Category Archives: Bioethics

Embryos in the Original Position:

Why Justice as Fairness Supports a Pro-Life Stance

Russell DiSilvestro
Bowling Green State University

How should followers of the late John Rawls think about the moral status of the human embryo? Those familiar with Rawls’ work might assume that it either does not provide enough material to formulate an answer to this question, or that the answer it provides is decidedly liberal. After all, Rawls has been the most recognizable intellectual champion of liberalism for the past several decades, and his few but famous remarks on the issue of abortion are clearly in line with a pro-choice framework. Nevertheless, I argue in this paper that other aspects of Rawls’ own writings lead naturally and directly into a staunchly conservative position regarding the defense of human embryos. This is most clearly proved from his remarks on how parties in his original position would think about issues like paternalism and human equality. In each case, Rawls discusses why the parties would seek to protect themselves in case they end up as an incapacitated or undeveloped human being when the veil of ignorance is lifted. My simple but surprising thesis, then, is that if one adopts Rawls’ own framework of justice as fairness, it is clear that human embryos should be entitled to the claims of justice.

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A Rational Look at the Abortion Controversy

A Rational[1] Look at the Abortion Controversy

by Mario Derksen, M.A. cand.

International Catholic University

Presented on April 26, 2003
at the Ohio University Student Conference on Applied Ethics, Athens, Ohio

Revised and Updated: May 1, 2003

One of the most hotly contested issues inside and outside of biomedical ethics today is abortion. The discussion received a new impetus at the release of the controversial abortion drug RU-486, “a pill to increase access to abortions and let women get them privately from their own doctor instead of facing shouting protesters at clinics.”[2] As is the case with all controversial issues, there are very passionate people on both sides of the fence. Unfortunately, a heated discussion on abortion can easily and quickly turn into a battle of rhetoric rather than a dialectic of reason. But the guiding light in such a discussion must always be reason, not rhetoric or other fallacies, for only reason can solve this issue and judge which side is correct.

In this brief essay, I shall attempt to clear away some of the confusion present in typical abortion debates by cooling the rhetoric with reason enlightened by scientific facts. Specifically, I will examine two common pro-abortion arguments made by Mary Anne Warren and Judith Jarvis Thomson and demonstrate that they cannot stand up to rational scrutiny and therefore fail to justify abortion. I shall also use a
”quadrilemma” argument similar to that of Peter Kreeft’s to show that, aside from all specific argumentation, abortion cannot be morally justified.

Before even beginning to discuss the issue of abortion, it is imperative to agree upon a starting point from which to reason. The fact that some people differ even about this very point tends to render the pro-abortion and the anti-abortion paradigms somewhat “incommensurable,” and this is probably one major reason why people are tempted to arrive at different conclusions about this topic. It seems to me, however, that to start with the definition of abortion and an examination of the beings involved would be a fair move.

Abortion is the unnatural termination of a pregnancy by killing (at least) one human fetus. This definition is not contested, and I think it seems clear that it is correct. Science confirms that life begins at conception,[3] and that this life is human is a—scientific as well as logical—necessity, because it is the product of two humans, and humans can only produce humans. Ergo, the fetus involved is human. Secondly, the fetus is, at least scientifically speaking, a singular and individual organism, as evidenced by his own unique genetic make-up, which he shares with no other human being on earth (unless he have an identical twin). There is thus an essential difference between a human fetus and, say, a tumor or similar parasite. Finally, that the fetus is alive is confirmed through empirical observation, and hence forcing that life to come to an end involves at least some sort of killing. Therefore, the unavoidable conclusion is that abortion deliberately and forcibly puts to death a human being. Again, this definition is uncontested and thus I shall not dwell on it any further. Rather, I shall now turn to the moral implications necessarily connected with abortion.

The question that arises is as to whether or not abortion is morally justifiable. It cannot be wrong by definition, since sometimes thereis moral justification for forcibly putting to death another human being, in such cases as self-defense, just war, or capital punishment.[4]Hence, it is reasonable to raise the question whether abortion might be another such instance where one is justified in taking a human life.

The pro-abortion side submits that it is, and different arguments have been put forward to substantiate that claim. A very popular one is the contention that human fetuses are not persons, and that only persons have a right to life and justice against others, at least when these others’ rights are at stake. Mary Anne Warren’s essay “On the Moral and Legal Status of Abortion”[5] argues just that. Curiously, though, Warren does not indicate in her essay why one should accept the view that one ought to be a person in order to have moral rights in the first place; it seems that she considers it self-evident that this is so, mentioning only that she thinks “there are very good reasons fornot defining the moral community”[6] in such a way that every human being is ipso facto included. Be that as it may, she asks: “What moral characteristics entitle an entity to be considered a person?”[7] and goes on to list five “traits which are most central to the concept of personhood”[8] in her opinion. They are: (1) consciousness, (2) reasoning, (3) self-stimulated activity, (4) the capability to communicate, and (5) the presence of self-concepts and self-awareness.

It is here that reason ought to make an objection. While Warren may think that the categories she lists are sufficient for personhood, I see no reason to believe that they are necessary. In fact, the author herself admits a few lines later that we do not “need to insist that any one of these criteria is necessary for personhood.”[9] But if not “any one” of them is necessary, then none of them are, and if that’s the case, what does her argument prove? And what if one thinks that it is totally unacceptable to define personhood in terms of functional abilities at all? For Warren’s argument to be forceful, one would have to presuppose her functionalist paradigm as true, i.e. the basic idea that there even are criteria a human being must meet in order to be considered a person. But this would be an instant of question-begging—after all, one could very well adopt the view that all humans are persons in virtue of their humanity, and thus being human necessarily implies being a person. I maintain that this alternative view is not only true but also does not carry any problems with it—Warren’s own objection notwithstanding, as will be shown later.

On the other hand, Warren’s functionalism comes with plenty of problems. For one thing, even if one agrees with Warren’s position that the functionalist view of human personhood is true, the criteria proposed by her could be rejected by anyone who disagrees with them, since they are imposed rather gratuitously, and what is gratuitously asserted can be just as gratuitously denied.

Secondly, a major problem Warren’s view faces is the fact that it disregards Francis Beckwith’s argument that “personhood is not something that arises when certain functions are in place, but rather is something that grounds these functions, whether or not they are ever actualized in the life of a human being,”[10] for “to claim that a human being can be functional, become non-functional, and then return to a state of function is to assume that there is some underlying personal unity to this individual.”[11] What Beckwith means by this is that, supposing that John Doe has a car accident and becomes comatose for three months, according to the functionalist view proposed by Warren, one would have to conclude that while Doe was in the coma, he ceased to be a person since he didn’t meet any of her proposed five criteria for personhood, and that when he awoke, he became a person again.

But this is surely absurd. Therefore, Beckwith concludes, “it is intelligible for us to say that the person who has returned to functional capacity is the same person who was functional prior to being in a non-functional state and yet continued to exist while not functioning.”[12] There must be some underlying personal unity, then, unless we wish to say that John Doe before the coma was a different person from the John Doe after the coma. While this objection to Warren’s position can perhaps be elaborated upon, as it is, it does present a major obstacle to her notion that human beings must first meet certain requirements before they can be considered persons, i.e. beings with moral rights.

Earlier I mentioned that Warren does not give us any justification for embracing a functionalist paradigm as far as personhood is concerned. This statement needs qualification, however. Warren does mention that the view that personhood is intrinsic to any human being from the first moment of his existence carries with it the problem that it makes the traditional syllogism against abortion[13]question-begging. But this is false. It does not make the traditional syllogism any more question-begging than the syllogism that since Socrates is a man and all men are mortal, therefore Socrates is mortal. The fact that the conclusion follows with great clarity and ease is not because it begs the question but because it is a deductive argument—and it is the nature of deduction to render “obvious” conclusions, since all deduction does is spell out what is already contained in the premises. Therefore, it should not be surprising that the conclusion of the traditional anti-abortion syllogism follows with relative ease. And this most certainly does not disprove the validity of the syllogism or suggest that it contains a fallacy, and hence the humanity-implies-personhood view is not refuted or infringed upon.

So, what reasons does Warren have to reject the view that humanity implies personhood? None, really. So, why does she reject it? She rejects it because otherwise she would have to admit that abortion is impermissible (she agrees, after all, that the statement “it is wrong to kill innocent human beings” is “a self-evident moral truth”[14]), and this is a conclusion she does not desire. In other words, it seems to me that Warren rejects the view that humanity necessarily implies personhood (or that being human suffices to have moral rights) precisely and only because it would make abortion impermissible. She presupposes that abortion is justified and thus proceeds to select only such criteria for personhood as allow for her preconceived conclusion, i.e. criteria that are not met by human fetuses.[15]Thus, she has ruled out from the beginning the possibility that abortion is wrong. But surely this is question-begging!

Of course, not all abortion advocates base their justification of abortion on a lack of personhood on the part of the preborn human. Some, such as Judith Jarvis Thomson, argue instead that even if the fetus is a person, abortion can still be morally justified. Certainly, such a justification, if valid, would make a much more forceful case for abortion than any attempt to base it on a lack of personhood. Hence, I will now proceed to examine Judith Thomson’s main argument in her essay “A Defense of Abortion.”[16]

According to Thomson, we are to imagine a situation in which a violinist with a fatal kidney disease has been artificially hooked up to you in order to use your kidneys for nine months. This has been done by the Society of Music Lovers and without your permission. If you unplugged yourself from this violinist now, he would die, and in that sense you would be responsible for his death. Inevitably, then, the moral question arises whether you are morally obligated not to unplug yourself from the violinist for the time being, even if this causes all sorts of inconveniences for you, such as staying in bed all day; after all, all “persons have a right to life, and violinists are persons . . . [and] a person’s right to life outweighs your right to decide what happens in and to your body.”[17]

This is Thomson’s main contention, and, even if somewhat bizarre, if the analogy holds which she is obviously drawing between the violinist situation and pregnancy, then the anti-abortion position would suffer a severe setback. However, it turns out that there is plenty of evidence to show that Thomson’s violinist analogy is in fact a false analogy and therefore fallacious and without rational force. To prove this, I shall now share several pieces of evidence that demonstrates that Thomson’s “Violinist” is in fact a false analogy.

First, the most obvious difference is perhaps that by unplugging the violinist, one would not engage in direct killing but in letting die. The violinist would be killed by a disease, whereas the fetus is aborted by killing him actively or at least forcibly removing him from his natural place of safety. It would not be correct, therefore, to treat the two situations as equal or analogous, because the violinist has a disease which he would die of, whereas the preborn human does not and would die of active violence done to him.

Another important consideration is that the violinist analogy, if valid, only holds true for rape cases, that is, in cases where a woman has been forcibly impregnated against her will, since in the analogy you were actually kidnapped by the Society of Music Lovers, and it was involuntary therefore. However, as John T. Wilcox points out, “the title of [Thomson’s] essay is ‘A Defense of Abortion,’ not ‘A Defense of Abortion in Rape Cases.’”[18] Thus, it is misleading and inconsistent to use an analogy that could only hold for rape cases to argue for a position that does not restrict itself to allowing abortion in rape cases only.[19]

Another point is that the violinist incident is artificial, bizarre, and contrived, whereas pregnancy is the exact opposite—it is most natural and occurs all the time. It is, in fact, necessary for the propagation of the human race. Says Wilcox: “In Thomson’s essay we have something as universal and necessary [for reproduction] as pregnancy compared to something so rare it has never happened and perhaps could never happen.”[20] He then goes on to make the point that it is “at least arguable . . . that the moralities we have represent some ways of dealing with the realities and regularities of human life; and they may not fit well the irregularities and impossibilities.” Given that, he concludes that it is “plausible to regard [the two cases] differently from an ethical point of view . . . [since] what is appropriate for kidnapped kidney bearers and their violinist parasites might not be appropriate for mothers and the babes in their wombs.”[21] This objection, though perhaps not necessarily conclusive by itself, is something which should definitely be seriously taken into consideration when evaluating the strength of Thomson’s violinist analogy.

A fourth objection that may be raised to Thomson’s analogy is the fact that the two cases are disanalogous inasmuch as unplugging the violinist is in no way comparable to the methods used for abortions. While the different methods vary, they all involve a very cruel killing of the fetus, whether it be through cutting, suctioning, or intoxication. Yet, at no abortion during any point of gestation is the fetus given pain relief, even though the “centers necessary for pain perception develop early in the second trimester,”[22] and so justice would require at least an attempt to relieve fetal suffering, especially in late-term abortions, where “[f]orcibly incising the cranium with a [sic] scissors and then suctioning out the intracranial contents is certainly excruciatingly painful.”[23] The point here is not to be graphic, but to point out that there is a fundamental difference between such a procedure, which is artificial, deliberate, and unnecessarily painful, and unplugging the violinist, which is nothing other than letting him die.

These are just some of the objections one can raise against Thomson’s analogy of the violinist, though multiplying them would extend the scope of this paper. I think, however, that the above objections are illustrative of some serious insufficiencies in Thomson’s argument, such that they take away from it the persuasive force that it may appear to have at first glance.

There are, without a doubt, many more arguments in favor of abortion that deserve careful analysis and critical examination but that I cannot treat here. But whatever these may be, I wish to offer one last objection to the pro-abortion position in general, an objection which looks at abortion also from an epistemological point-of-view and resembles in a way Blaise Pascal’s famous “wager.” It is an argument similar to that developed by Peter Kreeft,[24] and it can be judged on its own merits, even if one were to leave all previous argumentation aside.

The argument is simply this. In the abortion debate, there are only four possible scenarios which could obtain, namely that (1) abortion is right and we know it; (2) abortion is wrong and we know it; (3) abortion is right and we don’t know it; and (4) abortion is wrong and we don’t know it. No other option is possible.[25] So let us suppose that (1) obtains. In this instance, abortion would be morally justified, and no problem could arise. However, we know that (1) is false, for, obviously, there is serious controversy about abortion, and hence we do not “know” that abortion is morally right. If one of the other three scenarios should obtain, however, then abortion would be morally wrong, for if (2) obtains, then abortion is murder; if (3) obtains, then abortion is criminal negligence; and if (4) obtains, abortion is manslaughter.

I should perhaps elaborate on (3). Suppose you are a truck driver, and while you are driving at night, you suddenly see in front of you what looks like a man lying on the road, although you are not sure that it’s a man, for it might actually be a dummy. From your view, you simply cannot tell. Would it be morally justifiable for you to run over this “person”? Clearly, the answer is no. The very fact that youdon’t know whether it’s a human or a dummy obliges you not to run over it in order to be on the safe side, and to do otherwise would be morally reprehensible. This is how we are to understand (3), that not knowing whether abortion is right or wrong when in fact it is right is still morally inadmissible, for the uncertainty obliges us to err on the side of life. Therefore, anyone who would argue for abortion on the premise that we just don’t know whether the fetus is a human (or person) or not, is clearly wrong, as such a premise warrants the exact opposite conclusion, namely, that abortions must not be performed.

Thus, this “quadrilemma” argument establishes that even if we ignore all other rational arguments, in three out of four possible scenarios, abortion is morally wrong. But this number—namely, 75%—is sufficiently high to warrant the claim that abortions ought not to be performed.

Given all of the above, I propose that abortion, at least as far as the criticized arguments from Warren’s and Thomson’s essays are concerned, cannot be morally justified. On the contrary, the traditional anti-abortion syllogism remains as intact as ever and retains its moral force. Since abortion involves human life (on both sides), it is a very serious issue and must be very forcefully and convincingly argued for—by both sides. The principle of non-contradiction requires that only one of the two sides of the issue is right, and, necessarily, the other must be wrong, very wrong. Again, then, in order to come to a resolution of this issue, the primary requirement is that we let reason, not rhetoric, be our guide to show us what is morally right and what is morally wrong. We must go wherever reason leads us, even if the conclusion be uncomfortable or inconvenient.

Works Cited

“Abortion Pill Heads for Clinics.” USA Today, 20 November 2000. Internet edition.

Alcorn, Randy. Prolife Answers to Prochoice Arguments, expanded edition. Sisters, OR: Multnomah Publishers, 2001.

Beckwith, Francis J. “Abortion, Bioethics, and Personhood: A Philosophical Reflection.” Paper from the Center of Bioethics and Human Dignity at, n.d.

Guttmacher, Alan F. Planning Your Family: The Complete Guide to Contraception and Fertility. New York, NY: Macmillan Co., 1964.

Kreeft, Peter. Making Choices: Practical Wisdom for Everyday Moral Decisions. Ann Arbor, MI: Servant Books, 1990.

Sprang, M. LeRoy, and Mark G. Neerhof. “Rationale for Banning Abortions Late in Pregnancy.” Journal of the American Medical Association 280, no. 8 (1998): 744-747.

Thomson, Judith Jarvis. “A Defense of Abortion. In Tom L. Beauchamp and LeRoy Walters, eds. Contemporary Issues in Bioethics. 5thed. Belmont, CA: Wadsworth Publishing Company, 1999, 202-211.

Warren, Mary Anne. “On the Moral and Legal Status of Abortion.” In Tom L. Beauchamp and LeRoy Walters, eds. Contemporary Issues in Bioethics. 5th ed. Belmont, CA: Wadsworth Publishing Company, 1999, 222-231.

Wilcox, John T. “Nature as Demonic in Thomson’s Defense of Abortion.” New Scholasticism 63, no. 4 (1989): 463-484.

[1] The word “rational” is to be understood in the sense of “logically coherent,” such that when I say that opponents’ arguments are irrational, I mean to suggest that they contain a logical fallacy, false premises or are otherwise not sound. I do not mean to suggest that they are simple gibberish.

[2] “Abortion Pill Heads for Clinics,” USA Today, 20 November 2000, Internet edition.

[3] Even former Planned Parenthood president Alan Guttmacher admitted as much in his book Planning Your Family: The Complete Guide to Contraception and Fertility (New York, NY: Macmillan Co., 1964), 28. Numerous quotes from scientists and physicians that testify that human life begins at conception can be found in Randy Alcorn, Prolife Answers to Prochoice Arguments, exp. ed. (Sisters, OR: Multnomah Publishers, 2001), 51-55.

[4] I realize that even this is contested, but I think it is safe to say that most people agree that sometimes killing another human being is morally justifiable.

[5] See Mary Anne Warren, “On the Moral and Legal Status of Abortion,” in Tom L. Beauchamp and LeRoy Walters, eds., Contemporary Issues in Bioethics, 5thed. (Belmont, CA: Wadsworth Publishing Company, 1999), 222-231.

[6] Warren, “Status of Abortion,” 227; italics added.

[7] Warren, “Status of Abortion,” 227.

[8] Warren, “Status of Abortion,” 227.

[9] Warren, “Status of Abortion,” 227f.; italics given.

[10] Francis J. Beckwith, “Abortion, Bioethics, and Personhood: A Philosophical Reflection” (paper from the Center of Bioethics and Human Dignity at, n.d.), 2.

[11] Beckwith, “Abortion,” 2.

[12] Beckwith, “Abortion,” 2.

[13] That syllogism goes something along these lines: Deliberately killing innocent human beings is wrong; a fetus is an innocent human being; hence deliberately killing fetuses is wrong.

[14] Warren, “Status of Abortion,” 226.

[15] Incidentally, Warren’s position, if correct, would justify infanticide, something she tries to deny—unsuccessfully—in a 1982 postscript to her original essay.

[16] Judith Jarvis Thomson, “A Defense of Abortion,” in Beauchamp and Walters, Contemporary Issues in Bioethics, 202-211.

[17] Thomson, “A Defense of Abortion,” 203.

[18] John T. Wilcox, “Nature as Demonic in Thomson’s Defense of Abortion,” New Scholasticism 63, no. 4 (1989): 472.

[19] Thomson’s attempt to argue that an unwanted pregnancy after voluntary sexual intercourse due to contraceptive failure is equal to an unwanted pregnancy due to rape is nothing short of ridiculous. The sexual act by nature tends towards pregnancy, i.e., that is the natural purpose of the sexual act, and any woman who engages in this act voluntarily, with or without contraception, thereby willingly opens herself to pregnancy.

[20] Wilcox, “Nature as Demonic,” 468.

[21] Wilcox, “Nature as Demonic,” 468f.

[22] M. LeRoy Sprang and Mark G. Neerhof, “Rationale for Banning Abortions Late in Pregnancy,” Journal of the American Medical Association 280, no. 8 (1998): 745.

[23] Sprang and Neerhof, “Banning Abortions,” 745.

[24] Cf. Peter Kreeft, Making Choices: Practical Wisdom for Everyday Moral Decisions (Ann Arbor, MI: Servant Publications, 1990), 119-21.

[25] One might object that “abortion is morally neutral” is another possibility, but that which is morally neutral is morally permissible.


Defining Success: Assessing the Feasibility of Pig-to-Human Transplantation

Ololade Olakanmi, Grinnell College

Winner, 2003 essay contest

In light of the severe shortage of transplantable organs, scientists have been seriously considering using pigs as potential organ donors. In the past, pig-to-human transplantation was an idle hope, but with recent advances researchers have been able to develop this procedure into a potential therapy. However, the utilization of this procedure also begets a multitude of moral, ethical and biological dilemmas which must be addressed if animal-to-human transplantation is ever to become a clinical reality. In this essay I will enumerate and attempt to rationally reach a conclusion on many of the dilemmas that encircle the issue of cross-species transplantation. I will especially focus on many of the biological concerns. Furthermore, I will argue that before pig-to-human transplantation is implemented, the scientific community must agree on the degree of laboratory ?success? necessary for this procedure to advance into clinical trials.

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Medical Decision-Making: An Evaluation of Three Models

Esther Warshauer-Baker, Dartmouth College

There are several models for medical decision-making within the doctor-patient relationship, and this paper discusses three of these models: paternalism, informed decision-making, and shared decision-making. I describe each model and give arguments for the plausibility of each. I conclude that each is problematic. Paternalism, the traditional model, is problematic because it relies on a false ideal of medical certainty, and it devalues patient autonomy. This becomes apparent when one examines medical decisions involved in prostate cancer diagnosis and treatment. Informed decision-making, while possessing the merit of valuing patient autonomy, is also flawed, because it limits the roll of the doctor to a technician and information source, and it calls for an impossible bifurcation between information and values. Shared decision-making is the ideal model for most medical decisions, especially those involving a great deal of medical uncertainty. However, by examining the problem of doctors providing antibiotics to patients who do not have bacterial infections, it becomes clear that shared decision-making is not always appropriate. Doctors may have non-medical incentives to prefer what patients prefer. Indeed, to develop a non-problematic model for medical decision-making, we must take into account the societal and structural context within which medical decisions take place

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Ethics and Innovation in Surgery

Christine Bezouska, University of Pittsburgh

While IRB review of human subject research is well-established in academic medicine, oversight of technical innovation, especially in surgery, is not. The goal of protecting the interests of human patients and subjects is accepted; the best means to that goal is very much in dispute. Some authors assert that all innovation is essentially research, and should be treated as such. Others recognize a difference between innovation and research, but see a need to better understand the developmental processes involved in innovation. This paper considers the nature of clinical innovation in surgery, where technical innovation is particularly important. I examine two historical examples of surgical innovation, and propose that such innovations typically evolve through three distinct stages. These stages differ in the degree to which the surgeon is motivated by his or her care-giving duties, versus the desire to acquire new information. The ethical justification for innovation and the potential need for third-party oversight at each stage are derived from the fundamental trust relationship between physician and patient. Possible systems for regulating the dissemination of new technologies and techniques, including approaches currently being tried in other countries, are briefly considered.

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Issues of Distributive Justice in the Canadian Health-care System

Joy Kellen, University of Calgary

The Canada Health Act promotes foundational principles of universality and accessibility of health-care for all Canadians. Contrary to popular belief, a systematic analysis of social determinants of health indicates differential access continues to exist. This paper considers the impact of distributive justice on access to health-care in the Canadian health-care system. Distributive justice is about equal respect for persons – being entitled to the same rights and services as all other citizens and services of greatest benefit offered to the least advantaged (Rawls 1993, p. 5-6). Cardiovascular disease is used as an exemplar to consider the impact of distributive justice within the Canadian health-care system. This system traditionally focuses on treatment of diseases such as congestive heart failure at point of failure, with hospitalization for surgical intervention or intensive medical therapy. This concentration of funding and resources on interventions poses ethical problems of availability and accessibility of care for individuals living in low income or poverty situations. Their inherent social exclusion limits their freedom of choice and autonomy, and subsequently their opportunity for referral to specialty clinics for assessment and treatment. Such realities beg the question: Are health professionals truly attempting to provide care for those with the greatest need?


Human Genetic Diversity and the Threat to the Survivability of Human Populations

Christian Wolfe, Washington & Jefferson College

Ohio University Institute for Applied and Professional Ethics

Student Conference

April 26-27

(724) 503 – 1070 Ext 7844

50 S. Lincoln St

Campus Box 1174

Washington, PA 15301


Recent advances in reproductive technologies, especially those that alter the germ-line, raise many ethical and theological concerns. I address one of the pragmatic ethical concerns, the potential loss of genetic diversity. Since genetic diversity has an inverse relation with the survivability of populations, it is necessary to have strong evidence that the implementation of these technologies will not threaten the survivability of human populations. An examination of the genetic diversity argument (GDA) and the possible models under which the technologies would be distributed (free market and state control) reveals that there is not strongly persuasive evidence regarding the effects on genetic diversity of the reproductive technologies on human populations. The only available method to produce the required evidence is through a very complex form of human experimentation. The type of human experiment that would produce the evidence is incompatible with present ethical codes of conduct. Therefore, any implementation of these technologies on human populations should be banned.

Through advances in reproductive technologies humans will eventually have the ability to utilize nearly fully artificial selection on human populations. These technologies raise many ethical and theological concerns. I will address one of the pragmatic ethical concerns, the potential loss of genetic diversity. Genetic diversity has a direct relation to the fitness and survivability of various species and populations; as genetic diversity decreases within a population, so does the fitness and survivability of that population. An examination of the genetic diversity argument (GDA) reveals that there is not strongly persuasive evidence regarding the effects on genetic diversity of the reproductive technologies on human populations. The only method available to produce the required evidence is through a very complex form of human experimentation. The type of human experiment that would produce the evidence is incompatible with present ethical codes of conduct. Therefore, any implementation of these technologies on human populations should be banned.

There are many emerging technologies that could potentially affect genetic diversity. These include genetic testing and screening, selective breeding, population control, sterilization, selective abortion, embryo testing and selection, sperm donation, egg donation, embryo donation, surrogate pregnancy, fertility drugs, contraception, cloning embryos, and germ line or somatic cell manipulation (Resnik 2000, 454). Each of these reproductive technologies affects the composition of the human gene pool by increasing or decreasing the frequency of different genotypes or combinations of genotypes (Resnik 2000, 454).

The germ-cell line, or just germ-line, constitutes a cell line through which genes are passed from generation to generation (World of Genetics 322). Germ-line therapy is often differentiated from somatic cell therapy, which is the alteration of non-reproductive cells. This distinction is not as clear as much of the literature supposes, but the problems with the germ-line/somatic cell distinction are beyond the scope of this paper. The focus of this paper includes the screening of embryos with the possibility of destruction of certain embryos, the modification of DNA (deoxyribonucleic acid) of early stage embryos through in-vitro fertilization (IVF), and the modification of parent gametes (Zimmerman 594-5). These technologies pose the clearest threat to genetic diversity of human populations.

Genetic testing and screening examines the genetic information contained in a person’s cells to determine whether that person has or will develop a certain disease, is more susceptible to certain environmental risks, or could pass a disease on to his or her offspring (World 305). Parents could subject themselves to testing to determine whether or not to reproduce based on the likelihood of their potential children inheriting their genetic maladies. Also, embryos can be subjected to testing and screening to determine the likelihood that the future individual will develop a genetic disease. From that information, parents can decide to destroy the embryo, alter the embryo, or leave the embryo unmodified and risk that the child will develop a genetic disease.

Germ-line gene therapy (GLGT) is germ-line manipulation on the genetic level in order to prevent genetic diseases in future persons (Richter and Bacchetta 304). The goal of GLGT is to treat human diseases by correcting the genetic defects that underlie the genetic disorders (Anderson and Friedmann 907). Therapy presents an alternative to destroying embryos likely to develop genetic disease by actually correcting genetic defects. Also available is the alteration of parent gametes in order to eliminate the possibility of passing on genetic disease to their offspring. GLGT allows for the alteration of either the early stage embryo or the parent gametes to prevent genetic disease. By either eliminating those genotypes that are likely to produce genetic disease or by altering the genome to actually prevent the genetic disease from developing, these technologies have great potential to affect the genetic diversity of a population.

Genetic diversity is the variety and frequency of different genotypes or combinations of different genotypes within a population. A population is a geographically, socially, or culturally linked group whose reproductive decisions affect those within the group. Genetic diversity is measured by genetic variability, which diminishes in a population when the number of different phenotypes or the number of different combinations of genotypes decreases. Since populations are composed of individuals that carry genotypes, individual reproductive outcomes affect the genetic variability within specific populations (Resnik 2000, 452). Genetic diversity provides the resource for phenotypic variation that is integral in determining the rate of evolutionary change in an environment. A population that lacks genetic diversity will be poorly equipped to meet environmental changes and demands (Resnik 2000, 452). The importance of genetic diversity is undeniable; the survivability of a population is directly related to genetic diversity.

While genetic diversity has no intrinsic value, genetic diversity has a clear instrumental value. Humans place positive value in genetic diversity as it promotes the extrinsic value of survivability. There is an ethical duty to prevent decreases in the genetic diversity of populations because of its importance in the survivability of those populations. Decreases in genetic diversity in populations are ethically undesirable because actions that reduce the survivability of the population are unethical.

The genetic diversity argument (GDA) starts from the fact that scientific and technological developments in the realm of genetics and human reproduction will greatly affect the genetic diversity of human populations. There are both pessimistic and optimistic versions of the argument. I will briefly describe both versions of the GDA.

The pessimistic version of the argument contends that the increased ability to control human reproduction will result in a loss of genetic diversity that will threaten the health and survivability of human populations (Resnik 2000, 451). This threat to health and survivability is due to a decrease in the populations’ ability to adapt to environmental changes and demands. In effect, these technologies have the potential to make the pool of available phenotypic traits limited enough so that human populations will not be able to respond to changes in environmental demand.

This version of the GDA warns that germ-line altering reproductive technologies will reduce populations’ gene pools and eliminate potentially useful genes. Genetic diversity provides a resource of these useful genes. Evolutionary change is blind and has no way to know which genes are useful, therefore it is potentially damaging to population survivability to eliminate genes of any sort. As Glenn McGee notes, “The point of the GDA is that human beings also have no way of knowing which genes will be useful in the future or in different environments” (cited in Resnik 2000, 456). For instance, genetically homogenous populations of corn face problems with blight due to lack of genetic diversity. Although human populations have an ever-increasing level of control over the environment, the pessimistic response still turns on the inability to determine which genes will be useful in the future.

The optimistic version of the genetic diversity argument contends that these reproductive technologies could lead to increases in human health and survivability resulting in an improvement of the well being of populations (Resnik 2000, 457). The basis for this response rests on the historical fact that advances in technology increase humans’ ability to control nature. The ability to control nature often leads to positive changes in the adaptability and survivability of human populations. The optimistic GDA relies on this historical fact and the seemingly obvious inference that the above technologies will increase the ability to affect the genetic diversity of human populations (Resnik 2000, 457). A commonly cited example of how genetic diversity can be increased with the implementation of such technologies is the incredible diversity of canines. Of course, there are important dissimilarities such as the explicit intention to increase phenotypic diversity.

A major factor in whether these reproductive technologies will increase or decrease genetic diversity is what model they are implemented under, free market or state control. Each model addresses the concerns and motivations of those affected differently.

The free market model is based upon the reproductive decisions of a diverse group of potential parents with separate interests, motivations, and means. The free market is the method by which many consumer decisions are made in the United States. This model is fundamentally based on the interaction between supply and demand. If a market demands diversity of a product, then the market will often supply the desired diversity. If the market demands the standardization of goods, such as building supplies, then that homogeneity is likely to be supplied. Also, markets create new preferences and demands by introducing new goods and services to the market. Most often, advancements in technology increase market variability, except of course if that development results in the formation of a monopoly.

The diversity of goods in the free market system of America seemingly justifies the inference that a free market model for reproductive technologies would lead to increases, not decreases, in the genetic diversity of human populations. Both J. Glover and W. Gardner’s individual studies conclude, “Increases in our ability to control human reproduction will result in more genetic diversity in the human population because parents will have a variety of preferences and values that they can use in selecting offspring” (cited in Resnik 2000, 458). Just as technological advancements have increased the availability of diverse consumer products, germ-line altering technologies could increase the available options in reproduction and therefore increase the diversity of human populations. Nevertheless, confounding factors such homogeneity of desirable characteristics makes the above inference much more dubious than it first appears.

The major problem with the free market model is the potential emergence of the homogeneity of desirable characteristics. Many characteristics such as intelligence, athleticism, and health, are almost universally accepted as desirable. Other characteristics such as height, eye color, and hair color, also have particular value attached to them. Genetic homogeneity could arise if the consumers of reproductive technologies have similar preferences for traits. As Resnik states, “If most people want tall, intelligent, healthy children with blonde hair and blue eyes, then parental choices could produce a phenotypically and genetically homogeneous population” (2000, 459). This problem is only exacerbated when one considers the phenomenon of fads. Societal pressures and obligations may also produce conformity. While these social effects may not take hold immediately, it seems possible, if not probable that these pressures would eventually affect reproductive decisions. Genetic homogeneity may be an unintended consequence of a population sharing common values (Resnik 2000, 459). If most people within a population have similar characteristic preferences and a desire to conform, genetic homogeneity is almost inevitable.

Of course much of this line of reasoning depends on genetic determinism, which is incredibly naïve and misinformed. Environmental factors often play a decisive role in which phenotypes are displayed. If certain desirable traits, such as intelligence or health, were strongly linked to environmental factors regardless of genotype, then the inference from individual choices to phenotypic characteristics would be dramatically weakened (Resnik 2000, 465). On the other hand, if certain genes or series of genes are linked to a trait, and that genotype is most frequently selected, it would still poses the potential threat of a genetically homogeneous population, although not phenotypically homogeneous.

There are good reasons to believe that the free market system will create greater genetic diversity within human populations. On the other hand, the influences of societal pressures and expectations should not be underestimated or ignored (Resnik 2000, 459).

State control involves the local or federal government dictating the standards of practice in certain industries, such as the power industry, education, and mass transit. This model of control in implementing genetic technologies appears likely to lead to decreases in genetic diversity within a population. It is imaginable that the government would develop specific standards to which all human beings produced in that state would be subject. The effects of state control of reproductive technologies are not clearly predictable. A state controlled system could lead to a genetic caste system. For instance, if the state determined that all people should be a certain height, weight, IQ, color, sexual orientation, etc., then those who diverge from those state determined standards could be forced into different strata of the genetic caste system. Such scenarios are certainly plausible, if not likely under state controlled conditions.

Under free market conditions, reproductive technologies could lead to increases or decreases genetic diversity. On the other hand, state control would almost inevitably lead to decreases in genetic diversity, but the extent of such effects is not clear. As David Resnik claims, “the consequences of not exerting social or governmental control over human genetics may be just as troubling, since parents will in all likelihood attempt to provide their children with genetic advantages, and the long-term results of parental control over human genetics may further exacerbate existing social and economic inequalities and create a genetic caste system” (1997, 428). The inability to produce definitive evidence of the effects of reproductive technologies under either control model points to urgency of the issue and the minimal knowledge of these technologies’ implications for the future of humanity.

Each version of the GDA provides ground for arguments that could support or undermine the utilization of germ-line altering reproductive technologies. The most obvious conclusion from examining both versions is that there is no definitive evidence that implementing the above technologies will have positive or negative consequences for the survivability of human populations. Furthermore, an examination of the two most plausible options for methods of implementing the technologies within a population does not produce strong evidence that implementation will result in either increases or decreases in genetic diversity. This leaves medical science at an ethical crossroads between either continuing with the technologies and dealing with the results afterwards, or abstaining from research, or at least clinical trials, until such evidence arises. Neither of these paths seems to be positive, or even tenable.

The only method for producing clear evidence about the potential threat to survivability that these reproductive technologies pose would be to continue research and perform a massive clinical trial. Animal experimentation is not a viable alternative to human experimentation because it completely eliminates many of the confounding factors such as social influences. Since the arguments on either side of the GDA cannot produce conclusive results, and given the potential harm done to populations if the reproductive technologies are implemented and genetic diversity does decrease, some form of human experimentation seems necessary before the technologies should be implemented. Of course, there are many questions that arise in response to such a claim, including the justification of the inference to the necessity of human experimentation. I will discuss these concerns below.

To clarify the inference, one should be reminded of what is at stake with respect to genetic diversity. The cautionary tales of the GDA describe potentially analogous situations, such as the effects of artificial selection on the survivability of maize and the variety of canines that have been produced by artificial selection. It is not at all clear what effects the above reproductive technologies will have on a population’s genetic diversity. Their implementation could result in increases in disease susceptibility like the result of artificial selection on maize, or it could result in populations with incredible arrays of genetically distinct individuals, such as in the canine example. What is clear though is that genetic diversity has an inverse relationship with the adaptability and survivability of populations. Since human populations value their own survivability, it is clear that technologies that pose a great potential threat to genetic diversity should be closely examined before being implemented. Due to the great potential threat these technologies present to humans, it is necessary to produce very strong, if not definitive, evidence about the effects of these technologies on genetic diversity. The only way to produce such evidence is human experimentation.

There are many factors that must be accounted for in a human experiment that would produce definitive evidence. The number and diversity of subjects would have to emulate a population that would be affected by the technologies. The experiment would have to be extensive enough to determine the effects on future generations. To account for potential homogeneity of desirable characteristics, the experiment should account for both diverse cultural and societal pressures. Furthermore, the experiment should be carried out under the two control models mentioned above, free market and state control. Also, there would have to be a method of curtailing influences from the non-experimental population. Finally, in the event that something goes awry with the experiment, there must be a method of destroying the test subjects.

Given present ethical standards concerning human experimentation, the ethics of such an experiment are, at best, deeply problematic. While ethical norms can dramatically change with time through changes in societal norms and beliefs, the means necessary to employ such an experiment are almost incomprehensible. For instance, it is not at all clear how the experiment would quarantine the subjects or how to handle the necessity of multiple generations of researchers. The role of informed consent is unclear with such an experiment. In the proposed experiment, an unethical researcher could use informed consent in a manner to produce the results that the researcher desires and undermine the purpose of the experiment. Additionally, an integral part of informed consent is the ability to withdraw from the experiment at any time. This element could pose a serious problem for this type of research. Therefore informed consent must either be eliminated or be drastically altered. Under present ethical norms it is clear that the kind of experiment necessary to provide strongly persuasive evidence of the effects of germ-line altering reproductive technologies would be unethical. Ethical considerations aside, the pragmatics of such an experiment are daunting to say the least.

The use of germ-line altering technologies should not be implemented until strongly persuasive evidence regarding the effects on genetic diversity is concretely established. Decreases in the genetic diversity of a population would put at risk the survivability of that population. Humans place a clear value in the survivability of populations. Therefore anything that threatens the survivability of populations is unethical. Germ-line altering reproductive technologies may potentially decrease genetic diversity within a population. Until there is concrete evidence demonstrating that such technologies will not lead to decreases in a population’s genetic diversity, those technologies should not be utilized. The only method of assessment to produce such evidence is through human experimentation. The nature of the necessary experimentation involves unacceptable ethical violations and unavoidable pragmatic difficulties. Without strong proof that such technologies do not pose a threat to genetic diversity, and therefore population survivability, those technologies should not be implemented. Due to the fact that such evidence is not possible, germ-line altering technologies should be banned.

Works Cited

“Genetic Testing and Screening.” World of Genetics. Eds. K. L. Lerner and Brenda W. Lerner. 2 vols. New York: Gale Group, 2001. 305-309.

“Germ Cells and the Germ Cell Line.” World of Genetics. Eds. K. L. Lerner and Brenda W. Lerner. 2 vols. New York: Gale Group, 2001. 322.

Anderson, W. French and Theodore Friedmann. “Gene Therapy.” Encyclopedia of Bioethics. Ed. Warren T. Reich. Volume 2. New York: Simon & Schuster Macmillan, 1955. 907-914.

Resnik, David B. “Genetic Engineering and Social Justice: A Rawlsian Approach.” Social Theory & Practice 23.3 (1997): 427-49.

—. “Of Maize and Men: Reproductive Control and the Threat to Genetic Diversity.” Journal of Medicine and Philosophy 25.4 (2000): 451-467.

Richter, Gerd and Matthew D Bacchetta. “Interventions in the Human Genome: Some Moral and Ethical Considerations.” Journal of Medicine and Philosophy 23.3 (1998): 303-317.

Zimmerman, Burke K. “Human Germ-line Therapy: The Case for its Development and Use.” Journal of Medicine and Philosophy 16 (1991): 593-612.

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Considering the Use of Cost-Benefit Analysis in Biomedical Ethics

Sahar Akhtar, Duke University

Winner, 2003 essay contest

The field of bioethics, as with most areas of applied ethics, is laden with propositions about the intrinsic value of life, treating persons as ends in themselves, and bestowing priority to individual rights and autonomy. These ideals are important because they signify a society?s unwillingness to promote the common good at the expense of the individual. They also place emphasis on values, in particular respect for autonomy, that have historically been undervalued by various health-care practices. Furthermore, they offer goals to which to aspire. On the other hand, these values must also be vulnerable to evaluation, criticism and comparison with other significant values. Although this may seem obvious to some, few authors in the bioethics literature seem to fully appreciate the implications of the condition of scarcity. This is something which economists have taken seriously enough that they have built the condition into theories, both individual-based and public-based. Given that resources and time are both limited, we are often, indeed, always according to some views, forced to choose between competing values, claims, and preferences. However, economists are sometimes too quick to accept that trade-offs must be made, and a result of this may be that the ?costs? of adopting any one choice, which may be other significant values, are too easily written-off as being unavoidable. Both approaches seem to be incomplete in an important way. I argue that the requirement of trading off one value for another needs to be taken more seriously in bioethics. In addition, though, I also argue that there is the simultaneous need for identifying what would be intrinsically and absolutely valuable under ideal conditions?that is, in a world of abundance.

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