Confirming Pages Brief Contents Chapter 1 Ethical Reasoning, Moral Theories, Principles, and Bioethics Chapter 2 Requests to Die: Non-Terminal Patients Chapter 3 Requests to Die: Terminal Patients Chapter 4 Comas: Karen Quinlan, Nancy Cruzan, and Terri Schiavo Chapter 5 Abortion: The Trial of Kenneth Edelin Chapter 6 Assisted Reproduction, Multiple Births, and Elderly Parents Chapter 7 Embryos, Stem Cells, and Cloning Chapter 8 The Ethics of Treating Impaired Babies Chapter 9 Medical Research on Animals Chapter 10 Medical Research on Vulnerable Human Subjects Chapter 11 Surgeons’ Desire for Fame: Ethics of the First Transplants Chapter 12 Just Distribution of Organs: God Committee and Personal Responsibility Chapter 13 Using One Baby for Another: Babies Fae, Gabriel, and Theresa and Conjoined Twins Chapter 14 Ethical Issues of Intersex and Transgender Persons Chapter 15 Involuntary Psychiatric Commitment: The Case of Joyce Brown Chapter 16 Ethical Issues in Testing for Genetic Disease Chapter 17 Ethical Issues in Stopping the Global Spread of AIDS Chapter 18 Ethical Issues with the Affordable Care Act Chapter 19 Ethical Issues in Medical Enhancement x Pen38456_FM_i-xxii.indd x 12/31/13 3:35 PM Confirming Pages Contents PREFACE v 1. Ethical Reasoning, Moral Theories, Principles, and Bioethics 1 Good Reasoning in Bioethics 1 Giving Reasons 1 Universalization 2 Impartiality 3 Reasonableness 3 Civility 4 Mistakes in Ethical Reasoning 4 Slippery Slope 4 Ad hominem (“To the man”) 5 Tu quoque 5 Straw Man/Red Herring 5 Post Hoc, Ergo Propter Hoc 6 Appeal to Authority 6 Appeals to Feelings and Upbringing 7 Ad populum 7 False Dichotomy 7 Equivocation 7 Begging the Question 8 Ethical Theories, Principles, and Bioethics 8 Moral Relativism 8 Utilitarianism 9 Problems of Utilitarianism 10 Kantian Ethics 11 Problems of Kantian Ethics 12 The Ethics of Care 12 Virtue Ethics 13 Natural Law 13 Theories of Justice 15 Libertarianism 15 Rawls’ Theory of Justice 15 xi Pen38456_FM_i-xxii.indd xi 12/31/13 3:35 PM Confirming Pages xii Contents Marxism 16 Four Principles of Bioethics 16 2 . Requests to Die: Non-Terminal Patients 19 The Case of Elizabeth Bouvia 19 The Legal Battle: Refusing Sustenance 20 The Case of Larry McAfee 25 The Case of Dax Cowart 27 Background: Perspectives on Suicide 27 Greece and Rome 27 Philosophers on Voluntary Death 28 The Concept of Assisted Suicide 31 Ethical Issues: For and against Assisted Suicide 31 Easy to Kill Oneself? 31 Rationality and Competence 32 Autonomy 33 Treating Depression, Pain, and Symptoms Well 34 Social Prejudice and Physical Disabilities 34 Structural Discrimination Against the Disabled 35 Disability Culture 36 Further Reading and Resources 37 Discussion Questions 37 3. Requests to Die: Terminal Patients 38 Holland 38 Jack Kevorkian 39 Dr. Quill: Another Approach to Dying 41 Dr. Pou’s Case, Continued 41 Oregon’s Legalization 42 Background: Ancient Greece and the Hippocratic Oath 43 Dr. Pou’s Case, continued 44 The Nazis and “Euthanasia” 44 Modern Developments 46 Recent Legal Decisions 46 Ethical Issues 47 Direct Arguments—Physician-Assisted Dying 47 Killing Is Always Wrong 47 Killing Is Not Always Wrong 48 Killing vs. Letting Die 48 Relief of Suffering 49 Patient Autonomy 50 Indirect Arguments about Physician-Assisted Dying 51 The Slippery Slope 51 Inefficient Means 53 A Financial Empirical Slope? 54 Pen38456_FM_i-xxii.indd xii 12/31/13 3:35 PM Confirming Pages Contents xiii The Roles of Physicians 54 Mistakes and Abuses 55 Cries for Help 55 Anna Pou, Again: Hero or Villain? 56 Further Reading 57 Discussion Questions 58 4. Comas: Karen Quinlan, Nancy Cruzan, and Terri Schiavo 59 The Quinlan Case 59 Pulling the Plug or Weaning from a Ventilator? 62 Substituted Judgment and Kinds of Cases 63 The Cruzan Case 63 The Terri Schiavo Case 66 Enter Lawyers and Politicians 67 What Schiavo’s Autopsy Showed 70 Ethical Issues 71 Standards of Brain Death 71 Chances of Regaining Consciousness from Coma and PVS 72 Terri’s Chances of Re-Awakening 75 Compassion and Its Interpretation 75 Religious Issues 76 Nagging Questions 76 Disability Issues 77 Some Distinctions 77 Advance Directives 80 The Schiavo Case, Bioethics and Politics 80 Further Reading and Resources 81 Discussion Questions 81 5 . Abortion: The Trial of Kenneth Edelin 83 Kenneth Edelin’s Controversial Abortion 83 Background: Perspectives on Abortion 87 The Language of Abortion 87 Abortion and the Bible 87 The Experience of Illegal Abortions 89 1962: Sherri Finkbine 90 1968: Humanae Vitae 90 1973: Roe v. Wade 90 Abortion Statistics 91 Ethical Issues 91 Edelin’s Actions 91 Personhood 91 Personhood as a Gradient 92 The Deprivation Argument: Marquis and Quinn on Potentiality 93 Viability 94 The Argument from Marginal Cases 95 Thomson: A Limited Pro-Choice View 96 Pen38456_FM_i-xxii.indd xiii 12/31/13 3:35 PM Confirming Pages xiv Contents Feminist Views 96 Genetic Defects 97 A Culture of Life or a Culture of Death? 97 Abortion and Gender Selection 98 Abortion as a Three-Sided Issue 99 Anti-abortion Protests and Violence 99 Live Birth Abortions and How Abortions Are Done 100 Fetal Tissue Research 100 Emergency Contraception 101 Maternal versus Fetal Rights 101 Viability 102 The Supreme Court Fine-Tunes Roe v. Wade 103 Partial Birth Abortions 104 States Restrict Abortion Clinics 104 Further Reading 104 Discussion Questions 105 6 . Assisted Reproduction, Multiple Births, and Elderly Parents 106 The Octamom and the Gosselins 106 Background: Louise Brown, The First Test Tube Baby 107 Harm to Research from Alarmist Media 108 Later Developments in Assisted Reproduction 109 Sperm and Egg Transfer 109 Freezing Gamete Material 111 Payment for Assisted Reproduction: Egg Donors 112 Payment for Assisted Reproduction: Adoption 112 Paid Surrogacy: The Baby M and Jaycee Cases 113 Multiple Births: Before the Octamom and Gosselins 114 Older Parents 115 Gender Selection 116 Ethical Issues 116 Unnatural 116 Physical Harm to Babies Created in New Ways 118 Psychological Harm to Babies Created in New Ways 119 Paradoxes about Harm and Reproduction 119 Wronging versus Harming 120 Harm by Not Knowing One’s Biological Parents? 121 Is Commercialization of Assisted Reproduction Wrong? 122 Screening for Genetic Disease: A New Eugenics? 122 Designer Babies? 123 Assisted Reproduction Worldwide 124 Time to Regulate Fertility Clinics? 125 Conclusions 126 Further Reading 126 Discussion Questions 126 Pen38456_FM_i-xxii.indd xiv 12/31/13 3:35 PM Confirming Pages Contents xv 7 . Embryos, Stem Cells, and Cloning 128 Historical Background of Embryonic Research 128 Two Important Cases 129 History: Embryo Research, Cloning, and Stem Cells 130 Ethical Issues Involving Embryos in Research 135 Valuable from Conception 136 Potential for Personhood 136 Slippery Slopes 136 Reductio ad Absurdum 137 The Interest View 137 Embryos and Respect 138 The Opportunity Cost of Missed Research 139 My Tissue 139 Moot? 140 Reproductive Cloning 140 Reproductive Cloning: Myths about Cloned Persons 140 Against the Will of God? 141 The Right to a Unique Genetic Identity 141 Unnatural and Perverse 142 The Right to an Open Future 142 Abnormalities 143 Inequality 144 Good of the Child 144 Only Way to Have One’s Own Baby 146 Stronger Genetic Connection 146 Liberty 147 A Rawlsian Argument for Cloning and Choice 148 Links Between Embryonic and Reproductive Cloning 148 Further Readings 149 Discussion Questions 149 8 . The Ethics of Treating Impaired Babies 150 1971: The Johns Hopkins Cases 150 1970s: Pediatric Intensivists Go Public 151 Ancient History 152 1981: The Mueller Case: Conjoined Twins 152 1982: The Infant Doe Case 153 1982–1986: The Baby Doe Rules 154 1983–1984: The Baby Jane Doe Case 155 1983–1986: Baby Jane’s Case in the Courts 156 Follow-up on Baby Jane Doe 157 Media Ethics and Bias 159 Ethical Issues 160 Selfishness 160 Personal versus Public Cases 160 Abortion versus Infanticide 161 Killing versus Letting Die with Newborns 162 Pen38456_FM_i-xxii.indd xv 12/31/13 3:35 PM Confirming Pages xvi Contents Personhood of Impaired Neonates 162 Kinds of Euthanasia 163 Degrees of Defect 163 Wrongful Birth versus Wrongful Life 165 1984: Legislation 166 1992: The Americans with Disabilities Act (ADA) 166 The Strength of Disability Advocates 167 Conceptual Dilemma: Supporting Both Choice and Respect 168 Further Reading 168 Discussion Questions 169 9 . Medical Research on Animals 170 The Animal Liberation Front and Gennarelli’s Research 170 Evaluating the Philadelphia Study 172 PETA and Edward Taub’s Research on Monkeys 173 The Law and Animal Research 174 Numbers and Kinds of Animals in Research 175 Descartes on Animal Pain 176 C. S. Lewis on Animal Pain 177 Philosophy of Mind and Ethics 177 Peter Singer on Speciesism 178 Tom Regan on Animal Rights 179 Why We Need Animals in Research: The Official View 181 Critiquing the Official View 182 Chimpanzees and Research 183 Further Reading 184 Discussion Questions 184 10. Medical Research on Vulnerable Human Subjects 186 Infamous Medical Experiments 186 The Nuremberg Code 188 The Tuskegee Study (or “Study”) 190 Nature and History of Syphilis 190 The Racial Environment 191 Development of the Tuskegee Study 192 A Study in Nature Begins 192 The Middle Phase: Poor Design 193 Spinal Taps and Deception 193 Revelation of the Study to the World 194 Ethical Issues of the Tuskegee Study 196 Informed Consent and Deception 196 Racism 196 Media Coverage 197 Harm to Subjects 197 Effects on Subjects’ Families 198 Kant and Motives of Researchers 199 Pen38456_FM_i-xxii.indd xvi 12/31/13 3:35 PM Confirming Pages Contents xvii Hiv Prevention in Africa: Another Tuskegee Study? 199 The Krieger Lead Paint Study 201 1946–1948: The Guatemalan Syphilis Study 202 Financial Conflicts and Twenty-First-Century Research 202 Toward International Standards of Research Ethics 203 The Collaborative Model 204 The Death of Jesse Gelsinger 205 Further Reading 207 Discussion Questions 207 1 1 .