The Price of Precaution and the Ethics of Risk

Final draft is currently processed for submission to publisher. To be published by Rodopi in 2010.

Public Policies, Law and Bioethics: A Framework for Producing Public Health Policy Across the European Union

Final report of the EuroPHEN Project. Main author: Shickle, D. Co-authors: Richardson, E., Day, F., Munthe, C., Jovell, A., Gylling, H., Vos, R., Takala, T., Petrini, C., Torlone, G., Moran, N.E., Holme, I., El-Arifi, K., Hunt, A., Griffin, M., Coupland, A., Stroud, L.. Published by: The University of Leeds, 2007.

PURE SELECTION: The Ethics of Preimplantation Genetic Diagnosis and Choosing Children without Abortion

Preimplantation genetic diagnosis (PGD) is taken to mark the starting-point of a new phase in human reproduction, where the possibility of choosing children on genetic grounds without having to resort to dangerous or ethically controversial procedures (such as abortion) will gradually increase. Ethical and political issues actualised by this development are addressed.
The discussion touches upon issues regarding the moral status of embryos and gametes, the moral import of respecting individual autonomy and its implications for the requirement of informed consent in health-care, the connection between disease, disability and the value of life, the moral status of possible future people, and the connection between choosing children and eugenic policies of the past. Practical policy issues are addressed on the basis of this, as well as an empirical case-study of the introduction of PGD in Sweden.
The book ends up in a set of recommendations regarding the management of research on, introduction and routine use of pure selection, both within health care and from the point of view of society as a whole. It is argued that research on such procedures should be allowed and supported by society. However, tight restrictions regarding the clinical introduction of new procedures in this area is highly desirable. A rough model for implementing such restrictions is also presented. It is further asserted that, although reasons of economy and safety should limit the access to pure selection, society should not apply any explicit restrictions based on ideas regarding how different traits affect a person's quality of life. It is stressed that, in order to avoid a resurrection of eugenic policies of the past, the development in this field underlines the need for continued and strengthened public support to the sick, disabled and mentally retarded.

Keywords: assisted procreation, bioethics, embryo experimentation, eugenics, genetic testing, in vitro fertilisation, medical ethics, medical genetics, polar body biopsy, preconception diagnosis, preimplantation genetic diagnosis, prenatal diagnosis, public policy, reproductive medicine, research ethics, sex preselection.

The Moral Roots of Prenatal Diagnosis: Ethical Aspects of the Early Introduction and Presentation of Prenatal Diagnosis in Sweden

Motives put forward by specialists on prenatal diagnosis in support of this procedure when it was introduced in Swedish health care during the 1970's are described and analysed. The motives are set in relation later criticism of prenatal diagnosis as well as general bioethical issues.
Three motives are described: 1) Prenatal diagnosis is a tool for improving genetic counselling, thereby promoting the autonomy and reducing the anxieties of pregnant women who fear having children with some disorder or disease. 2) The point of prenatal diagnosis is to effect medical prevention by reducing the number of children born with diseases or disorders. 3) Prenatal diagnosis has an economic advantage in that it may save society from some of the costs involved in the care for disabled or retarded people.
These motives are found to communicate an unclear and partly inconsistent body of ethical values. First, complex ethical issues in connection with abortion were not addressed. Secondly, it is highly unclear how considerations of autonomy was balanced against considerations of well-being and economic aims. This unclear picture of the support of the autonomy of patients is also relevant when the economic motive is set in relation to accusations that prenatal diagnosis springs from similar moral values as eugenic policies of the past. Three interpretations of this motive are distinguished of which only one may actually support eugenic policies. However, even if the economic motive is interpreted in a very defensive way, it still expresses a tolerance of policymakers setting aside the autonomy of individual patients in order to achieve economic aims. It is argued that the expression of such tolerance can only be blocked by a clear willingness to actively fight any threat against the autonomy of patients, and that the expression of such an attitude is incompatible with the use of the economic motive.

Livets slut i livets början. En studie i abortetik (The End of Life in Life's Beginning: A Study on the Ethics of Abortion)

In Swedish only, w. english summary: http://www.phil.gu.se/munthe/dissSummary.htm. Published by Thales, Stockholm, 1992.

Arguments put forward for five positions on the moral status of abortion are discussed. The positions range from the view that abortion may be right only if it is necessary to save the woman's life, to the claim that while most safe abortions requested by the woman are right, some abortions would be wrong not to perform and there are cases where it is right to perform abortion even if the woman does not want it. The arguments are found invalid and/or irrelevant. It is argued that a tenable position on the moral status of abortion has to be supported by an act-utilitarian moral theory dubbed BHU.

Application of BHU yields that it is impossible to obtain good reasons for any of the positions. However, this is also true of most other moral theories. Four tentative conclusions seem plausible: 1) Abortion is seldom right in countries where most women lack opportunities to have cheap, safe legal abortions. In other countries, however, many abortions can be right. 2) In many of the justifiable cases of abortion, the woman faces a moral dilemma where she cannot avoid acting wrongly even if she acts rightly. 3) It is in general wrong to omit abortion if the foetus is so severly deformed that it would develop into a person with a life worth not living. It is also in general wrong to omit abortion if this results in abortion being performed at a later time. 4) In very rare cases it may be right to perform abortion even if the woman does not want it, but in practice we lack all means of identifying these cases.