For Experts Only?

How closely involved with hospital ethics committees should patients and their families become? Should they routinely have access to committees, or be empowered to initiate consultations? To what extent should they be informed of the content or outcome of committee deliberations? Seeing ethics committees as the locus of competing responsibilities allows us to respond to the questions posed by a patient rights model and to acknowledge more fully the complex moral dynamics of clinical medicine.     

The Experts Are Not Enough

As Achim Rosemann and colleagues rightly suggest in their article “Heritable Genome Editing in Global Context: National and International Policy Challenges,” in this issue of the Hastings Center Report, the scientific, ethical, and governance challenges associated with heritable genome editing are global in scope. Both the genetic interventions and the social and moral judgments about human identity and integrity associated with them will affect all humanity. Yet the worries, problems, and solutions that the study illuminates reflect only a partial picture of those challenges. That is to be expected from a study of this sort: the “stakeholders” who were consulted are a limited group and as such are bound to provide a particular, limited picture. One of the important contributions that such a study can make is in providing a picture of what problems particular kinds of experts see as the primary problems and how the framing of those problems may displace other questions and perspectives, especially when such parochial framings of problems are elevated to the level of the “global.” Rosemann et al. do not explain how participants were identified as stakeholders or, indeed, how the study identified the stakes. This is a missed opportunity, and it points toward a set of questions that themselves need to be asked about how the stakeholders—and the stakes—of global governance of heritable genome editing are identified.     

Moral transhumanism

In its basic sense, the term "human" is a term of biological classification: an individual is human just in case it is a member of the species Homo sapiens. Its opposite is "nonhuman": nonhuman animals being animals that belong to other species than H. sapiens. In another sense of human, its opposite is "inhuman," that is cruel and heartless (cf. "humane" and "inhumane"); being human in this sense is having morally good qualities. This paper argues that biomedical research and therapy should make humans in the biological sense more human in the moral sense, even if they cease to be human in the biological sense. This serves valuable biomedical ends like the promotion of health and well-being, for if humans do not become more moral, civilization is threatened. It is unimportant that humans remain biologically human, since they do not have moral value in virtue of belonging to H. sapiens.     

Beyond the Moral Status of the Fetus

Book reviewed in this article: Abortion and Woman's Choice: The State, Sexuality, and Reproductive Freedom . By Rosalind P. Petchesky. Abortion and the Politics of Motherhood . By Kristin Luker.     

Moral transhumanism: the next step

Although transhumanism offers hope for the transcendence of human biological limitations, it generates many intrinsic and consequential ethical concerns. The latter include issues such as the exacerbation of social inequalities and the exponentially increasing technological capacity to cause harm. To mitigate these risks, many thinkers have initiated investigations into the possibility of moral enhancement that could limit the power disparities facilitated by biotechnological enhancement. The arguments often focus on whether moral enhancement is morally permissible, or even obligatory, and remain largely in the realm of the hypothetical. This paper proposes that psilocybin may represent a viable, practical option for moral enhancement and that its further research in the context of moral psychology could comprise the next step in the development of moral transhumanism.     

Pharmaceutical Company Corruption and the Moral Crisis in Medicine

A much‐debated series of articles in the New England Journal of Medicine in May 2015 labeled the pharmaceutical industry's critics “pharmascolds.” Having followed the debate for two decades, I count myself among the scolds. The weight of the evidence overwhelmingly supports the claim that pharmaceutical policy no longer serves the public interest; the central questions now are how this happened and what to do about it. I approached three of the most recent books on the industry with these questions in mind. Deadly Medicine and Organized Crime (CRC Press, 2013), by Peter Gøtzsche, Bad Pharma (Faber & Faber, 2013), by Ben Goldacre, and Good Pharma (Palgrave MacMillan, 2015), by Donald Light and Antonio Maturo, all situate their critical assessments in high‐income countries globally, depicting the problem of pharmaceuticals as too many drugs approved with too little evidence, causing too many needless deaths, and prices spiraling to heights unimaginable just a decade ago. Light and Maturo, while no less critical of the status quo than Gøtzsche and Goldacre, take a different tack: they detail the success of an alternative model for pharmaceutical research, the Mario Negri Institute in Italy, citing it as proof positive that we can indeed defy capitalism's profit imperative.