Suppose that a colleague proposed a fantastic experiment: to introduce human stem cells into a neonatal mouse so that its entire brain developed into “human-like” neuronal structures. The colleague claimed it would still be a mouse, and that its chimeric brain would be nothing like a “human” one. It would not, as a result, have a moral status beyond its nonhuman animal origins. Thus, the “human neuron mouse” would allow scientists to tinker with human-like neurology in ways that would be precluded if it were a human being, and that would promise to lead to substantial understanding of the destructive and incurable brain diseases that befall humanity. The colleague does admit, however, that for reasons of comparative fidelity, experiments in human patients would be scientifically preferable, although in this case, neither ethically justified nor legally permitted. For that reason, it might be desirable to create a human brain in a nonhuman primate, where it would be more likely that significant human-like neuronal development would occur, but still could not become a person. This article explores the significance of a “human neuron chimpanzee,” and suggests that contradictions in the design of the experiment make it unethical to proceed in either murine or primate models.

For some, synthetic biology represents great hope in offering possible solutions to many of the world’s biggest problems, from hunger to sustainable development. Others remain fearful of the harmful uses, such as bioweapons, that synthetic biology can lend itself to, and most hold that issues of biosafety are of utmost importance. In this article, I will evaluate these points of view and conclude that although the biggest promises of synthetic biology are unlikely to become reality, and the probability of accidents is fairly substantial, synthetic biology could still be seen to benefit humanity by enhancing our ethical understanding and by offering a boost to world economy.

A number of healthcare professionals assert a right to be exempt from performing some actions currently designated as part of their standard professional responsibilities. Most advocates claim that they should be excused from these duties simply by averring that they are conscientiously opposed to performing them. They believe that they need not explain or justify their decisions to anyone, nor should they suffer any undesirable consequences of such refusal.

Those who claim this right err by blurring or conflating three issues about the nature and role of conscience, and its significance in determining what other people should permit them to do (or not do). Many who criticize those asserting an exemption conflate the same questions and blur the same distinctions, if not expressly, by failing to acknowledge that sometimes a morally serious agent should not do what she might otherwise be expected to do. Neither side seems to acknowledge that in some cases both claims are true. I identify these conflations and specify conditions in which a professional might reasonably refuse to do what she is required to do. Then I identify conditions in which the public should exempt a professional from some of her responsibilities. I argue that professionals should refuse far less often than most advocates do . . . and that they should be even less frequently exempt. Finally, there are compelling reasons why we could not implement a consistent policy giving advocates what they want, likely not even in qualified form.

Diagnostic classification systems in psychiatry have continued to rely on clinical phenomenology, despite limitations inherent in that approach. In view of these limitations and recent progress in neuroscience, the National Institute of Mental Health (NIMH) has initiated the Research Domain Criteria (RDoC) project to develop a more neuroscientifically based system of characterizing and classifying psychiatric disorders. The RDoC initiative aims to transform psychiatry into an integrative science of psychopathology in which mental illnesses will be defined as involving putative dysfunctions in neural nodes and networks. However, conceptual, methodological, neuroethical, and social issues inherent in and/or derived from the use of RDoC need to be addressed before any attempt is made to implement their use in clinical psychiatry. This article describes current progress in RDoC; defines key technical, neuroethical, and social issues generated by RDoC adoption and use; and posits key questions that must be addressed and resolved if RDoC are to be employed for psychiatric diagnoses and therapeutics. Specifically, we posit that objectivization of complex mental phenomena may raise ethical questions about autonomy, the value of subjective experience, what constitutes normality, what constitutes a disorder, and what represents a treatment, enablement, and/or enhancement. Ethical issues may also arise from the (mis)use of biomarkers and phenotypes in predicting and treating mental disorders, and what such definitions, predictions, and interventions portend for concepts and views of sickness, criminality, professional competency, and social functioning. Given these issues, we offer that a preparatory neuroethical framework is required to define and guide the ways in which RDoC-oriented research can—and arguably should—be utilized in clinical psychiatry, and perhaps more broadly, in the social sphere.

This article analyzes the idea of a legal right to conscientious refusal for healthcare professionals from a basic legal ethical standpoint, using refusal to perform tasks related to legal abortion (in cases of voluntary employment) as a case in point. The idea of a legal right to conscientious refusal is distinguished from ideas regarding moral rights or reasons related to conscientious refusal, and none of the latter are found to support the notion of a legal right. Reasons for allowing some sort of room for conscientious refusal for healthcare professionals based on the importance of cultural identity and the fostering of a critical atmosphere might provide some support, if no countervailing factors apply. One such factor is that a legal right to healthcare professionals’ conscientious refusal must comply with basic legal ethical tenets regarding the rule of law and equal treatment, and this requirement is found to create serious problems for those wishing to defend the idea under consideration. We conclude that the notion of a legal right to conscientious refusal for any profession is either fundamentally incompatible with elementary legal ethical requirements, or implausible because it undermines the functioning of a related professional sector (healthcare) or even of society as a whole.

The term “moral bioenhancement” conceals a diverse plurality encompassing much potential, some elements of which are desirable, some of which are disturbing, and some of which are simply bland. This article invites readers to take a better differentiated approach to discriminating between elements of the debate rather than talking of moral bioenhancement “per se,” or coming to any global value judgments about the idea as an abstract whole (no such whole exists). Readers are then invited to consider the benefits and distortions that come from the usual dichotomies framing the various debates, concluding with an additional distinction for further clarifying this discourse qua explicit/implicit moral bioenhancement.

This article discusses the roles of ethicists in the governance of synthetic biology. I am particularly concerned with the idea of self-regulation of bioscience and its relationship to public discourse about ethical issues in bioscience. I will look at the role of philosophical ethicists at different levels and loci, from the “embedded ethicist” in the laboratory or research project, to ethicists’ impact on policy and public discourse. In a democratic society, the development of governance frameworks for emerging technologies, such as synthetic biology, needs to be guided by a well-informed public discourse. In the case of synthetic biology, the public discourse has to go further than merely considering technical issues of biosafety and biosecurity, or risk management, to consider more philosophical issues concerning the meaning and value of “life” between the natural and the synthetic. I argue that ethicists have moral expertise to bring to the public arena, which consists not only in guiding the debate but also in evaluating arguments and moral positions and making normative judgments. When ethicists make normative claims or moral judgments, they must be transparent about their theoretical positions and basic moral standpoints.

The spread of demands by physicians and allied health professionals for accommodation of their private ethical, usually religiously based, objections to providing care of a particular type, or to a particular class of persons, suggests the need for a re-evaluation of conscientious objection in healthcare and how it should be regulated. I argue on Kantian grounds that respect for conscience and protection of freedom of conscience is consistent with fairly stringent limitations and regulations governing refusal of service in healthcare settings. Respect for conscience does not entail that refusal of service should be cost free to the objector. I suggest that conscientious objection in medicine should be conceptualized and treated analogously to civil disobedience.

The Commission of the (Catholic) Bishops’ Conferences of the European Community (COMECE) has issued an opinion on the ethics of synthetic biology (synbio). Examining synbio from religious and more general ethical perspectives, it examines synbio’s potential pros and cons, as well as whether it is ethical in and of itself. Its conclusions mirror those of the ethical mainstream; namely, that synbio may present humanity with opportunities for both great advancement and great destruction. It suggests a prudent approach, and calls for regulation to be used to encourage positive outcomes while reducing the likelihood of negative ones.

There is growing evidence about the influence of chemical exposures on specific molecular systems and mechanisms involved in cognitive and mental function. Evidence is also emerging about the negative impact of these chemical exposures on mental health, including depression, suicide, and other risks. Despite the growing appreciation of these factors, however, little attention has been paid to the ethical and social implications of their interactions. Drawing on recent work that argues for an environmental neuroethics approach that explicitly brings together ethics, environment, and conditions of the central nervous system, this article focuses on these critical issues for pesticides specifically.

This article first critically reviews the major philosophical positions in the literature on conscientious objection and finds that they possess significant flaws. A substantial number of these problems stem from the fact that these views fail to assess the reasons offered by medical professionals in support of their objections. This observation is used to motivate the reasonability view, one part of which states: A practitioner who lodges a conscientious refusal must publicly state his or her objection as well as the reasoned basis for the objection and have these subjected to critical evaluation before a conscientious exemption can be granted (the reason-giving requirement). It is then argued that when defenders of the other philosophical views attempt to avoid granting an accommodation to spurious objections based on discrimination, empirically mistaken beliefs, or other unjustified biases, they are implicitly committed to the reason-giving requirement. This article concludes that based on these considerations, a reason-giving position such as the reasonability view possesses a decisive advantage in this debate.

Certain changes in the way that states classify people by sex as well as certain reproductive innovations undercut the rationale for state identification of people as male or female in signifying gendered parental relationships to children. At present, people known to the state as men may be genetic mothers to their children; people known to the state as women may be genetic fathers to their children. Synthetic gametes would make it possible for transgender men to be genetically related to children as fathers and transgender women to be genetically related to children as mothers, even if they have otherwise relied on naturally-occurring gametes to be genetic mothers and genetic fathers of children respectively. Synthetic gametes would presumably make it possible for any person to be the genetic father or genetic mother of children, even in a mix-and-match way. Other reproductive innovations will also undercut existing expectations of gendered parental identity. Uterus transplants would uncouple the maternal function of gestation from women, allowing men to share in maternity that way. Extracorporeal gestation ((ExCG)—gestation outside anyone’s body—would also undercut the until-now absolute connection between female sex and maternity. In kind, effects such as these—undoing conventionally gendered parenthood—undercut the state’s interest in knowing whether parents are male or female in relation to a given child, as against knowing simply whether someone stands in a parental relationship to that child, as a matter of rights and duties.

Severe head injury or brain injury presents clinical neuroscientists with a unique challenge. Based on an objective assessment of cognitive and neurological function, it is sometimes hard to recognize our patients as members of our moral community (actually or potentially) but we treat them as if that were is the case, and, therefore, as if they need rescuing. Thus their existences as enigmata—beings who may or may not reveal themselves to us through social and personal function realized in conversations and relationships—are in doubt. However, the objective mode of assessing individuals and their mental functions needs to be bracketed here, as we reconnect with them and offer them our help in the restorative journey that they need to take. The journey has many tortuous paths comprising it, not the least of which is the existential question of whether the damaged human being with whom we are engaged actually can be restored to a meaningful life. A negative answer to that question can bring the whole process to an abrupt end. Neuroscience cannot answer some of these questions, as they are ethical. Is this a life worth living and are our commitments going to go the distance that must be traversed here. Therefore, this is an area where ethics take priority over neuroscience, and it is on our ethical response that everything else hinges. Understanding the light this throws on the nature of a human being takes us to the heart of the value of every human being and the nexus of mutuality that is the moral community.

In this article, we consider contexts or domains in which (future) moral bioenhancement interventions possibly or most likely will be implemented. By looking closely at similar or related existing practices and their relevant ethical frameworks, we hope to identify ethical considerations that are relevant for evaluating potential moral bioenhancement interventions. We examine, first, debates on the proper scope of moral education; second, proposals for identifying early risk factors for antisocial behaviour; and third, the difficult balancing of individual freedom and third party concerns in (forensic) psychiatry. In imagining moral bioenhancement in practice, we observe that unlike other forms of enhancement, moral enhancement fundamentally asks how the interests and preferences of the individual and the interests of others should be weighed (in view of public safety and managing public risk). Highly diverse domains such as education, mental health, and the judicial domain might be involved, and moral bioenhancement might challenge existing institutional settings. Given these highly varied contexts and domains, it appears unlikely that there will be a distinct set of practices that will be referred to as “moral bioenhancement.”

This article addresses questions surrounding the minimally conscious state (MCS) from the perspective of adult clinical ethics. It describes the background of the MCS diagnosis, analyzes phenomenological ambiguities inherent in the nature of MCS, and raises epistemological concerns surrounding its diagnosis. It argues that in many cases, the burdens of prolonging treatment for people who have sustained certain severe brain injuries (SBI) outweigh the benefits, even if they are in or have the prospect of entering into MCS. It also argues that often such long-term measures are problematic from the perspective of patient preferences and stewardship of resources. Consequently, it suggests that the delineation of MCS as a distinct neurological state, along with research that seeks to expand how MCS is diagnosed, poses ethical difficulties for families and providers making decisions for affected patients.

Healthcare professionals are not currently obliged to justify conscientious objections. As a consequence, there are currently no practical limits on the scope of conscience-based refusals in healthcare. Recently, a number of bioethicists, including Christopher Meyers, Robert D. Woods, Robert Card, Lori Kantymir, and Carolyn McLeod, have raised concerns about this situation and have offered proposals to place principled limits on the scope of conscience-based refusals in healthcare. Here, I seek to adjudicate among their proposals. I argue that to adjudicate among them properly it is important to consider the theoretical bases for conscientious objection. I further argue that there are two such bases to be considered. Some conscientious objections are justified by appeal to all-things-considered moral judgments, and some are justified by appeal to the “dictates of conscience.” I argue that both of these bases are legitimate and that both should be accommodated in any principled scheme to limit the scope of conscientious refusals in healthcare.