The JME editorial team selects its feature articles from the best papers accepted for publication based on their quality, novelty and capacity to move debate forward on a specific issue. Feature articles are made freely available and are published alongside reviewed and submitted commentaries. We do this partly to promote and acknowledge excellent work in medical ethics, but also to encourage authors to submit their best papers to the JME. JME feature articles have deepened the analysis of some central issues (...) for medical ethics. ‘Common morality’ is one way of underpinning general ethical principles and it is a concept that is central to the justification that Beauchamp and Childress give in their classic articulation of the four principles. 1 Rhodes’ critical discussion of common morality in her feature article 2 has been well cited since then, which is a good thing from the perspective of the author... (shrink)

Patients with delusions of control are abnormally aware of the sensory consequences of their actions and have difficulty with on-line corrections of movement. As a result they do not feel in control of their movements. At the same time they are strongly aware of the action being intentional. This leads them to believe that their actions are being controlled by an external agent. In contrast, the normal mark of the self in action is that we have very little experience of (...) it. Most of the time we are not aware of the sensory consequences of our actions or of the various subtle corrections that we make during the course of goal-directed actions. We know that we are agents and that we are successfully causing the world to change. But as actors we move through the world like shadows glimpsed only occasional from the corner of an eye. (shrink)

We have only limited awareness of the system by which we control our actions and this limited awareness does not seem to be concerned with the control of action. Awareness of choosing one action rather than another comes after the choice has been made, while awareness of initiating an action occurs before the movement has begun. These temporal differences bind together in consciousness the intention to act and the consequences of the action. This creates our sense of agency. Activity in (...) the anterior cingulate cortex and medial prefrontal cortex is associated with awareness of our own actions and also occurs when we think about the actions of others. I propose that the mechanism underlying awareness of how our own intentions lead to actions can also be used to represent the intentions that underlie the actions of others. This common system enables us to communicate mental states and thereby share our experiences. (shrink)

People should be allowed to decide how and where they wish to be tested for HIV without there being a formal requirement for pretest counsellingIn his paper, Ethics of HIV testing in general practice without informed consent, Fraser argues that pretest counselling and informed consent are pillars of the ethical conduct of HIV testing. In my response I want to look critically at these contentions. While I will agree with Fraser that it is always necessary to get informed consent from (...) a patient for an HIV test I will argue that an emphasis on pretest counselling as a prerequisite for testing can actually undermine a patient’s autonomy, the very principle that informed consent seeks to promote.This response will start with an analysis of Case Two as this highlights the fundamental importance of informed consent. It will then go on to look at Case One and show how the special application of informed consent in the field of HIV testing can, in certain circumstances, lead to a reduction in patient autonomy.CASE TWOIn Fraser’s second case a 43 year old married clergyman presented with a recurrent infection of his little toe and the preliminary lab reports queried Kaposi’s sarcoma. The general practitioner thought that because of the patient’s lifestyle there was little risk of HIV infection, “suggesting the possibility of HIV, when it is unexpected and the risk low, can in itself cause anxiety and distress”. On these grounds the GP did not call the patient in for an HIV test.Some might argue that the GP should have tested the clergyman. This could have been done in one of two ways: by seeking his explicit consent for an HIV test, or by getting blanket consent for a range of tests, including HIV, without HIV being explicitly mentioned. …. (shrink)

In their paper Hortonet alargue that it is acceptable to contact an anonymous egg-donor to facilitate diagnostic genetic testing for the donor conceived child, despite the donor, ‘indicating on a historical consent form that she did not wish to take part in future research, and that she did not wish to be informed if she was found to be a carrier of a “harmful inherited condition”’. There are a number of claims embedded in Hortonet al’s position that it is acceptable (...) to contact the donor and request that she at least think about participating in genetic testing. In this response. I will go through their main claims and argue that the area of genomic medicine does not justify exceptions to general consent conditions as the authors suppose and conclude that the donor should not be contacted. I will then go on to suggest a policy change that would address Hortonet al’s concerns but would not involve over-riding any previously expressed wishes. (shrink)

Gray has expanded his account of schizophrenia to explain consciousness as well. His theory explains neither phenomenon adequately because he treats individual minds in isolation. The primary function of consciousness is to permit high level interactions with other conscious beings. The key symptoms of schizophrenia reflect a failure of this mechanism.

As John McMillan notes in January’s editorial,1 many countries are reflecting on how they responded to the COVID-19 pandemic, what went wrong and how responses to such system shocks can be better managed in the future. However, while it is tempting to think that the COVID-19 pandemic is over and that what is now needed is a reflection on how countries could have responded better, some of the underlying issues and problems COVID-19 both highlighted and created are still with us. (...) The legacy of the pandemic has continued particularly for healthcare workers at all levels, who have had to continue providing services with little time to rest and reflect and with new ‘shocks’ to the systems to cope with. For example, in England, industrial action by junior doctors has put already fragile systems under pressure, and the issues that staff are campaigning about remain unaddressed. Many of these issues are not distinctive to COVID-19, but as has been noted, ‘From an ethical perspective, the COVID-19 pandemic is like a prism: it helps us see the spectrum of …. (shrink)

Mentalizing refers to our ability to read the mental states of other agents and engages many neural processes. The brain's mirror system allows us to share the emotions of others. Through perspective taking, we can infer what a person currently believes about the world given their point of view. Finally, the human brain has the unique ability to represent the mental states of the self and the other and the relationship between these mental states, making possible the communication of ideas.

The literature on patient public involvement and engagement (PPIE) in health research has grown significantly in the last decade, with a diverse range of definitions and topologies promulgated. This has led to disputes over what the central functions and purpose of PPIE in health research is, and this in turn makes it difficult to assess and evaluate PPIE in practice. This paper argues that the most important function of PPIE is the attempt to make health research more democratic. Bringing this (...) function to the fore and locating PPIE in the wider context of changes in contemporary forms of democratic engagement provides greater conceptual clarity over what PPIE in research should be trying to achieve. Conceptualizing PPIE as a form of democratization has a number of benefits. First, theories of what are appropriate, normatively justifiable and workable criteria for PPIE practices can be developed, and this can provide tools to address the legitimacy and accountability questions that have troubled the PPIE community. Second, this work can be used to form the basis of a research agenda to investigate how PPIE in health research operates, and how it can facilitate and/or improve democratic processes in health research. (shrink)

Over the last 20 years the comparator model for delusions of control has received considerable support in terms of empirical studies. However, the original version clearly needs to be replaced by a model with a much greater degree of sophistication and specificity. Future developments are likely to involve the specification of the role of dopamine in the model and a generalisation of its explanatory power to the whole range of positive symptoms. However, we will still need to explain why symptoms (...) can be so variable and we still do not understand the origin of the most mysterious symptom of all: thought insertion. (shrink)

Autism provides a model for exploring the nature of self‐consciousness: self‐consciousness requires the ability to reflect on mental states, and autism is a disorder with a specific impairment in the neurocognitive mechanism underlying this ability. Experimental studies of normal and abnormal development suggest that the abilities to attribute mental states to self and to others are closely related. Thus inability to pass standard ‘theory of mind’ tests, which refer to others’ false beliefs, may imply lack of self‐consciousness. Individuals who persistently (...) fail these tests may, in the extreme, be unable to reflect on their intentions or to anticipate their own actions. In contrast, individuals with high‐functioning autism or Asperger syndrome often possess a late‐acquired, explicit theory of mind, which appears to be the result of effortful learning. An experimental study with three people with Asperger syndrome suggested that level of performance on standard theory of mind tasks was strongly related to the ability to engage in introspection. Qualitative differences in the introspections of high‐functioning people with autism are also reflected in autobiographical accounts which may give a glimpse of what it is like to be autistic. (shrink)

It is nearly 20 years since Tony Hope wrote an editorial in this journal on Empirical Medical Ethics,1 arguing for both a recognition of the increasing amount of work being done in ‘empirical ethics’ and for its importance as a new direction for medical ethics research. Since then empirical ethics has flourished, with debates over the role of ‘empirical’ data in ethical reasoning producing a growing body of literature and the JME and other bioethics journals regularly publishing empirical studies. While (...) bio/medical ethics has grappled with ‘incorporating’ or using more empirical data in ethical analysis, with varying degrees of success, and some criticism, there has not been a corresponding willingness of more empirical disciplines to embrace ethical analysis. This is a particular lack for applied research areas that see their role as predominately influencing policy and practice, such as health services research. Health services research ‘is the integration of epidemiological, sociological, economic, and other analytic sciences in the study of health services.’ Whose ‘main goals … are to identify the most effective ways to organize, manage, finance, and deliver high quality care; reduce medical errors; and improve patient safety’.2 Health services research brings together a wide variety of disciplines and would seem ideally placed to include ethics. However, if you search health services research journals and conference programmes there is very little consideration of ethics as a substantive topic and often scant attention paid to the ethical issues that might be raised by an intervention or policy. Ethics and ethical issues are generally confined to discussions over priority setting, and occasionally health technology assessment, with other areas of health service research seldom engaging in ethical debate. In the Encyclopaedia of Health Services Research,3 ethics …. (shrink)

This issue of the Journal of Medical covers a range of ethical issues and care settings making the task of beginning to summarise these papers challenging. They reflect the diversity of our field, representing different branches of bioethics focussing on specific areas or topics using a variety of methodologies: but how do we categorise these branches of bioethics? What demarks one branch from another? And what function do such categorisations fulfil? From the early days of medical ethics we now have (...) a growing proliferation of different branches, from those with a more specific focus: clinical ethics, global ethics, nursing ethics, public health ethics for example, to a widening out, in terms of bioethics becoming the broader usage and medical ethics sitting within that. More recently, a new area of ethical focus has arisen, One Health, the subject of Johnson and Degeling’s article in this issue. They define One Health as follows: ‘One Health is generally construed as an integrated approach to understanding and managing disease. Although primarily associated with the prevention and control of Emerging Infectious Diseases, the approach is also relevant to dealing with endemic and zoonotic animal diseases, as well as securing food safety. In its most comprehensive form, it extends to fostering the health of humans, animals and their shared environments.’ This raises, in many ways, a different set of ethical concerns from those usually encountered in bioethics and medical ethics and this leads Johnson and Degeling to ask whether One Health merits having its own ‘ethical framework’. They use ethical frameworks in two senses: as value neutral deliberative tools and as embodying values, and consider how each usage could be applied in One Health. In terms of the first usage they state: ‘When ethical frameworks are regarded as a procedural tool then, the One Health perspective can broaden …. (shrink)

This paper examines the role of clinical ethics committees (CECs) in infertility clinics in the UK, focusing on whether they usefully support infertility clinicians' ethical decision-making. The overall aim of the study reported here was to investigate how infertility clinicians approached and handled ethical problems in their everyday practice and this paper reports on one aspect of these data – what they thought about the use of CECs. This paper gives an overview of what arrangements there are for such committees (...) in infertility clinics; considers why the clinicians used CECs; and examines how these committees provided a useful function in the infertility setting and contributed to making ‘good’ ethical decisions. Finally, the paper examines how the form of ethics support can be developed and strengthened, and concludes with recommendations for a particular model of CECs in infertility units – a designated CEC for each infertility unit. (shrink)

Christopher Frith is a research professor at the Functional Imaging Laboratory of the Wellcome Department of Imaging Neuroscience at University College, London. He explores, experimentally, using the techniques of functional brain imaging, the relationship between human consciousness and the brain. His research focuses on questions pertaining to perception, attention, control of action, free will, and awareness of our own mental states and those of others. As the following discussion makes clear, Frith investigates brain systems involved in the choice (...) of one action over another and in the understanding of other people. Such investigations are aimed at understanding brain basis of autism and schizophrenia. In his widely cited study of schizophrenia, The Cognitive Neuropsychology of Schizophrenia , Frith argues that many of the positive symptoms of schizophrenia, such as delusions of control, auditory hallucinations, and thought insertion, involve problems of self-monitoring. Patients, in effect, lose track of their own intentions and mistakenly attribute agency for their own actions to someone else. Frith employs models of motor control, involving comparator mechanisms and efference copy, not only to explain delusions that involve movement, but also to develop a neurocognitive explanation of delusional cognition. (shrink)

On 22nd September 2020 the UK Government announced new lockdown restrictions to supress the COVID-19 virus, with some areas of England having more restrictive lockdown guidance. Students in a number of cities have been confined to their halls of residences after outbreaks of COVID-19 and in Manchester security guards were preventing students leaving the buildings. The scientific community are, unsurprisingly, divided over the question of how far lockdowns should extend.1 Monday 21st September 2020 saw the publication of two open letter (...) to the UK government and Chief Medical Officers. One group, Sunetra Gupta et al,2 argued for a selective lockdown targeting the most vulnerable. The other, headed by Trisha Greenhalgh, arguing that attempts to suppress the virus should operate across the whole community.3 As we enter what appears to be a second wave of COVID-19 infections and accompanying lockdown measures, ethical debates over the appropriateness and extent of such measures are critical. Julian Savulescu and James Cameron4 in their article on lockdown of the elderly and why this is not ageist, put forward the case that, ‘an appropriate approach may be to lift the general lockdown but implement selective isolation of the elderly.’ Their central claim is that selective isolation of the elderly is to be preferred to imposing lockdown on all members of society. The aim of lockdown, restricting movement and key activities, is designed to reduce the number of deaths from COVID-19 and also to prevent the healthcare system from becoming overwhelmed. As the elderly are at significantly more risk of having severe cases of COVID-19 and therefore more likely to place demands on healthcare services, they are clearly prime candidates for lockdown measures, measures that will not only benefit them but the whole of society. This is not ageist as …. (shrink)

This paper will critically examine the use of evidence in creating policy in the area of reproductive technologies. The use of evidence in health care and policy is not a new phenomenon. However, codified strategies for evidence appraisal in health care technology assessments and attempts to create evidence based policy initiatives suggest that the way evidence is used in practice and policy has changed. This paper will examine this trend by considering what is counted as ‘good’ evidence, difficulties in translating (...) evidence into policy and practice and how evidence interacts with principles. To illustrate these points the removal of gamete donor anonymity in the UK in 2005 and the debates that preceded this change in the law will be examined. It will be argued that evidence will only ever take us so far and attention should also be paid to the underlying principles that guide policy. The paper will conclude with suggestions for how underlying principles can be more rigorously used in policy formation. (shrink)

Arguably one of the strengths of the discipline of medical ethics is its close attention to the context in which ethical dilemmas, questions and issues play out. As a discipline that is concerned with helping and supporting practitioners, policy-makers and the public to address the ethical aspects of healthcare provision and practice in the best way they can, context is crucially important. As McMillan puts it, ‘ethics should be grounded’ in the practical realities of the situation.1 What, where and who (...) are important questions that set the parameters of the debate and, to some extent, frame the subsequent solution or decision. What is happening in a particular case, what is the source of controversy, is it a conflict of values, regulations or professional viewpoints? Where does it take place, under which rules, jurisdiction or in which professional setting? And who does it involve? Whose rights, interests or decision-making capacity do we prioritise? All these contextual questions need to be carefully articulated before it is possible to draw any normative conclusions. The importance of context is clear in this issue’s ‘Engagement without entanglement: a framework for non-sexual patient–physician boundaries’ by Appel.2 What might be seen as entirely appropriate behaviour in one context, for example, when I help out a friend and let them stay in my house for a few weeks while they recover from an operation, is entirely inappropriate in another—in …. (shrink)

Like any discipline, bioethics is a developing field of academic inquiry; and recent trends in scholarship have been towards more engagement with empirical research. This ‘empirical turn’ has provoked extensive debate over how such ‘descriptive’ research carried out in the social sciences contributes to the distinctively normative aspect of bioethics. This paper will address this issue by developing a practical research methodology for the inclusion of data from social science studies into ethical deliberation. This methodology will be based on a (...) naturalistic conception of ethical theory that sees practice as informing theory just as theory informs practice – the two are symbiotically related. From this engagement with practice, the ways that such theories need to be extended and developed can be determined. This is a practical methodology for integrating theory and practice that can be used in empirical studies, one that uses ethical theory both to explore the data and to draw normative conclusions. (shrink)

Cognitive neuroscience aspires to explain how the brain produces conscious states. Many people think this aspiration is threatened by the subjective nature of introspective reports, as well as by certain philosophical arguments. We propose that good neuroscientific explanations of conscious states can consolidate an interpretation of introspective reports, in spite of their subjective nature. This is because the relative quality of explanations can be evaluated on independent, methodological grounds. To illustrate, we review studies that suggest that aspects of the feeling (...) of being in control of one's bodily movement can be explained in terms of the complex and surprising way the brain predicts movement. This is a modest type of functional, contrastive explanation. Though we do not refute the threatening philosophical arguments, we show that they do not apply to this type of explanation. (shrink)

Antti Revonsuo has given us an engaging and deliberately provocative paper discussing the value of brain imaging in the search for the neural basis of consciousness. In some places, however, his enthusiasm for the controversial nature of the topic has led him to overstate or misdirect his case.

The systematic examination of the relationship between brain and behavior is generally considered to have begun in 1861 with Broca's description of a patient with a specific language deficit associated with a circumscribed lesion of the left frontal cortex. This observation was taken to show that there was a specific region in the brain concerned with language which was relatively independent of other regions concerned with other abilities. In the next decade a number of other patients were described with various (...) circumscribed deficits. Wernicke described aphasic patients who, in contrast to Broca's patients, were better at speech production than they were in understanding speech. Harlow described the case of Phineas Gage, who showed little sign of loss in his intellectual abilities but suffered a disastrous change in personality after bilateral damage to his frontal cortex. The aim of many of these early neuropsychologists was to associate particular psychological functions with specific brain regions by detailed study of neurological cases. (shrink)

We have only limited awareness of the system by which we control our actions and this limited awareness does not seem to be concerned with the control of action. Awareness of choosing one action rather than another comes after the choice has been made, while awareness of initiating an action occurs before the movement has begun. These temporal differences bind together in consciousness the intention to act and the consequences of the action. This creates our sense of agency. Activity in (...) the anterior cingulate cortex and medial prefrontal cortex is associated with awareness of our own actions and also occurs when we think about the actions of others. I propose that the mechanism underlying awareness of how our own intentions lead to actions can also be used to represent the intentions that underlie the actions of others. This common system enables us to communicate mental states and thereby share our experiences. (shrink)

In this paper, we attempt to make a distinction between egocentrism and allocentrism in social cognition, based on the distinction that is made in visuo-spatial perception. We propose that it makes a difference to mentalizing whether the other person can be understood using an egocentric (‘‘you'') or an allocentric (‘‘he/ she/they'') stance. Within an egocentric stance, the other person is represented in relation to the self. By contrast, within an allocentric stance, the existence or mental state of the other person (...) needs to be represented as independent from the self. We suggest here that people with Asperger syndrome suffer from a disconnection between a strong naı¨ve egocentric stance and a highly abstract allocentric stance. We argue that the currently used distinction between first-person and third-person perspective-taking is orthogonal to the distinction between an egocentric and an allocentric stance and therefore cannot serve as a critical test of allocentrism. (shrink)

This paper will take as its starting point the premise that developing translational bioethics is a worthwhile endeavour. I will develop an account of translational bioethics and discuss what implications this would have for the wider discipline of bioethics and argue that this would be a useful development for bioethics. The paper will conduct a form of ‘translational meta‐bioethics analysis’, in the words of Bærøe. I will argue that if we are serious about instituting translational bioethics, then it will need (...) to look and be organised in a very different way from current bioethics research, this will be a radically different form of bioethics from what we currently have. In this paper I will sketch what translational bioethics might look like. My proposal here is not that translational bioethics should supplant existing ways of doing bioethics, but rather that it should be an addition to it, another subdiscipline of bioethics. (shrink)

A step towards a theory of consciousness would be to characterise the effect of consciousness on information processing. One set of results suggests that the effect of consciousness is to interfere with computations that are optimally performed non-consciously. Another set of results suggests that conscious, system 2 processing is the home of norm-compliant computation. This is contrasted with system 1 processing, thought to be typically unconscious, which operates with useful but error-prone heuristics. -/- These results can be reconciled by separating (...) out two different distinctions: between conscious and non-conscious representations, on the one hand, and between automatic and deliberate processes, on the other. This pair of distinctions is used to illuminate some existing experimental results and to resolve the puzzle about whether consciousness helps or hinders accurate information processing. This way of resolving the puzzle shows the importance of another category, which we label ‘type 0 cognition’, characterised by automatic computational processes operating on non-conscious representations. (shrink)

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further ‘market-style’ reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English (...) NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers. (shrink)

The attempt to develop a systematic approach to the study of consciousness begins with René Descartes (1596–1650) and his ideas still have a major influence today. He is best known for the sharp distinction he made between the physical and the mental (Cartesian dualism). According to Descartes, the body is one sort of substance and the mind another because each can be conceived in terms of totally distinct attributes. The body (matter) is characterized by spatial extension and motion, while the (...) mind is characterized by thought. This characterization of the mind also renders it private, a precursor of the distinction between the first‐person and the third‐person perspectives. Today, most scientists do not accept dualism, instead believing that mind somehow emerges from the physical properties of the brain. However, the distinction between mind and matter is still perceived as being so clear‐cut that explaining how mind can emerge from matter, and reconciling the first‐person and third‐person perspectives, remain the hardest problems facing the student of consciousness. (shrink)

For the new generation of cognitive neuroscientists, the mind-brain problem is no longer a matter for philosophical speculation; how the mind links with the brain can be studied experimentally. The strength of this belief is demonstrated by a stream of popular science books purporting to show how consciousness emerges from the brain. In contrast, Sean Spence presents a rigorous, modest and wholly admirable discussion of the physiological underpinnings of free will. It is of particular importance that he brings to our (...) attention various phenomena associated with psychotic illnesses. It is generally agreed that schizophrenia has a biological basis. Yet the characteristic symptoms reflect disorders of self-awareness, especially in the experience of free will (delusions of control). It follows that studies of the physiological basis of psychotic symptoms (e.g. Silbersweig et al. 1995) must also increase our understanding of the physiological basis of free will. The test for any discussion of the mind-brain problem from a scientific stance is that it suggests new possibilities for experimental studies. I think a number of the points raised in this essay provide clear starting points for the development of such experiments. (shrink)

McCoy et al. (2020) give a finely tuned analysis of the role and responsibilities of non-elected or self-appointed representatives in public policy. They take the example of autism activism to illu...

Choice is probably one of the most often discussed areas in bioethics, alongside the related concepts of informed consent and autonomy. It is generally, prima facie, portrayed as a good thing. In healthcare, the 2000s saw the UK Prime Minister Tony Blair pursue the ‘Choice Agenda’ where, ‘As capacity expands, so choice will grow. Choice will fundamentally change the balance of power in the NHS.’1 In a consumerist society giving consumers more choice is seen as desirable. However, choice is not (...) a good in itself, giving people more choice in certain situations can be problematic: i.e. consumerism drives economic growth and this has a detrimental effect on the environment; and increasing the range of choices a patient is offered is often not the best way to improve the quality of healthcare provision.2 The assumptions behind the valuing of choice need careful unpacking and this Issue of the Journal of Medical Ethics includes papers that explore choice in a number of areas. This Issue's Editor’s choice is Tom Walker’s ‘The Value of Choice’,3 which puts forward a suggestion for the importance of the symbolic value of choice. There are a number of ways of categorising the value of choice in healthcare. One account sees choice as valuable because it is by choosing that individuals make their life their own. Another account sees choice as valuable for instrumental reasons, people are generally, assuming they are sufficiently informed, the best judge of their own best interests. Walker argues for an additional third reason, the symbolic value of choice, originally proposed by Scanlon. This sees choice as valuable because being given the option to choose, whether or not one takes it up, not the act of choosing is what makes choice valuable. Being offered the option to choose has a …. (shrink)

Consciousness has many elements - from sensory experiences such as vision, audition, and bodily sensation, to nonsensory aspects such as volition, emotion, memory, and thought. With all these facets - how can consciousness appear to us as a unified experience? Is this apparent unity just an illusion? Why and when does this unity break down? In recent years many have attempted to answer this, one of the most puzzling and intriguing dimensions of consciousness. With chapters from leading thinkers on consciousness, (...) from psychology, neuroscience, and philosophy this is a thought-provoking book that attempts to answer some of the big questions. (shrink)

The use of rights based arguments to justify claims that donor offspring should have access to information identifying their gamete donor has become increasingly widespread. In this paper, I do not intend to revisit the debate about the validity of such rights. Rather, the purpose is to examine the way that such alleged rights have been implemented by those legislatures that have allowed access to identifying information. I will argue that serious inconsistencies exist between the claim that donor offspring have (...) a right to know the identity of their gamete donor and the way such a right is currently met in practice. I hope to show that in systems where non‐anonymous donation is practised, an understanding of the proclaimed right of donor offspring to know their genetic identity is one composed of two different rights – the right to know the circumstances of their conception and the right to information identifying the gamete donor – can provide important insights into this important area of public policy. (shrink)

There are substantial numbers of frozen embryos in storage that will not be used by those who produced them for their own fertility treatment. One option for such embryos is to donate them to others to use in their fertility treatment. There has been considerable debate about how this process should be organized. In the US, there are embryo adoption programmes that mediate between those relinquishing embryos and potential recipients. This is a form of conditional embryo donation, where the relinquishing (...) couple can choose the recipient of their embryo. This article examines the ethical debate over conditional embryo donation for family building and explores the question of whether those who have unused frozen embryos should be able to determine who receives their embryos. The main objections to conditional embryo donation are examined: first, the embryo is not a person and therefore such concern over the placement of an embryo is unwarranted; secondly, potential donors might impose morally problematic conditions on who should receive their embryo; and thirdly, there are practical difficulties regarding organizational arrangements and the associated costs involved. It will be concluded that these objections can be countered and that if people wish to donate and receive embryos in this way there is no ethical objection to them doing so. (shrink)