Introduction to Bioethics

John A. Bryant is Professor Emeritus of Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UKLinda 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.

• Preface xiiiAbout the Companion Website xvPart I Setting the Scene 11 Science and Society 31.1 What’s It All About? 31.2 What Is Science? 51.2.1 Introduction: Some History (But Not Very Much) 51.3 Modern Science 91.4 Science, Ethics and Values 101.4.1 Introduction 101.4.2 Scientific Fraud 111.4.3 Science and Societal Values 111.5 Attitudes to Science 131.5.1 Science and the Enlightenment 131.5.2 Science, Modernism, Modernity and Postmodernism 141.5.3 Postmodernism and ‘Pseudo]modernism’ 161.5.4 Public Attitudes to Science 17Key References and Suggestions for Further Reading 212 Ethics and Bioethics 232.1 Ethics and Morals 232.2 The Development of Ethics 252.2.1 Introduction 252.2.2 Virtuous Greeks 252.2.3 Ethics and Duty 262.2.4 What Happens If…? 272.2.5 Natural Law 282.2.6 Moral Relativism: My View Is as Good as Yours 282.2.7 The Revival of Virtue 292.2.8 Ethics and Rights 292.2.9 Ethics and Religion 302.2.10 Ethics: A Summary 302.3 Making Ethical Decisions 312.4 Medical Ethics 332.5 The Growth of Bioethics 34Key References and Suggestions for Further Reading 36Part II Biomedical Science and Medical Technology 393 Life before Birth I: The New Reproductive Technologies 413.1 Introduction 413.2 Gametes Outside the Body 423.3 Techniques of Artificial Reproductive Medicine 433.3.1 Objections to Assisted Reproduction 433.3.2 Donor Insemination 443.3.3 Gamete Donation 443.3.4 In Vitro Fertilisation and Variations 473.3.5 Reception of Oocytes from Partner 503.4 Embryo Testing 513.5 Mitochondrial Donation 513.6 Embryo Research 543.7 Rights of the Unborn Child 563.8 Men and Women: Do We Need Both? 56Key References and Suggestions for Further Reading 584 Life before Birth II: Embryos, Foetuses and Associated Issues 614.1 Introduction 614.2 The Early Human Embryo 634.2.1 Introduction: Embryos and Persons 634.2.2 Status of the Embryo: Human Life Begins at Fertilisation 644.2.3 Status of the Embryo: The 14]Day Approach 654.3 Embryo Research 664.4 Screening and Diagnosis 694.5 Reproductive Rights 714.5.1 Scope of Reproductive Rights 714.5.2 Contraception 714.6 Abortion: Maternal–Foetal Conflict 724.7 Surrogacy 774.8 Artificial Wombs 78Key References and Suggestions for Further Reading 805 Cloning and Stem Cells 835.1 Introduction 835.2 Frogs and Sheep 845.3 Genes and Clones 875.4 It’s Not Natural: It Should Be Banned! 875.5 The Ethics of Human Cloning: An Overview 915.6 Reproductive Cloning of Non]human Mammals 935.7 Unlocking the Genetic Potential of Stem Cells 965.7.1 Embryonic Stem Cells 965.7.2 Therapeutic Potential 985.7.3 Embryonic Stem Cells and the Ethical Status of the Early Human Embryo 985.7.4 Therapeutic Cloning 1015.7.5 Adult Stem Cells 1025.7.6 Novel Sources of Stem Cells 1035.8 Concluding Remarks 105Key References and Suggestions for Further Reading 1066 Human Genes and Genomes 1096.1 Some History 1096.2 Molecular Genetics and the Human Genome Project 1106.3 Some Thoughts on Eugenics 1126.4 Use of Human Genetic Information 1136.4.1 Introduction 1136.4.2 Genetic Diagnosis 1146.4.2.1 Postnatal Diagnosis 1146.4.2.2 Prenatal Diagnosis 1156.4.2.3 Pre]implantation Genetic Diagnosis 1166.4.2.4 Saviour Siblings: A Very Special Case 1186.4.2.5 Where Next? 1196.4.3 Genetic Screening 1206.4.4 The Possibility of Genetic Discrimination 1246.4.5 Community]Wide Genome Sequencing 1256.4.6 Direct]to]Consumer Genome Analysis 1276.4.7 The Burden of Genetic Knowledge 1296.4.8 A Promise Unfulfilled? 1306.5 Genetic Modification of Humans: Fact or Fiction? 1316.5.1 Introduction 1316.5.2 Somatic Cell Gene Therapy 1316.5.3 Germ]Line Gene Therapy 1336.5.4 Genetic Enhancement and Designer Babies 1356.5.5 Genome Editing 1386.6 A Gene for This and a Gene for That 140Key References and Suggestions for Further Reading 1417 Transhumanism 1437.1 Introduction 1437.2 From Wooden Legs to Would]Be Cyborgs 1447.3 Mind and Matter 1497.4 Stronger, Fitter, Faster, Cleverer: Biological Aspects of Transhumanism 1527.4.1 Genetic Modification 1527.4.2 Life Extension 1537.4.3 Biochemical and Pharmaceutical Enhancement 1547.5 Military Applications 156Key References and Suggestions for Further Reading 1578 Decisions at the End of Life: When May I Die and When Am I Dead? 1598.1 Introduction: Four Important Examples to Inform Our Thinking 1598.1.1 Charlotte Wyatt 1598.1.2 Mark Sanderson 1618.1.3 King George V 1618.1.4 Reginald Crew 1618.2 How Did We Get Here? 1628.3 What Is Euthanasia? 1638.3.1 Introduction 1638.3.2 Euthanasia 1638.3.3 Is Assisted Suicide Different? 1648.4 Case for Assisted Dying 1648.4.1 Openness 1648.4.2 Necessity 1658.4.3 Autonomy 1658.5 The Arguments against Assisted Dying 1668.5.1 Controlling Pain and Suffering 1668.5.2 The Downside of Autonomy 1668.6 The Debate Continues: Will the Law Ever Be Changed? 1688.7 When Should Medical Treatment Be Withheld or Withdrawn? 1728.7.1 Introduction 1728.7.2 The Right to Refuse Treatment 1738.7.3 Making Decisions for People Who Cannot Make Them for Themselves 1738.7.4 The Liverpool Care Pathway 1768.8 Concluding Remarks 176Key References and Suggestions for Further Reading 177Part III Biotechnology 1799 Genetic Modification and Synthetic Biology 1819.1 Introduction 1819.2 Ethical Aspects of Genetic Modification 1829.2.1 Introduction 1829.2.2 Ethical Analysis of Genetic Modification 1829.2.3 Risks Associated with Genetic Modification 1839.2.4 Possible Misuse of Genetic Modification 1869.3 Pharmaceuticals 1879.4 Genetic Modification of Animals 1909.4.1 Introduction 1909.4.2 Scientific Background 1909.4.3 Applications of Animal Genetic Modification 1919.4.4 Animal GM and Animal Welfare Issues 1929.5 Research Uses of Genetic Modification 1939.6 Gene and Genome Editing 1959.6.1 Introduction 1959.6.2 The CRISPR/Cas9 Genome Editing System 1969.7 Synthetic Biology 1979.7.1 Introduction 1979.7.2 What Is Synthetic Biology? 1989.7.3 Applications of Synthetic Biology 2009.7.4 Ethical Aspects of Synthetic Biology 201Key References and Suggestions for Further Reading 20210 Genetic Modification of Plants 20510.1 Introduction and Definitions 20510.2 Back to the Beginning 20610.3 Basic Methodology 20810.4 The Debate 20910.4.1 Introduction 20910.4.2 Conducting the Debate 21010.4.3 The Key Issues 21310.4.3.1 Intrinsic Objections 21310.4.3.2 Risk 21410.4.4 The Debate Continues 21710.4.5 Genome Editing: A Special Case? 22210.5 GM Crops: Is a Different Approach Possible? 22310.6 Closing Comments: Consumer Choice 224Key References and Suggestions for Further Reading 22611 Genes: Some Wider Issues 22911.1 Introduction 22911.2 Crop GM Technology, World Trade and Global Justice 23111.3 Gene Patenting 23511.3.1 Gene Patents in Crop GM Technology 23511.3.2 Gene Patents and Medical Genetics 23611.4 Genetic Piracy 23811.5 DNA Fingerprinting and DNA Databases 24311.5.1 Introduction 24311.5.2 Applications of DNA Fingerprinting 24311.5.3 DNA Databases 24511.6 Concluding Remarks 246Key References and Suggestions for Further Reading 24612 Biofuels and Bioenergy: Environmental and Ethical Aspects 24912.1 Introduction 24912.2 Biofuels: A Brief Survey 25112.3 Biofuels: Ethical Issues 25412.3.1 Introduction 25412.3.2 Can Biofuels Be Produced without Affecting Food Production? 25412.3.3 Is Growth of Biofuel Crops Sustainable? 25812.3.4 Biofuel Production and Land Allocation 25912.4 Concluding Comment 261Key References and Suggestions for Further Reading 261Part IV Humans and the Biosphere 26313 Humans and Non]human Animals 26513.1 Introduction 26513.2 Humankind’s Place in the Animal Kingdom 26613.3 Human Use of Animals: An Overview 26713.3.1 Historic and Present]Day Perspectives 26713.3.2 ‘Speciesism’ 27013.4 Vivisection and the Use of Animals in Research 27113.4.1 Definitions, Laws and Numbers 27113.4.2 Reasons for Experimenting on Animals 27213.4.3 All Animals Are Equal, or Are They? 27413.5 The Ethics of Animal Research 27413.6 Animals in Sport, Companionship, Leisure and Fashion 27713.6.1 Sport 27713.6.2 Companion Animals and Pets 27813.6.3 Fashion and Fur 27913.7 Working Animals 27913.8 Animals for Food 28013.9 Concluding Comments 282Key References and Suggestions for Further Reading 28314 The Environmental Crisis: Not Just about Climate 28514.1 Introduction 28514.2 Environmental Damage: It’s a Fivefold Problem 28714.2.1 Introduction 28714.2.2 Environmental Pollution 28714.2.3 Environmental Degradation 29014.2.4 Loss of Habitat and of Biodiversity 29114.2.5 Over]exploitation of Earth’s Resources 29314.2.6 Pause for Reflection 29414.3 Climate Change 29514.3.1 Introduction 29514.3.2 Sea Levels 29714.3.3 How Much Can We Cope With? 29814.3.4 Fuels and Energy Sources 29914.3.5 Resilience 30214.3.6 The Future 30214.4 Valuing the Environment 305Key References and Suggestions for Further Reading 31015 Planet and Population 31115.1 Introduction: The Anthropocene 31115.2 How Many? 31215.3 How Many Can We Feed? 31315.3.1 Agricultural and Scientific Aspects 31315.3.2 Social and Societal Aspects 31615.3.3 War 31715.4 How Many Is Too Many? 31815.5 Water 31915.6 Concluding Comments 321Key References and Suggestions for Further Reading 323