Introduction to Bioethics
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About the Authors
John A. Bryant is Professor Emeritus of Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
Linda la Velle is Professor of Biology in Education, Institute of Education, University of Plymouth, Plymouth, UK, and Visiting Professor of Education, Bath Spa University, UK.
Content
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
1
Science and Society
There is not a discovery in science, however revolutionary, however sparkling with insight, that does not arise out of what went before.
From Adding a Dimension: Seventeen Essays on the History of Science, Isaac Asimov (1964)
I feel the story should be told, partly because many of my scientific friends have expressed curiosity about how the double helix was found, and for them an incomplete version is better than none. But even more important, I believe, there remains a general ignorance about how science is 'done'. That is not to say that all science is done in the manner described here. This is far from the case, for styles of scientific research vary almost as much as human personalities. On the other hand, I do not believe that the way DNA came out constitutes an odd exception to a scientific world complicated by the contradictory pulls of ambition and a sense of fair play.
From The Double Helix, James D Watson (1968)
The saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom.
From Isaac Asimov's Book of Science and Nature Quotations, Isaac Asimov and Jason A. Shulman (1988)
1.1 What's It All About?
This is a book about bioethics but we are starting with a consideration of the practice of science and its relationship with wider society. Why? Consider the four following case studies:
Case Study 1
- Donated gametes - sperm and ova - are used in fertility treatments for patients who are unable to produce their own.
- It is much easier, for obvious reasons, to donate sperm than ova.
- Donated ova are very scarce.
- During foetal development, females lay down more than a lifetime's supply of oocytes (egg cells).
- It has therefore been suggested that aborted female foetuses may be used to supply oocytes/ova for fertility treatments.
- Note: Of the approximately 200,000 abortions that occur in the United Kingdom each year, up to 10,000 of those that involve a female foetus are late enough for egg cells to be present.
Do you approve or disapprove of this idea? What are your reasons?
Case Study 21
- A small less-developed country in South America is deep in debt.
- Its main resource is its rainforest.
- In order to raise revenue, the government has granted a licence to a Japanese logging company to clear 25% of the forest.
- The land that has so far been cleared is used for cattle ranching, mainly to raise beef for the US market.
- The government has also granted a licence to a transnational biotechnology company to exploit the forest's gene pool.
- In addition to the income from the licence, the company has agreed to pay royalties on income generated from discoveries based on the rainforest gene pool.
What are the issues involved in dealing with this situation?
Case Study 3
- On several occasions over the past 15 years, normally fertile couples have sought permission to undergo in vitro fertilisation in order to produce a baby that can be a stem cell donor for an older sibling.
- In most of the cases, the older sibling suffers from a genetic disorder, and the embryos created in vitro would be tested for the absence of the mutation and for a positive tissue match to the older sibling.
- In another case, the condition suffered by the older sibling is not 'genetic' but the child still needs donated stem cells. In this case the in vitro embryo would be selected solely as a tissue match.
In which of these cases, if any, would you grant permission? Give your reasons.
Case Study 4
- A small biotechnology company in Mexico has discovered a gene that encodes a protein in the network of resistance to oxidative stress in plants.
- Laboratory experiments have shown that when the gene is transferred by genetic modification techniques to crop species, the crop plants show an enhanced capacity to grow and produce yield under conditions where water supply is limiting.
- The company has not published its data because it is filing a patent on the gene.
- If the patent is granted, the company plans to licence it out to a major transnational agrichemical company.
Should the patent be granted? Give your reasons.
These case studies are on the surface very different from each other. However, they all describe situations in which ethical dilemmas have been raised by advances in science and by the way that the science, through its application, may have impacts on the lives of individuals and/or on wider society. The issues presented in these case studies are discussed in detail in later chapters. In the mean time it is important to consider briefly the factors that influence our decision-making in these and similar situations:
- Firstly, there may be an immediate personal reaction - a 'gut response' - along the lines of 'Yuk, that's awful' or 'Wow, that's brilliant' or along more sociopolitical lines: 'That's just not fair/not right'.
- Secondly, there will (it is hoped) be a more thought-out ethical analysis that may complement the gut reaction but which may also cause the gut reaction to be questioned.
- Thirdly, it is important to realise that both gut response and the more thought-out ethical analysis are very likely to be affected by one's world view or personal philosophy (which for some will include religious commitment).
- Fourthly, because advances in science are embedded in all these studies, one's view of the science itself is important. Do we know all that we need to know in order to go ahead or is more work needed? Are the conclusions presented in support of a particular proposal soundly drawn? Do these scientists know what they are doing? Should the basic research that led to the current situation have been permitted in the first place?
Thus, science is one of the factors that informs bioethical decision-making; we cannot avoid thinking about science, why and how it is done and how it relates to wider society. And that is what we explore in the rest of this chapter.
1.2 What Is Science?
1.2.1 Introduction: Some History (But Not Very Much)
We get the word science from a Latin word, scio, which means 'I know' and in the original usage science simply meant knowledge. The application of the word specifically to knowledge about the material nature of the universe, gained by a particular set of methods, dates back less than 200 years (see a more detailed discussion towards the end of this section). Some of those whom we regard as the great scientists of the past, such as Isaac Newton or Robert Boyle, would not have called themselves scientists. Indeed, Newton's position at Cambridge was Lucasian Professor of Mathematics and his major work was called (translating from the Latin original) The Mathematical Principles of Natural Philosophy. The latter term natural philosophy was what we now call 'science' but because of the emphasis in the science of the time, in practice it came to mean physics. Indeed, it was used in this way in the older Scottish universities well into the second half of the 20th century. However, we now have a very clear idea of what we mean by the more general term science: the word implies a whole approach to the material world, to methods of acquiring knowledge about that world and to the body of knowledge thus acquired. So, how did we arrive at this situation?
To an early human being, the world around must have seemed a strange and often hostile place. It was certainly a place of contrasts, embodying both provision and threat. So while plants could be harvested, some were poisonous; while animals could be hunted, some animals, including some quarry animals, were very dangerous. Further, there were (and indeed still are) unpredictable and often devastating events such as storms, earthquakes and volcanic eruptions. Nature was not to be taken lightly and it was important that knowledge of the positive and negative aspects of the natural world was passed on verbally from generation to generation. Doubtless humankind's investigation and knowledge of nature remained at this level for tens of thousands of years. However, dating from over 75,000 years ago, there is evidence of art; as that art, over successive millennia, became more sophisticated, it relied on quite detailed observations of nature. One just has to look at rock art and cave paintings in places as diverse as Australia, France, Siberia, South Africa2 and Spain dating from between 25,000 and 10,000 years ago to become aware of this. Furthermore, as cultures evolved, so did descriptive knowledge of the times and seasons, so that there was confidence that the sun would rise daily and that the seasonal rains would fall, that certain animals migrated and that plants grew at particular times. Some of that knowledge may have been very sophisticated; in Britain, for example, the alignment of particular stones in the stone circle at Stonehenge with the sunrise on the summer solstice and the sunset on the winter solstice indicates quite a detailed knowledge of astronomical events through the year. Stonehenge dates at about 2800 BC, around the same time as the period of building pyramids in Giza, Egypt, was under way. The alignment of the pyramids shows that the Egyptians...
