Ethics chapter 4-6 notes

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Health Sciences
Health Sciences 2610F/G
Aleksandra Zecevic

Reproductive Technology Abortion Judith Jarvis Thomson No woman is morally required to allow a fetus to develop to term. Because it requires the person to make large sacrifices to keep another person alive. Hence, aborting a fetus and detaching one’s body from it is morally permissible. The right to life can’t depend on whether pregnancy resulted from a voluntary or involuntary sexual act, because no property intrinsic to the fetus justifies this distinction. Insofar as an individual’s right to life does not depend on how that individual came into existence, the argument from responsibility is not a successful argument against Thomson’s defense. 2 Important qualifications to her position: 1.) Abortion is generally permissible, not always permissible. 2.)Although it is permissible to detach one’s body from the fetus through abortion, it is not permissible to guarantee the death of a baby once it is born. The right to an abortion does not entail the right to commit infanticide. Important to acknowledge the distinction between negative rights and positive rights. A negative right of one individual implies an obligation for other individuals not to interfere with the expression of that right. A positive right implies an obligation for others to support or facilitate its expression. Negative rights outweigh positive rights because the right not to be burdened or harmed has more moral weight than the right to be benefited. The pregnant woman has a negative right not to be burdened or to take on risk. So there fore has a right to not allow the fetus the use of her body. The fetus’ presumed right to life and right to use the woman’s body are positive rights. Because the fetus’ positive rights threaten or violate the woman’s negative right to bodily noninterference, and negative right outweigh positive rights, the woman has a right to abort the fetus. Don Marquis Argues that the claim of wrongness in killing adults extends to the wrongness in killing fetuses. It is morally wrong to kill adults because it deprives the victim of a valuable future. However the future is only valuable to those who have the capacity for experiences. Fetuses lack the mental capacity to have interest in or to value experiences, so, as opposed to an adult, they have nothing to lose. The capacity to value experiences comes at the earliest during infancy not during pregnancy. Therefore abortion is not morally wrong. The moral permissibility of abortion hinges on the moral status of the fetus. A fetus has this status when it possesses the property of having avaluable feture, but because it doesn’t, the fetus has no moral status. Marquis’ antiabortion argument is an argument from potential. Jeff MacMahan explains the 2 types of potential: 1.) Identity-preserving potential- in the sense that the fetus and the newborn child are 2 phases of one individual who persists through the changes from the earlier to the late phase. In this case, potential is intrinsic to the fetus because it is realized from within. 2.) Non-identity preserving potential in the sense that the fetus and the neonate(newborn child) are 2 distinct beings. This case is different because the fetus requires external factors in order to realize its potential and thus the potential is extrinsic to the fetus. Only intrinsic, identity-preserving potential can give a fetus moral status and interest in living that make it wrong to kill it. This is why it is wrong to kill a late-stage fetus. Because it has already developed the functions and structures necessary for the potential for consciousness. This distinction makes Marquis’ antiabortion argument persuasive for late-stage fetuses not early-stage fetuses. The moderate position defines moral status in terms of sentience and viability. In this view, killing early-stage fetuses is morally permissible, but killing late-stage fetuses and infants would not be permissible. Third perspective is Richard Dworkin – moral objections to abortion rest in people’s views of the sanctity of human life. Has religious and secular interpretations. The sanctity of human life principle says that every human life has intrinsic value, independent of whether it is valued by or good for everyone. A fetus is a human with intrinsic value therefore killing even an early-stage fetus is wrong. This view however still doesn’t stand against the argument that life has no value when it is independent of individuals, and fetuses can’t express or experience value because they don’t have the capacity for interests and rights. The Moral Status of Embryos The right to reproduce is a prima facie right meaning that meaning that without the introduction of other factors or arguments, it is a right, but it can easily be argued away. Some argue that reproduction is not a right but a privilege which means that not everyone is entitled to it or to have access to IVF. This is further supported by the argument that the right to have access to medical procedures pertains only to the treatment of disease and infertility is not a disease. However, these arguments are only plausible if the negative right to abortion and bodily non-interference can be separated from the positive right to reproduction. Often people argue that the two are inseparable. Embryos fall under the procreative autonomy of both the genetic parents. When there is conflict between the genetic parents, the right not to use embryos for reproduction outweighs the right to use them for this purpose. Surrogate Pregnancy Surrogacy requires distinguishing among social, gestational and genetic mothers. The social mother or father is more important than the gestational or genetic mother because she is responsible for the welfare of the child from birth onwards. At some point during pregnancy, the surrogate may express interest in wanting to be the social mother as well. At this point, her custody over the child may outweigh that of the social mother and father. Paid contractual surrogacy is not the selling of children. The surrogate is making available her biological services so others can have a child. If the social parents act in the child’s best interest, the child will not be treated merely as property. There are many child abuse and neglect laws in place to help ensure this. Overall surrogacy is not unethical. Surrogacy also does not exploit women because it is an expression of a woman’s reproductive autonomy and control over her body. Sex Selection The practice of selecting males over females and allowing male fetuses to grow to term, but aborting female fetuses; reinforces discrimination against women and leads to unequal sex ratios and demographic issues in developing countries. The only time when sex selection is morally permissible is in the case where sex-linked diseases are detected early on. The reason would be to prevent harm caused to a child who would have the disease if he/she were born. Family balancing is also not immoral – having a girl and selecting for a boy, or having a boy and selecting for a girl. Cloning Cloning is the most ethically controversial among new medical technologies. There is disagreement on whether therapeutic cloning should be permitted however; most people agree that reproductive cloning should be prohibited. The objection to therapeutic cloning is that it is morally wrong to create embryos solely for the sake of research leading to therapy, because once the ES cells have been mined from the embryos, the embryos will be destroyed thus destroying potential human life. Also there is the argument that creating embryos for research violates the sanctity of human life from the time of conception. A solution is the promotion of adult stem cells however; they don’t generate as many different kinds of cells and ES cells and are more likely to provoke an adverse immune response. The argument to ban therapeutic cloning rests on the claim that embryos’ right to life outweighs any potential benefit to existing people. But while embryos cannot suffer from or be harmed by not realizing their potential, existing people can suffer from and be harmed by disease. If the suffering of existing people is morally worse than creating and destroying embryos, then we should be more concerned about alleviating the suffering of existing people. If embryos cannot be harmed, and if therapeutic cloning can alleviate suffering, then therapeutic cloning should be permitted. Genetics Monogenic – diseases caused by one gene - 3 types of monogenic disorders: - 1.) Sex-linked – disorders traced to sex chromosomes, usually the X chromosome, and is passed on by the woman so that her sons will display the disorder and daughters will be carriers but not affected. - 2.) Autosomal Recessive – when child inherits the recessive gene for the disease from both parents. Both copies of the gene from each parent are mutated. - 3.) Autosomal Dominant – a mutation in one copy of a gene inherited from either parent. Polygenic – diseases caused by more than one gene Multifactorial – diseases caused by the interaction of several or more genes with the environment. Genetic testing is for individuals who are known to be at increased risk of having a genetic disorder with a familial mode of inheritance. Genetic screening is designed to test members of a particular population for a disorder of which there may be no family history or other evidence of its presence. A predisposition to a disease is no guarantee that one will develop it. Preimplantation Genetic Diagnosis is a means of selecting against embryos with genetic mutations that cause the most severe disorders. This is a means of preventing diseases by preventing the lives of the people who would have them. This is morally justified on grounds of nonmaleficence and justice. Nonmaleficence requires that we not harm people by causing them to experience significant pain and suffering over the balance of their lives. Justice requires that we not deny people the same opportunities for achievement and well-being that are open to others who are healthy or have only moderate diseases. Together, these principles imply that it can be morally wrong to cause a person to exist with a severe disease when it is possible to cause a different person to exist without the disease. Quality of life is a function of the presence or absence of pain and suffering, and of the cognitive, physical and emotional ability to have opportunities for achieving a decent minimum level of well-being. Most people prefer a life that starts poorly and gets better to one that starts well and then goes progressively downhill. The probability of penentrance – the probability that a mutated gene will express itself and develop into a disease. Assuming that a defective gene can be detected in an embryo, 4 criteria will determine whether a life should be prevented by not selecting that embryo for implantation and birth: 1.) the probability of genotypic penetrance or how likely it is that a genetic mutation will cause a disease. 2.) The severity of the symptoms of the disease 3.) The time of onset of the symptoms 4.) And the time between onset and death. Gene Therapy Gene therapy has been the cause of many participants of clinical trials. While researchers have experienced some success in some forms of gene therapy, many have died due to adverse reactions to genetically engineered proteins or have developed cancers and other diseases. The principle of beneficence specifies an obligation to move forward with gene therapy research, provided that it is balanced by the principle of nonmaleficence specifying an obligation to minimize risks. The potential benefits of gene therapy outweigh the risks. Germ-line genetic intervention vs. Somatic-cell genetic intervention Germ-line – consists of going into existing DNA and correcting or deleting the mutated gene in the germ cell. This way it wouldn’t be passed onto the individual’s offspring. By intervening at the germ line, we would be preventing certain diseases from occurring in the first place. Our scientific ability hasn’t successfully reached this stage yet. Somatic-cell genetic intervention – involves replacing or inserting a new gene in the place of the mutated gene. This would have to be done to each successive generation that expressed the disease. Germ-line genet
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