, NY 10010. Palgrave Macmillan is the global academic imprint of the above companies and has companies and representatives throughout the world. Palgrave® and Macmillan® are registered trademarks in the United States, the United Kingdom, Europe and other countries. ISBN 978-0-230-24704-8 ISBN 978-0-230-27393-1 (eBook) DOI 10.1057/9780230273931 This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. Logging, pulping and manufacturing processes are expected to conform to the environmental regulations of the country of origin. A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Philosophical reflections on medical ethics / edited by Nafsika Athanassoulis. p. cm. Includes bibliographical references and index. 1. Medical ethics. 2. Medical ethics – Philosophy. I. Athanassoulis, Nafsika, 1973– R725.5.P48 2005 174.2–dc22 2005043760 10 9 8 7 6 5 4 3 2 1 19 18 17 16 15 14 13 12 11 10 Transferred to Digital Printing 2010 Contents Acknowledgements vii Notes on the Contributors viii Introduction 1 Nafsika Athanassoulis 1 Benefit, Disability and the Non-Identity Problem 24 Hallvard Lillehammer 2 ‘Designer Babies’, Instrumentalisation and the Child’s 44 Right to an Open Future Stephen Wilkinson 3 Why There is no Right to Know One’s Genetic Origins 70 Heather Draper 4 Compromise and Moral Complicity in the Embryonic 88 Stem Cell Debate Katrien Devolder and John Harris 5 Towards a Natural Law Critique of Genetic Engineering 109 David S. Oderberg 6 Autonomy Inducements and Organ Sales 135 James Stacey Taylor 7 The Role of Conscience in Medical Ethics 160 Piers Benn 8 The Treatment that Leaves Something to Luck 180 Nafsika Athanassoulis 9 Passive Death 198 Ray Frey Index 208 v Acknowledgements This volume is the result of four years of thinking about and teaching medical ethics, so my greatest debt is owed to the hundreds of students at the University of Leeds who have stimulated my own research with their arguments and ideas. I am also particularly grateful to all the con- tributors to this volume for their hard work and excellent papers. vii Notes on the Contributors Nafsika Athanassoulis is Lecturer in Ethics at Keele University. She is the author of Morality, Moral Luck and Responsibility: Fortune’s Web(Palgrave Macmillan, 2005), and has published articles on moral luck, virtue ethics and consent. She teaches medical ethics to any- one who will listen, including philosophy students, medical stu- dents, biomedical sciences students and professionals returning to education. Piers Bennis Lecturer in Medical Ethics and Law, Imperial College. He is the course organiser for the new MSc in Medical Ethics and has general interests in moral theory, meta-ethics and applied ethics. His research interests in medical ethics include issues at the beginning and end of life, including the metaphysics of ‘personhood’ and the debate about brain death; ethical issues in psychiatry, especially the moral responsibility of psychopaths; the nature and defensibility of paternal- ism in medicine; lying and deception in medicine and the interplay of secular and theological approaches to biological concerns. His publica- tions include Ethics, (1998); ‘Morality, the Unborn and the Open Future’, in Questions of Time and Tense, edited by R. LePoidevin (1998); ‘New Issues: Health Care Ethics’, Journal of Applied Philosophy 18:2 (2001); ‘Medicine, Lies and Deceptions’, Journal of Medical Ethics 27:2 (2001). He is currently working on a book on death. Katrien Devolder is a postdoctoral research fellow of the Research Foundation – Flanders and is based at the Bioethics Institute Ghent at Ghent University, Belgium. Her chief interests are in bioethics, more particularly in cloning, stem cell research and genetics. She is the author, together with Johan Braeckman, of a book on human cloning, which was published in 2001. She is currently writing a book on the ethics of human embryonic stem cell research and has published extensively on this topic. Heather Draperis Reader in Biomedical Ethics, Centre for Biomedical Ethics, Primary Care Clinical Sciences, at the University of Birmingham, UK. One of her primary research interests is the ethics of human repro- duction and the role in ethics and policy of genetic relatedness in viii Notes on the Contributors ix determining parental rights and responsibilities. Published papers related to the one in this collection include: ‘Paternity Fraud and Compensation for Misattributed Paternity’ Journal of Medical Ethics (2007), ‘Gametes, Consent and the Point of No Return’ Human Fertility (2007), and with Jonathan Ives ‘Testing for Fatherhood: Two Paradoxes of Paternity Testing’ Journal of Social Welfare and Family Law (forth- coming) and ‘Becoming a Father/Refusing Fatherhood: An Empirical Bioethics Approach to Paternal Responsibilities and Rights’ Clinical Ethics(2008). Ray Frey is Professor of Philosophy, Bowling Green University. He is the author of numerous articles and books on ethical theory, applied ethics, the history of ethics and social and political theory, including Euthanasia and Physician-Assisted Suicide (1998, with Gerald Dworkin and Sissela Bok), Awaiting publication are books on Joseph Butler, an edition of Butler’s ethical writings, a volume of essays on topics in applied ethics and a volume on utilitarianism. He teaches courses in all the areas of his research, including legal philosophy. Previously, he tutored students at Oxford and taught in the Universities of Liverpool and Toronto. He is Senior Research Fellow at the Social Philosophy and Policy Center in Bowling Green, a Senior Research Fellow of the Kennedy Institute of Ethics, Georgetown University, and a Senior Research Fellow of the Westminster Institute of Ethics and Public Policy at the University of Western Ontario, Canada. John Harrisis Sir David Alliance Professor of Bioethics, School of Law, University of Manchester and is joint Editor-in-Chief of The Journal of Medical Ethics. He was elected a Fellow of the Academy of Medical Sciences (FMedSci) in 2001 and has been a member of the Human Genetics Commission since its foundation in 1999. Recent books include: Clones Genes and Immortality (1998); Bioethics(2001); A Com- panion to Genethics: Philosophy and the Genetic Revolution (2002 and 2004); and On Cloning(2004). Hallvard Lillehammer is Fellow of King’s College and Lecturer in Philosophy at Cambridge University. He is co-editor of Real Metaphysics (2003) and Genetics, Persons, and Responsibility(2001). He has published a number of papers on medical ethics, including ‘Voluntary Euthanasia and the Logical Slippery Slope Argument’, The Cambridge Law Journal (2002), and ‘Who Needs Bioethicists?’, Studies in the History and Philo- sophy of Biological and Biomedical Sciences (2004). x Notes on the Contributors David S. Oderberg is Professor of Philosophy at the University of Reading. He is the author of many articles in metaphysics, ethics, philosophical logic and other subjects. His publications include Moral Theory: A Non-Consequentialist Approach (2000); Applied Ethics: A Non- Consequentialist Approach (2000); and Human Lives: Critical Essays on Consequentialist Bioethics(co-editor with Jacqueline A. Laing, 1997). James Stacey Taylor is an Associate Professor of Philosophy at The College of New Jersey, USA. He is the editor of Personal Autonomy: New Essays (2005, paperback 2008), and the author of both Stakes and Kidneys: Why Markets in Human Body Parts are Morally Imperative (2005) and Practical Autonomy and Bioethics (2009). He is also the author of over 30 articles in academic journals, including Social Philosophy & Policy, Public Affairs Quarterly, American Philosophical Quarterly, the Journal of Applied Ethics, and the Journal of Medicine and Philosophy. His work has also appeared in many edited collections and has been widely anthologized. He currently serves as the Managing Editor of the Journal of Value Inquiry, and is completing two books: Death Unterrible: Epicurean Thanatology and Contemporary Bioethics and Toxic Trade: An Unapologetic Defense of Universal Commodification. Stephen Wilkinson is Senior Lecturer in Ethics and Philosophy at Keele University, where he directs a number of graduate programmes including the PgDip/MA in Medical Ethics and Law, taught jointly with Keele University’s Law Department, and the UK’s first professional doctorate in Medical Ethics (the DMedEth), which was launched in 2002. His recent research papers have addressed topics including the allocation of health service resources, pre-implantation genetic dia- gnosis, separating conjoined twins, and the nature of mental illness. A paper on the latter won the Philosophical Quarterly International Essay Prize in 1999. He has recently completed a book on the ethics of commercialising the human body (Bodies for Sale, 2003). This work was supported by a research grant by the Arts and Humanities Research Board.