Independent Moral Status Research Articles

Human Embryonic Stem Cell Research: A Comparison Between Turkey and Iran

: The human embryo has a special character, with its ability to hold the personal data of both ova and sperm donors and its own, in addition to its potential to become a human being. For this reason, states should give the human embryo proper protection, which should be more rigorous than any somatic or germ cells of a human being. Legal protection provided by states reflects their view on the moral status of the human embryo. The moral status of the human embryo is gradual, but it is difficult to measure the stages of the human embryo’s development since its development is a continuous process. It is possible to say that the 14-day rule, the early embryonic stage, transfer to the women’s body, and ensoulment are accepted as important stages for human Embryonic Stem Cell Research (hESCR). According to Turkish regulations, it is not possible to do hESCR in Turkey. Iran gives permission to use spare/surplus embryos in hESCR based on fatwas, and regulates the conditions clearly in guidelines. Iran’s regulations and practices are a reflection of the view that the human embryo has a gradual independent moral status. Graduality is provided by the stages of the 14-day rule, implantation into the womb, and ensoulment. However, in Turkey, although the gradual independent moral status view is seen in the regulations on abortion and assisted reproductive techniques, it is seen that regulations on hESCR are incompatible with other regulations on the practices concerning the human embryo. We believe that Turkey should permit hESCR, at least, on spare/surplus human embryos.

Editors' Introduction

Editors' Introduction

Dotting the I's and crossing the T's: autonomy and/or beneficence? The ‘fetus as a patient’ in maternal–fetal surgery

Chervenak and McCullough, authors of the most acknowledged ethical framework for maternal–fetal surgery, rely on the ‘ethical–obstetrical’ concept of the fetus as a patient in order to determine what is...

A Critical Analysis of the Concept and Discourse of ‘Unborn Child’

Despite its prominence in the abortion debate and in public policy, the discourse of ‘unborn patient’ has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of ‘unborn child.’ There is a long history of the descriptive use of ‘unborn child.’ Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that opponents of abortion want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of ‘unborn child’ should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively.

Under Darwin’s Cosh? Neo-Aristotelian Thinking in Environmental Ethics

As a first shot, one might say that environmental ethics is concerned distinctively with the moral relations that exist between, on the one hand, human beings and, on the other, the non-human natural environment. But this really is only a first shot. For example, one might be inclined to think that at least some components of the non-human natural environment (non-human animals, plants, species, forests, rivers, ecosystems, or whatever) have independent moral status, that is, are morally considerable in their own right, rather than being of moral interest only to the extent that they contribute to human well-being. If so, then one might be moved to claim that ethical matters involving the environment are best cashed out in terms of the dutes and responsibilities that human beings have to such components. If, however, one is inclined to deny independent moral status to the non-human natural environment or to any of its components, then one might be moved to claim that the ethical matters in question are exhaustively delineated by those moral relations existing between individual human beings, or between groups of human beings, in which the non-human natural environment figures. One key task for the environmental ethicist is to sort out which, if either, of these perspectives is the right one to adopt—as a general position or within particular contexts. I guess I don’t need to tell you that things get pretty complicated pretty quickly.

Under Darwin's Cosh? Neo-Aristotelian Thinking in Environmental Ethics

As a first shot, one might say that environmental ethics is concerned distinctively with the moral relations that exist between, on the one hand, human beings and, on the other, the non-human natural environment. But this really is only a first shot. For example, one might be inclined to think that at least some components of the non-human natural environment (non-human animals, plants, species, forests, rivers, ecosystems, or whatever) have independent moral status, that is, are morally considerable in their own right, rather than being of moral interest only to the extent that they contribute to human well-being. If so, then one might be moved to claim that ethical matters involving the environment are best cashed out in terms of the dutes and responsibilities that human beings have to such components. If, however, one is inclined to deny independent moral status to the non-human natural environment or to any of its components, then one might be moved to claim that the ethical matters in question are exhaustively delineated by those moral relations existing between individual human beings, or between groups of human beings, in which the non-human natural environment figures. One key task for the environmental ethicist is to sort out which, if either, of these perspectives is the right one to adopt—as a general position or within particular contexts. I guess I don't need to tell you that things get pretty complicated pretty quickly.

Gerard W. Ostheimer “What’s New in Obstetric Anesthesia” Lecture

Gerard W. Ostheimer “What’s New in Obstetric Anesthesia” Lecture

Ethics: an essential dimension of clinical obstetric anesthesia.

Ethics: an essential dimension of clinical obstetric anesthesia.

What is obstetric ethics?

Ethics is the study of morality that encompasses right or wrong behavior. The ethical principles of beneficence for autonomy are cornerstones of medical ethics. The physician can identify those clinical strategies that will result in the protection and promotion of the health related interests of the patient. The ethical principle of beneficence from the time of Hippocrates has dictated seeking the greatest balance of good over harm for patients. Respect for autonomy enters clinical practice by the informed-consent process: disclosure by the physician to the patient of adequate information about the patient's condition and its management and a decision by the patient to authorize or refuse clinical management. Beneficence-based obligation to the fetus begins with the recognition that being a patient does not require independent moral status. Viability exists as a function of biomedical and technologic capacities without worldwide uniform gestational age. In the US, it occurs at approximately 24 weeks' gestational age. Directive counseling for fetal benefit is justified ethically based on the fetus as a patient. In clinical practice it involves recommending 1) against termination of pregnancy, 2) against nonaggressive management, or 3) for aggressive management (interventions such as fetal surveillance, tocolysis, Caesarean delivery). Directive counseling for fetal benefit must consider the severity of fetal anomalies, extreme prematurity, and obligations to the pregnant woman. Inquiry into the various issues in obstetric ethics entails a basic distinction between descriptive and normative ethics. The criteria is normative obstetric ethics require clarity, consistency, coherence, clinical applicability, clinical adequacy, and completeness. Pitfalls to be avoided in law, religion, professional consensus, uses of authority, and philosophy that contribute to normative obstetric ethics are also considered.

Selective termination to a singleton pregnancy is ethically justified.

Consensus presently opposes selective termination of a multifetal pregnancy to a singleton. We reject this consensus because the arguments made in defense of it are deficient. We show that these arguments rely on the indefensible assumption that the previable fetus possesses independent moral status. We conclude that, since selective termination of a multifetal pregnancy of any order to a singleton is ethically justifiable, a pregnant woman's request for selective termination to a singleton from twins or a higher-order multiple gestation should be respected and implemented. Physicians who object to selective termination to a singleton in private conscience should not feel compelled to perform the procedure but are obligated to make an appropriate referral.

Does obstetric ethics have any role in the obstetrician's response to the abortion controversy?

We defend the view that the obstetrician's response to the abortion controversy cannot be based on accounts of the independent moral status of the fetus, because all such accounts are irresolvably disputable. That response, however, can be based on an account of the dependent moral status of the fetus. For such an account the central question is, When is the fetus a patient? Viable fetuses are patients. Nonviable third-trimester fetuses are not patients. Previable fetuses are patients solely as a function of the woman's autonomous decision to confer such status. The abortion of a viable fetus is, with few exceptions, never ethically justified, because it is a patient. The abortion of nonviable third-trimester fetuses (i.e., premature termination of pregnancy) is justified when the pregnant women consents to it. Abortion of the previable fetus is justifiable when the pregnant women consents to it. We distinguish between professional and private conscience. We identify the limits of the former and the legitimate role of the latter, especially in the area of religious beliefs. Finally, we address the implications of our view for residency training programs. The most important of these implications is that requiring all residents to perform abortions is ethically unjustifiable.

The Fetus as Patient: Implications for Directive versus Nondirective Counseling for Fetal Benefit

The authors provide an ethical account of the fetus as patient and identify the implications of that account for directive versus nondirective counseling for fetal benefit. They argue that such an account cannot be grounded in the independent moral status of the fetus. Instead, the concept of the fetus as patient is best understood in terms of the principle of beneficence. On the basis of this principle, the fetus is a patient depending on whether links can be established between the fetus and the child it can become. The viable fetus is a patient. Directive counseling for fetal benefit of the viable fetus is appropriate, provided that it takes account of the presence and severity of fetal anomalies, extreme prematurity, and obligations to the pregnant woman. The previable fetus, including the in vitro embryo and the near-viable fetus, is a patient solely as a function of the pregnant woman's autonomous decision to confer such status. If she confers such status, the fetus is a patient and directive counseling is appropriate, provided that it takes account of the factors noted above. If she denies such status, the fetus is not a patient and nondirective counseling is appropriate.

Does obstetric ethics have any role in the obstetrician's response to the abortion controversy?

We defend the view that the obstetrician's response to the abortion controversy cannot be based on accounts of the independent moral status of the fetus, because all such accounts are irresolvably disputable. That response, however, can be based on an account of the dependent moral status of the fetus. For such an account the central question is, "When is the fetus a patient?" Viable fetuses are patients. Nonviable third-trimester fetuses are not patients. Previable fetuses are patients solely as a function of the woman's autonomous decision to confer such status. The abortion of a viable fetus is, with few exceptions, never ethically justified, because it is a patient. The abortion of nonviable third-trimester fetuses (i.e., premature termination of pregnancy) is justified when the pregnant woman consents to it. Abortion of the previable fetus is justifiable when the pregnant woman consents to it. We distinguish between professional and private conscience. We identify the limits of the former and the legitimate role of the latter, especially in the area of religious beliefs. Finally, we address the implications of our view for residency training programs. The most important of these implications is that requiring all residents to perform abortions is ethically unjustifiable.