Fluent Essays

I attached the study Guide, Please read it carefully. There will be two questions with 3 parts each. For each part, I will need 1-2 sentences. No outside References. Exa will start at 5: 30 PM EST. You will get 60 min total. Medicine and Morality PHIL 30015 Exam 1 Study Guide Dr. Garchar You will write essay responses to two, 3-part questions. Write 1-2 paragraphs addressing each part of the three part of each questions; meaning you should write 5-8 paragraphs for each essay. You may study and prepare together and may refer to your book and notes throughout the exam. I strongly, strongly caution you against using online sources. Any suspected plagiarism or cheating with be thoroughly investigated and established cases will result in the guilty student(s) failing the class. Your exam is an INDIVIDUAL activity and you will have 90 minutes to complete the exam once you begin. You must complete the exam in one setting. The exam must be taken during class time, that means you must begin between after 5:30 pm on Tuesday, October 5 and submit by 8:15 on Tuesday, October 5. IN OTHER WORDS, YOU MUST BEGIN BY 6:45 TO BE ALLOWED YOUR FULL 90 MINUTES. You will find your exam in the “EXAMS” folder on Bb. You will see he word document with the directions and exam questions, and you will write your answers in a word processor. You MUST submit your answers in a .doc, .docx, or .pdf format. As always, no late exams will be administered without permission from the instructor prior to the time of the exam. All quotations are from our Buchanan et al text, From Chance to Choice. Key points and ideas: · Reflective equilibrium · Considered judgments · Top-down reasoning · Bottom-up reasoning · Balancing social good v. individual freedom · The social lottery · The natural lottery · Eugenics, both negative and positive, common goals, and five reasons why it’s wrong · The history of eugenics and involuntary sterilization in the U.S., including Buck v. Bell · Mainline v. reform eugenics · G.I.N.A. · The concept/idea of disease · Fair Opportunity Rule · Equal opportunity (non-discrimination v. level playing field) · John Rawls · Rawls’ principles of justice · The “veil of ignorance” · “Normal functioning,” how it is defined, and how it functions in arguments about genetics · How “normal functioning” is determined · Difference between neg/pos eugenics and neg/pos genetic medicine · Negative v. positive genetic interventions · Medical treatment v. medical enhancement · Obligatory v. non-obligatory treatments · Normal competitors v. equal competitors (p. 127) · Defense of the normal function model (p. 145) · Final thought on the “naturalness” of the treatment v. enhancement distinction (p. 151) Sample Questions: “Genetic determinism betrays, above all, a failure to understand that genes are always only contributing causes” (23). a. Explain the quotation. b. Further consider, “Genetic determinism is not merely a tendency to make erroneous causal judgments about genes; it is a cognitive error that fosters the abdication of moral and social responsibility” (24). Explain what this quotation means and be thorough in your answer. c. How did genetic determinism affect the eugenics movement of the early 20th century? Provide and explain one example to support you answer. (Please note: the example does not replace your own explanation, it only provides support.) “Equal opportunity requires not only the elimination of legal and informal barriers of discrimination, but also efforts to eliminate the effects of bad luck…” (65). a. Explain the natural lottery and the social lottery. b. Explain the concept of “normal functioning.” The concept of normal functioning plays a central role in one of the two version of the “level playing field” above. In which version is it important? Explain why. c. Lastly explain whether “normal functioning” is a social concept or a scientific concept. FROM CHANCE TO CHOICE Genetics and Justice A powerful alliance of government, business, and science is propelling society into a new era in which human beings will possess a much greater understanding of the most basic functions of human life. Scientific knowledge of how genes work will empower human beings to cure and prevent diseases. It may also enable us to shape some of the most important biological characteristics of the human beings we choose to bring into existence. No one knows the limits of our future power to shape human lives or when those limits will be reached. One thing, however, is certain: Whatever those limits turn out to be, coping with these new powers will tax our wisdom to the utmost. This book, written by four internationally renowned bioethicists, is the first systematic treatment of the fundamental ethical issues underlying the application of genetic technologies to human beings. Probing the implications of the re- markable advances in genetics the authors ask how they should affect our un- derstanding of distributive justice, equality in opportunity, the rights and obli- gations as parents, the meaning of disability, and the role of the concept of human nature in ethical theory and practice. Unlike any other study of the ethical issues in genetics, the book offers a historical context to contemporary debate over the use of these technologies by providing an ethical autopsy of mankinds first attempts to use the scientific knowledge of heredity to improve human lives: the eugenics movement of the late 19th and early 20th centuries. In addition lucid appendices explain the na- ture of genetic causation and gene-environment interaction, and expose wide- spread misconceptions of genetic determinism, as well as outline the nature of the ethical analysis used in the book. The questions raised in this book will be of interest to any reflective reader concerned about science and society and the rapid development of biotechnol- ogy, as well as to professionals in such areas as philosophy, bioethics, medical ethics, health management, law, and political science. Allen Buchanan is Professor of Philosophy at the University of Arizona. Dan W. Brock is Professor of Philosophy at Brown University. Norman Daniels is Goldthwaite Professor of Philosophy at Tufts University, and Professor of Medical Ethics at Tufts Medical School. Daniel Wikler is Professor in the Program in Medical Ethics and in the Depart- ment of Philosophy at the University of Wisconsin, Madison. In 1999 he was appointed Senior Staff Ethicist for the World Health Organization. FROM CHANCE TO CHOICE Genetics and Justice ALLEN BUCHANAN University of Arizona DAN W. BROCK Brown University NORMAN DANIELS Tufts University DANIEL WIKLER University of Wisconsin, Madison, and World Health Organization CAMBRIDGE UNIVERSITY PRESS cambridge university press Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo, Delhi, Tokyo, Mexico City Cambridge University Press 32 Avenue of the Americas, New York ny 10013-2473, USA www.cambridge.org Information on this title: www.cambridge.org/9780521669771 © Allen Buchanan, Dan Brock, Norman Daniels, Daniel Wikler 2000 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2000 9th printing 2009 A catalogue record for this publication is available from the British Library. Library of Congress Cataloguing-in-Publication Data From chance to choice: genetics and justice / Allen Buchanan … [et al.]. p. cm. Includes bibliographical references. ISBN 0-521-66001-7 (hardcover) 1. Human genetics – Moral and ethical aspects. 2. Genetic engineering – Moral and ethical aspects. 3. Eugenics – Moral and ethical aspects. 4. Medical ethics – Moral and ethical aspects. 5. Human Genome Project – Moral and ethical aspects. I. Buchanan, Allen. QH431.F8765 2000 174´.25–dc22 99-24025 CIP The views expressed in this publication do not represent positions endorsed by the World Health Organization. isbn 978-0-521-66977-1 Paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Information regarding prices, travel timetables, and other factual information given in this work is correct at the time of first printing but Cambridge University Press does not guarantee the accuracy of such information thereafter. CONTENTS Preface page xiii CHAPTER ONE INTRODUCTION T Challenges of the Genetic Age T Previews of Perplexities j Scenario i: Genetic Communitarianism 2 Scenario 2: Personal Choice or Public Health Concern? 2 Scenario 3: The Quest for the Perfect Baby 2 Scenario 4: Health Care in the Age of Genetic Intervention * Scenario 5: The Genetic Enhancement Certificate , The Need for Systematic Ethical Thinking 4 Genomic Research and Genetic Intervention r The Human Genome Project and Related Genetic Research ^ Modes of Genetic Intervention 6 The Shadow of Eugenics o Two Models for Genetic Intervention T 1 The Public Health Model xx The Personal Service Model I 2 A Third Approach j. Ethical Analysis and Ethical Theory x. Principles for Institutions j r Justice I 5 VI CONTENTS Preventing Harm 18 Limits on the Pursuit of Genetic Perfection 19 The Morality of Inclusion 20 Ethical Theory and Public Policy 21 Science Fiction Examples, Reflective Equilibrium and the Ideological Uses of Genetic Determinism 22 The Risk of Reinforcing Gene-Mania 23 Genetic Determinist Fallacies 24 Ideological Functions of Genetic Determinism 24 CHAPTER TWO EUGENICS AND ITS SHADOW 27 The Relevance of Eugenics 27 Optimism and Anxiety 27 Eugenics as a Cautionary Tale 28 Eugenics: A Brief History 30 Origins and Growth 30 Varieties of Eugenics 3 2 The Nazi Debacle 37 Decline and Fall 38 Common Themes of Eugenicists 40 Degeneration 40 Heritability of Behavioral Traits 41 Eugenic Ends 42 Ethical Autopsy 42 A Creature of Its Time 43 Why Was Eugenics Wrong? Five Theses 46 The Public Health and Personal Service Models 53 Cost-Benefit Justifications for Genetic Intervention 54 The Social Dimension of Genetics 5 5 Genetics Constrained by Justice 57 Genetics in Pursuit of Justice 59 Conclusion 60 CHAPTER THREE GENES, JUSTICE, AND HUMAN NATURE 61 Distributive Justice Issues Raised by Genetic Intervention 61 Including the Distribution of Natural Assets in the Domain of Justice 63 CONTENTS Vll The Traditional View: Natural Inequalities Are N o t a Concern of Justice 63 Challenging the Traditional View 64 Equality of Opportunity 65 Two Variants of the Level Playing Field Conception 66 Resource Egalitarianism and the Domain of Justice 76 Individual Liberty and Genetic Intervention 77 Genetic Equality? 79 A Genetic Decent Minimum? 81 Points of Convergence 82 The Colonization of the Natural by the Just 82 Blurring the Distinction Between the Subjects and Objects of Justice 84 Justice, Human Nature, and the Natural Bases of Inequality 86 Three Conceptions of the Relation of Human Nature to Ethics 88 Genetic Causation, Freedom, and the Possibility of Morality 90 Human Nature and the Idea of Moral Progress 94 Genetic Intervention in the Name of Justice 9 5 Intervening to Prevent Limitations on Opportunity 95 Regulating Access to Interventions to Prevent a Widening of Existing Inequalities 96 Ratcheting Up the Standard for Normal Species Functioning 98 Tailoring Environments to Special Genetic Needs 99 The Obligation to Prevent Harm 99 Conclusions 100 CHAPTER FOUR POSITIVE AND NEGATIVE GENETIC INTERVENTIONS 104 Old Distinctions in New Clothes 104 Positive and Negative Eugenic Goals for Populations 104 Positive and Negative Interventions and the Health and Welfare of Individuals 105 Moral Boundaries and the Positive/Negative Distinction 107 Treatment Versus Enhancement: Wide Use, Hard Cases, Strong Criticism no Vlll CONTENTS Insurance Coverage and Medical Necessity no Treatment/Enhancement and Moral Hazard 112 Treatments and the Limits of Obligations 113 Hard Cases and Expansion of Obligations 115 The Microstructure of the Normal and Moral Arbitrariness 116 Two Objections to the Treatment/ Enhancement Distinction 118 A Limited Defense of the Treatment/Enhancement Distinction and Its Circumscribed Use 119 Treatment/Enhancement and the Obligatory/ Nonobligatory Boundary 119 The Primary Rationale for Medical Obligations 121 Hard Cases and Expansive Views of Medical Obligations 124 Three Philosophical Models of the Relationship Between Equal Opportunity and the Goals of Health Care 126 The Normal Function Model as Better Public Policy 141 Is the Normal Function Model a Moral Second- Best? 144 Is the Treatment/Enhancement Distinction a Natural Baseline? 149 Positive Versus Negative Genetic Interventions and the Permissible/Impermissible Boundary 152 A Reminder about Science Fiction 152 Negative and Positive and the Permissible/ Impermissible Boundary 153 Treatment/Enhancement and Moral Warning Flags 154 CHAPTER FIVE WHY NOT THE BEST? 156 Having the Best Children We Can 156 What Could Be More Natural Than Parents Seeking the Best? 156 Environmental Versus Genetic Pursuits 159 What Is the Best and Who Decides? 161 A Moral Distinction Between Actions 161 CONTENTS IX Pursuing the Best for the Child 164 Harms, Benefits, and General-Purpose Means 167 The Right to an Open Future 170 Limits on Pursuit of the Best 172 Pluralism and Liberalism 176 Virtues and the Best 179 Constraints on Permissions Allowed Parents 181 Enhancements, Coordination Problems, and Harms to Others 182 Enhancements and Fairness 187 Uncertainty and the Risks of Pursuing the Best 191 Cloning 196 Conclusion 202 CHAPTER SIX REPRODUCTIVE FREEDOM AND THE PREVENTION OF HARM 204 The Wider Context: Conflicts Between Liberty and Harm Prevention 204 What Is Reproductive Freedom? 206 Rights and Freedoms 206 Positive and Negative Freedom 207 Summary of the Scope of Concern 213 The Interests and Values That Determine the Moral Importance of Reproductive Freedom 214 Self-Determination 214 Individual Good or Weil-Being 219 Equality of Expectations and Opportunity 220 Use of Genetic Information to Prevent Harm 222 Distinguishing Cases 223 Post-Conception Interventions to Prevent Harms Compatible with a Worthwhile Life 226 Prevention of Harms across Many Generations 230 Pre- and Post-Conception Interventions to Prevent Harms Incompatible with a Worthwhile Life 232 Pre-Conception Interventions to Prevent Conditions Compatible with a Worthwhile Life 242 Conclusion 256 X CONTENTS CHAPTER SEVEN GENETIC INTERVENTION AND THE MORALITY OF INCLUSION 258 Objectives 258 The Morality of Inclusion 258 Neglect of the Morality of Inclusion in Ethical Theory 260 The Allegation That the New Genetics is Exclusionary 261 The Public Promise of the New Genetics: Better Lives for All Through Medical Genetics 263 Challenging the Rhetoric: The Radical Disabilities Rights Advocates Complaints 264 Sorting Out the Concerns of Disabilities Rights Advocates 266 The Loss of Support Argument 266 The Justice Trumps Beneficence Argument 270 The Expressivist Objection 272 The Deaf Culture Argument 281 The Social Construction of Disability and the Morality of Inclusion 284 Distinguishing Disabilities from Impairments 285 Options for Eliminating Disabilities 288 Choosing a Dominant Cooperative Framework 288 The Concept of a Dominant Cooperative Framework 288 Why the Choice Is a Matter of Justice 291 How Genetic Interventions Might Affect the Character of the Dominant Cooperative Scheme 296 Knowledge of Genetic Differences and the Morality of Inclusion Conclusion CHAPTER EIGHT POLICY IMPLICATIONS Where Does the Shadow of Eugenics Fall? The Inevitable Comparison Public Concern about Genetic Research Beyond Rules of Thumb Distributive Justice The Right to Health Care 2 9 8 3 0 2 3 0 4 3 0 6 3 0 6 3 0 6 3 0 7 3 0 9 3 0 9 CONTENTS XI Additional Arguments for Access to Genetic Interventions 314 Securing Equality 315 If People Are Not Equal Should We Treat Them So? Should We Make Them So? 315 Will Human Genomic Research Push Society to the Right? 317 Must Everyone Have Access to Enhancements? 318 Enhancements versus Treatments 321 Families 321 Reproductive Freedom and Coercive Eugenics 322 Restrictions on Parental Choice 324 Citizenship and Inclusion 325 A Ghetto Walled by Data 326 Devaluing the Less Than Perfect 327 Reducing the Risk of Exclusion 3 29 State, Society, Individual, and Markets 333 The Threat of the Eugenic State 333 Eugenics as a Moral Obligation? 333 Eugenic Public Policy? 336 Utopian Eugenics? 337 Markets and Individual Liberty 339 Commercial Genetics 341 Liberal Neutrality and Democratic Decisionmaking 343 The Permissibility of Rights-Respecting Genetic Perfectionist Policies 345 APPENDIX ONE THE MEANING OF GENETIC CAUSATION 347 Three Modes of Intervention 349 Four Key Questions 353 Question 1: Do Genes Causally Contribute to the Trait? 355 Question 2: How Much Do Genes, as Opposed to Environment, Contribute to the Trait? 356 Question 3: Which Genes Contribute to the Trait? 364 Question 4: How Do These Genes Contribute to the Trait? 367 Xll CONTENTS Conclusion 3 69 Acknowledgments 3 70 APPENDIX TWO METHODOLOGY The Method of Reflective Equilibrium The Charge of Parochialism The Communitarian Challenge 373 The Limits of Principlism 375 A Liberal Framework 378 Negative and Positive Rights: Freedom and Weil-Being 380 Justifying the Liberal Framework 382 References 383 Index 395 PREFACE We began thinking about writing this book in the spring of 1991 because we believed that new genetic knowledge and technology posed challenges not only to traditional social practices but also to ethical theory. We believed, as nearly everyone does, that ethics should pro- vide guidance for social practice. We also believed that our ethical understanding — the reasons, principles, and theory we draw on — itself has developed in response to specific challenges of social life. Conse- quently, we thought, the new human capabilities genetics creates re- quires an examination of ethical theory, not just an application of it. What distinguishes this book is the conviction that we must look deeply inward to the core of our field as moral and political philoso- phers as well as outward from it toward the engagement of social practices with new genetic powers. Because our goal was to produce a sustained and systematic analy- sis, we have produced a multiauthored book, not an anthology of separate articles. Although all four authors collaborated on each chap- ter, there was a division of labor. Allen Buchanan is the primary author of the Introduction, Chapters 3 and 7, and the appendix on moral methodology. Dan Brock is chiefly responsible for Chapter 6 and shares primary responsiblity with Norman Daniels for Chapter 5. In addition, Daniels is the primary author of Chapter 4. Daniel Wikler is the primary author of Chapter 2 and of Chapter 8 (with some input from Buchanan). Although Elliot Sober did not work on other parts of the book, he is the sole author of the appendix on genetic causation. Skillful copyediting by Linda Starke has produced a degree of uni- formity in style, but differences among the authors regarding philo- sophical substance remain, in particular regarding some aspects of the theory of just health care and the place of equality of opportunity in a x i n XIV PREFACE comprehensive theory of justice. In a few cases these differences mani- fest themselves in rather subtle ways in the book. This necessity we regard as a virtue. The differences among us represent hard philosoph- ical choices at the frontiers of ethical theorizing; we have attempted to signal their presence clearly to the reader, believing that they add richness to the discussion and will help dissipate any illusion that there is one clearly superior ethical framework that best responds to all the problems. From the outset of this project the authors were keenly aware of a fundamental limitation: Although our topic clearly has interdiscipli- nary dimensions, we are all philosophers, not geneticists, social scien- tists, or historians. Because of generous funding from the Program on Ethical, Social, and Legal Implications of the Human Genome Project (now called the Human Genome Institute), we were able to enlist an impressive interdisciplinary panel of advisors who provided invaluable guidance at critical junctures during the course of the project: Mark Adams, Paul Billings, Robert Cook-Deegan, and Richard Lewontin. In addition, Robert Cook-Deegan, Thomas Christiano, and Clark Wolf supplied line-by-line comments on a complete draft of the manuscript. The authors are also indebted to David Benatar and Jeff McMahon, who generously commented on several key arguments, and to Diane Paul, who guided the presentation of the history of eugenics in Chapter 2. We are also grateful for research and logistical contributions by Sandra Arneson, David Benatar, Ric (Frederick) Bolin, Cindy Holder, and Dale Murray. Through the long process of completing this project we were sus- tained by the generous and enthusiastic support of Elizabeth Thomson, Eric Juengst, and Eric Meslin, all of the Program on the Ethical, Legal, and Social Implications of the Human Genome Research Institute (formerly the Human Genome Project), which supplied funding for the project as a whole. Special thanks are also due to Terence Moore of Cambridge University Press for his editorial expertise and his enthu- siastic support. ONE INTRODUCTION CHALLENGES OF THE GENETIC AGE A powerful alliance of government, business, and science is propelling society into a new era in which human beings will possess a much greater understanding of the most basic functions of all forms of life. With this understanding will come unprecedented control over living things, including ourselves. Scientific knowledge of how genes work will empower human beings to cure and prevent diseases. It may also let us shape some of the most important biological characteristics of the human beings we choose to bring into existence. No one knows the limits of our future powers to shape human lives - or when these limits will be reached. Some expect that at most we will be able to reduce the incidence of serious genetic diseases and perhaps ensure that more people are at the higher end of the distribu- tion of normal traits. More people may have long and healthy lives, and perhaps some will have better memory and other intellectual powers. Others foresee not only greater numbers of people functioning at high levels, but the attainment of levels previously unheard of: lives measured in centuries, people of superhuman intelligence, humans endowed with new traits presently undreamt of. One thing, however, is certain: Whatever the limits of our technical abilities turn out to be, coping with these new powers will tax our wisdom to the utmost. PREVIEWS OF PERPLEXITIES Consider a few of the perplexities with which the genetic revolution is likely to confront us in the future. FROM CHANCE TO CHOICE Scenario i: Genetic Communitarianism A disaffected member of what the media refer to as a religious cult announces that the group is attempting to implement its vision of the good society by mass producing human embryos cloned from the groups leaders. He claims that the group has its own genetics lab and hopes to adapt for use on humans techniques for cloning embryos commonly employed in the commercial production of animals. Several members of Congress express outrage and urge that the government take action against the religious group. A spokesperson for the Amer- ican Civil Liberties Union says that if we value reproductive freedom and freedom of religion, we must respect the right of religious com- munities to attempt to transmit their beliefs and way of life to future generations, whether by the traditional methods of teaching and indoc- trination or by the application of genetic technology. Scenario 2: Personal Choice or Public Health Concern? A single, inexpensive blood test for prospective parents can detect high risk for virtually all serious genetic disorders as well as a broad range of genetic susceptibilities for illnesses. An initiative is afoot to provide mass genetic screening using this test. A government commission ex- amining the feasibility of this proposal notes that the programs cost- effectiveness depends on whether a sufficient number of those tested act on the knowledge of positive results - that is, whether they choose to avoid conception of affected fetuses. An advocate of the mass screening program says this is a public health matter; people should not be free to inflict avoidable diseases on their children, especially if we are ever to have an affordable health care system that provides coverage for everyone. An opponent replies that genetic services of any kind are strictly a matter of personal choice - respect for repro- ductive freedom requires this. People must be free to act on the test results as they see fit; any program that will result in pressures that limit reproductive freedom would be unacceptable. Scenario 3: The Quest for the Perfect Baby Excerpt from the introduction to a dissertation in a history of medicine written in 2040: INTRODUCTION 3 In the 1990s, as in the preceding three decades, parents mainly practiced negative eugenics, using tests for major chromosomal defects such as Down syndrome and aborting defective fetuses. By 2020 the standards for ac- ceptable babies had been raised: prospective parents routinely aborted fe- tuses that were otherwise healthy but that had genes that gave them a significantly higher than average risk of breast cancer, colorectal cancer, Alzheimers dementia, or coronary artery disease. By 2030, the trend was toward even higher standards: Fetuses with any of a range of undesirable or less than optimal combinations of genes were routinely aborted, includ- ing those predicted not to be in the highest quintile with respect to intelli- gence or even height. Widespread use of these techniques by parents who could afford them began to raise the average level of health, physical strength and stature, and intellectual ability in the population, a trend en- couraged by nationalist politicians. But the insistence of many parents that their child be in the upper quintile created a spiral in which no amount of genetic boost ever seemed enough. Scenario 4: Health Care in the Age of Genetic Intervention At a congressional hearing, Dr. Philip Jones testifies that the standard benefit package that all insurance companies are federally mandated to offer should be expanded to include what are popularly called mood enhancer drugs for all persons who have the mild depression gene, even though these individuals do not usually meet existing criteria for having bipolar affective disorder. According to Jones, What is important is whether clinical science can help people live better lives; the fact that a persons mood swings dont qualify as bipolar disorder isnt really important. A spokesperson for the Na- tional Association of Health Insurers protests, Health care coverage stops where treatment for disease ends; theres a right to health care, but theres no right to be happy. Jones, shaking his head with a somewhat patronizing air, replies, What we now know about the way genes affect the brain and hence the personality renders the dis- tinction between psychiatric disorders and undesirable psychological conditions unimportant. Scenario 5: The Genetic Enhancement Certificate Katherine and Bill are applying for the same management position in a large firm. Included in Katherines dossier is a genetic enhancement 4 FROM CHANCE TO CHOICE certificate from Opti-Gene, Inc. It certifies that the bearer has bene- fited from cutting-edge genetic enhancement technology and asserts that those who have had the package of services in question on average have fewer colds and other common respiratory infections, are less likely to suffer depression, and score higher on tests of memory skills. Bill, who cannot afford genetic enhancement, protests that hiring on the basis of genetic enhancement is just as unfair as hiring on the basis of race or gender - its a violation of equal opportunity and makes a travesty of the merit system. Katherine replies indignantly, Merit means the position goes to the best candidate, and I am the best candidate, so whats the problem? THE NEED FOR SYSTEMATIC ETHICAL THINKING Reflection on scenarios such as these prompts two sorts of self-doubt. We worry whether, like the sorcerers apprentice, we will suffer the consequences of partial knowledge, overestimating our power to pre- dict and control the causal chains we initiate through the application of our newfound knowledge. But we also worry about values. Even if we were more assured than we should be that our technical control will be complete, we would continue to wonder whether we will be able to distinguish between what we can do and what we ought to do. Do we have the ethical resources to use our genetic powers wisely and humanely? Or are we like hapless space-travelers embarking on an interstellar voyage equipped only with a pocket compass? Do existing ethical theories, concepts, and principles provide the materials for constructing more adequate instruments for moral navigation? In the face of these doubts about whether our values will keep pace with our powers, there is an unfortunate tendency to rest content with inarticulate forebodings about the dangers of playing God when confronted with revelations of particular new genetic discoveries or technical breakthroughs. The admonition not to play God is useless, except as a general warning against hubris. It tells us nothing about how we should respond to any particular choice we may confront. Something more is needed. A systematic vision of the moral char- acter of the world we hope to be moving toward is required. The primary objective of this book, accordingly, is to make a contribution toward answering a single question: What are the most basic moral principles that would guide public policy and individual choice con- cerning the use of genetic interventions in a just and humane society INTRODUCTION 5 in which the powers of genetic intervention are much more developed than they are today? Accomplishing this will require responding to many other ques- tions, among the most important of which are: What are the most important ethical problems to which greatly increased powers of ge- netic intervention will give rise? Are these new problems? How ade- quate are the resources of existing ethical theory to cope with them? And what sorts of ethical principles and distinctions are needed to help a society equipped with formidable powers of genetic intervention avoid the mistakes and evils of the eugenics movements of the late nineteenth and early to mid-twentieth centuries? GENOMIC RESEARCH AND GENETIC INTERVENTION The Human Genome Project and Related Genetic Research Our knowledge of how genes function is growing at an almost impon- derable rate. The Human Genome Project is ahead of schedule in achieving its goal of determining the sequence of the three million or so base pairs of nucleotides that make up the complete genetic material of a human being. Presumably the coming years will also bring a great expansion of our knowledge of how particular genes function. Almost daily, newspaper headlines proclaim startling and sometimes disquiet- ing discoveries and feats of technological virtuosity, from the identifi- cation of a fat gene to the cloning of a sheep from an adult sheeps mammary cell. Eventually these advances will bear practical fruit: the ability to use knowledge of how genes function to intervene in signifi- cant ways in human life. The Human Genome Project, in part because of the impetus it has given to the rapid, worldwide sharing of infor- mation and technique, does much to guarantee that the stream of genetic knowledge will continue to increase in volume and speed. Although it is the most highly publicized locus of research, the Human Genome Project does not stand alone. Many other projects for human genetic research are funded by the National Institutes of Health in the United States and by government agencies in other industrial countries. And private, commercial research efforts are in- creasingly capitalizing on the knowledge base provided by the Human Genome Project and other government-funded research and on the expertise of researchers in academic institutions, many of … Medicine and Morality Write essay responses to both of the following 3-part questions. Write 1-2 paragraphs for each part (a., b., and c.) of the questions; meaning you should write 5-8 paragraphs total for each essay. Write your response in a Word document and submit the document through the “Exam 1” link on Bb. · You may refer to your book and notes throughout the exam. · You may NOT confer with others while taking the exam. · You may NOT pull information from the internet while taking the exam. Any suspected plagiarism or cheating with be thoroughly investigated and established cases will result in the guilty student(s) failing the class. 1. Consider our discussions and write an essay addressing the questions below a. First, explain mainline and reform eugenics and how they differ. b. Then, explain the goals common to both eugenics movements (hint: there are three of them). c. Lastly, fully explain how social biases were at work in both eugenics movements and how they continue to make their way into contemporary genetic medicine. 2 Consider the following quotation and write an essay addressing the questions below. “As the possibilities for significant and large-scale genetic interventions on human beings come closer to being actualized, we may be forced to expand radically conceptions of the domain of justice by including natural as well as social assets among the goods whose distribution just institutions are supposed to regulate (63). a. Explain the natural lottery and the social lottery, and the Fair Opportunity Rule. b. Think of equal opportunity and describe the difference between non-discrimination and a level playing field. c. Lastly, consider the concept of normal functioning and normalcy. How is normalcy determined? How does normalcy function in your answers to parts a. and b., above?