Germline Gene Editing and Savulescu's Procreative Beneficence Principle

The possibility of using engineered enzymes to alter DNA means germline editing seems to be becoming a practical possibility with CRISPR. Such a possibility raises important ethical concerns. Some of these ethical concerns are concerned with safety but in this posting I will assume these safety concerns can be successfully adressed. In this posting I want to consider whether these possibilities mean parents should adopt Savulescu’s procreative beneficence principle using such editing. I will then consider two objections to doing so. Firstly it might be objected that the adoption the principle would lead to inequality and create some sort of genonobility. Secondly that the adoption of the principle might mean that in the future parents who use germline editing to enhance their future children damage these children’s autonomy.

Savelescu’s procreative beneficence principle states that prospective parents using IVF should choose among embryos so that the embryo selected if it became a child would be expected to have the best life, or at least as good a life as any other resulting child, based on the relevant available information. This principle can be broadened. It seems that in the reasonably near future that a combination of IVF and germline editing means that prospective parents would be able to use these techniques to enhance any possible child so she is expected to have the best possible life based on the available information. It appears follow from the procreative principle that provided germline editing is completely safe parents should select children who are expected the best life possible. Savelescu’s argument is a consequentialist one and if we accept the premise, that it is possible to predict the sort of life a child will lead, then provided we are consequentialists we should accept Savelescu’s principle. Should we accept the above premise? I would question whether we can really predict now that some possible future child will have the best life possible in thirty or forty years time. I would suggest that whilst we might possess some relevant information we don’t possess enough of it to make accurate predictions. If we accept the above then it follows prospective parents would have no reason why they should adopt Savelescu’s procreative beneficence principle, even if they could afford to do so and safety concerns had been allayed. However even if prospective parents cannot be certain that they are acting beneficently if they adopted the principle when conceiving future children does this mean that they shouldn’t do so in the hope that these children have the best possible lives? I would suggest it doesn’t. If we can’t choose to do x for beneficent reasons then this doesn’t mean we can’t choose to do x provided by doing so we don’t do any harm. If we can’t use the principle of beneficence then we can use the principle of non-maleficence. In the light of the above it might be suggested that provided germline editing is safe then it should be permissible for prospective parents to use it to apply principle when conceiving a future child in the hope that they are acting beneficently provided in doing so they aren’t doing any harm.

I now want to consider two objections to the above suggestion. It might be objected that the use of the procreative beneficence principle to conceive future children might harm society and might also harm these future children by damaging their autonomy. I will consider each of these objections in turn.

For many parents the costs involved with using the procreative beneficent principle are likely to be prohibitive and this means the use of the principle would not be open to all. Let us assume that some parents use the principle and that as a result their children have, on average, greater cognitive skills or physical abilities. It might then be argued that permitting the use of the principle would create a less equal society and that because a less equal society is damaging we should prohibit the use of such gene editing. It might even be suggested that over time the use of the principle would lead to a two tier society with a genenobility. However such a strict prohibition would harm some people affected by genetic diseases which might be treated by germline editing. Let us accept that germline editing should be permitted to combat specific diseases. However even if we permit germline editing for therapeutic purposes it doesn’t mean we shouldn’t prohibit it if it is being used to apply the procreative principle.

Let us now specifically consider germline editing with the express aim of creating children who are expected to have the best possible lives. However even if germline editing does create a less equal society this fact doesn’t alone mean it should be prohibited. Kant famously argued ought implies can. It might be that whilst a prohibition on such germline editing is desirable that achieving it is impractical. For instance whilst doctors in the US are presently prohibited from using gene editing tools on patients those in China aren’t, see Wall Street Journal . However even if a worldwide prohibition is possible it doesn’t mean it is desirable. For instance private healthcare and education also lead to inequalities. If we are prepared to accept the inequalities caused by private health care and education it might be argued by analogy that we should also be prepared to accept inequalities caused by some parents using germline editing to apply the procreative principle. The soundness of this argument depends on closeness of the analogy. It might be that such editing would lead to far greater inequalities than those caused by private healthcare or education. The question whether we should prohibit germline editing becomes no longer solely dependent on the creation of inequality but also depends on the degree of inequality created. Let us assume for the sake of argument that germline editing produces greater inequality than private health care or education. It might then be argued that this greater inequality means that it should be prohibited provided that this is possible. Such an argument also seems to be unsound. Even in these circumstances it still might be acceptable to accept germline editing, provided that the inequalities it created were only for a limited period. Inequality matters, the degree of inequality matters and the length of time this inequality persists for also matters. Clearly any permanent inequality such as that which might lead to a genenobility is unacceptable and in these circumstances we should prohibit germline editing provided of course we can do so on a worldwide basis. However it is possible that germline editing might be acceptable if it only produced greater inequalities for a limited period. It seems probable that many people would be prepared to undergo some inequality if this inequality was for a short period and they benefitted from it in in the long term. Would the introduction of germline editing only produce inequalities for a limited period? I would suggest we have two reasons to suggest it would. Firstly experience teaches us that the cost of any new technology falls over time. Secondly I would argue governments have reason to subsidise germline editing. If germline editing is likely to cause inequalities then this is likely to be due it creating children with better cognitive and physical abilities. Citizens with better cognitive and physical abilities are likely to be less costly to society and as a result the state has reason to encourage such citizens. Presently it does this by means of health campaigns and education. Perhaps in the future it might do so by subsidising germline editing. In light of the above before permitting germline editing in order to apply the procreative principle we should consider how long any inequality produced by such editing is likely to persist. If after careful consideration we come to believe that such inequality will be a temporary matter then have no reason based on inequality to prohibit germline editing in order to apply the procreative principle.

Let us now consider the second objection to parents using germline editing to apply Savulescu’s procreative beneficence principle. It might be objected that any parents who do so damage their future children’s autonomy. This objection can be split into two parts. Firstly it might be argued that any children conceived using the principle might not have consented in retrospect thereby damaging their autonomy. Secondly it might be argued that any children born using the principle have already had their future partly determined and this again damages their autonomy. I will consider each of these parts of the objection in turn.

Let us first consider the autonomy of someone whose germline has been altered by the decision of her parents. It might be argued that because such a person couldn’t have consented to these changes that her autonomy has been damaged. I believe that such an argument is unsound. Let us accept that consent and autonomy are sometimes connected. Let us also accept that if a doctor operates on a competent patient without her consent, when it is possible to obtain her consent, that her autonomy is damaged. However a failure to obtain consent isn’t always linked to damaging autonomy. Consider someone who is unconscious after a serious road accident and needs surgery. If a doctor operates on her without her actual consent in what he perceives to be his best interests then he is acting in accordance with her presumed consent. In these circumstances it would be wrong to say that he has damaged her autonomy. Indeed, it might be argued that he preserved her autonomy. She might have died or been severely handicapped without his intervention. Let us now consider someone whose germline has been altered. It might be argued by analogy that someone who could not consent to her germline being edited hasn’t had her autonomy damaged because her parents have acted in accordance with her presumed consent. However the analogy between the two cases is not a close one. In the case of the accident victim an actual person already exists making it easier to foresee her wishes. In the case of germline editing we would be trying to foresee the wishes of a hypothetical person at least a decade and a half later.

In the light of the above it might appear that it should be impermissible for parents to adopt the procreative principle because any child conceived using this principle because they have no reason to presume that she would have consented. I would argue this appearance is also unsound. The above appearance depends on connecting our inability to obtain consent or presume consent with doing nothing. Let us assume that sometime in the future germline editing becomes reasonably cheap to use and will not result in any future children having cognitive or other health problems. In these circumstances potential parents have to decide whether or not to use the procreative principle when conceiving a future child. Not adopting such editing is a decision. I have suggested that it would be difficult for parents to ascertain what would be in a child’s best interests decades later. In these circumstances it is hard for potential parents to make a decision based on beneficence. However provided safety concerns can be fully allayed there seems to be no reason why parents shouldn’t use germline editing to apply the procreative principle. In response to the above it might be objected that children whose germlines have been edited would most probably not consented rather than consented. I find this objection based on hypothetical probabilities unconvincing. The present discussion is concerned with germline editing for beneficial reasons. In this scenario is it really more probable that the recipient would think in hindsight that she would have refused consent? If we reject the above suggestion above, then once again we have no reason to reject germline editing used to apply the procreative principle due to our failure to secure consent.

Let us now return to the second part of the objection to prospective parents use germline editing to apply the procreative principle based on damaging autonomy. It might be objected that the use of the procreative beneficence principle to conceive future children might harm these future children by damaging their autonomy. Autonomy roughly speaking is the ability to govern oneself by deciding what is best for you. How might this ability to decide be damaged? It might be damaged in two ways. Firstly the mechanism by which we decide might be damaged. Secondly our ability to decide might be damaged by limiting the choices we can make. If parents use germline editing to apply the procreative principle the any resulting children are likely to have improved cognitive or physical abilities in order for them to live the best possible life. If someone has improved cognitive or physical abilities then these abilities are more likely to enhance her mechanism to decide than damage it. It follows that if we only improve these abilities that we can discard the first reason not to permit germline editing. If parents use germline editing to apply the procreative principle might any resulting children have more limited options when making decisions than if no editing had been applied? Options might be limited in two ways. First there might just be less options and secondly someone might be less able to exercise the options available. It seems improbable that altering someone’s germline will alter the number of potential options. It also seems improbable that germline editing will alter someone’s ability to exercise some of these potential options. If someone parents used germline editing to apply the procreative before she was born then her cognitive and physical abilities should at least be equal to those which would have pertained had not such editing taken place. It follows that germline editing to apply the procreative principle won’t damage her ability to exercise potential options.

I have concluded that whilst we don’t have solid reasons to apply Savulescu’s procreative principle using germline editing that we do not have reasons based on inequality or damaging autonomy to make it impermissible. However a note of caution is needed at this point. The above conclusion depends on the assumption that germline editing is completely safe. The truth of this assumption might be difficult to ascertain in practice as some of the effects of such editing might not become evident in humans for decades. For this reason if we are ever to use germline editing extremely rigorous safety standards would need to be applied.

Why I'm not a Stoic

I admire fortitude, detachment and many other stoic virtues but believe full blown stoicism is damaging. Let us accept that for someone living in an extremely deprived environment with limited options that these virtues can help him to survive. An account of how stoicism can help people survive in such circumstance is given by James Stockdale who was shot down in the Vietnam War and detained in Hanoi, see Stockdale . Someone who suffers from a life limiting disease might also find himself in an extremely deprived environment and once again with few options. In these deprived circumstances adopting a stoical perspective seems to be a sensible option.

Fortunately, most of us don’t live in such circumstances. The question I wish to address is this, in more normal circumstances should we lead a stoic life? Some stoics believe that the only thing that always makes us happy in life is leading a life of virtue.

“The only thing that always contributes to happiness, as it is necessary and sufficient for the condition, is virtue. Conversely the only thing that necessitates misery and is “bad” or “evil” is the corruption of reason, namely vice.” Internet Encyclopedia of Philosophy

Perhaps virtue is the only thing that always makes us happy but I will argue there are some things which even if they don’t always make us happy are nonetheless essential for a happy life. Certain things such as fame and material goods might make us happy temporarily.  However, we can’t always attain these goods and once attained these goods might not always make us happy. Let us accept that the excessive pursuit of these goods can damage our happiness in three ways. Firstly, we might be disappointed if we fail to obtain these goods, secondly even if we do obtain them they might fail to meet our expectations once again leading to disappointment, lastly the pursuit of these goods might divert us from the one thing that always makes us happy namely virtue. Let us consider the harm done by disappointment first. A stoic would argue that in order to avoid such disappointment that whilst we might prefer such goods we should remain indifferent to them. I would suggest that with regard to disappointment stoicism is a philosophy of pessimism by rejecting hope. A stoic shouldn’t hope because hope would make him vulnerable to disappointment. Let us assume that the excessive pursuit of fame or material goods hinders us from pursuing the only thing that always makes us happy, virtue. A stoic would argue we should always pursue virtue and as a result we not pursue those things which damage this pursuit. Let us agree with our stoic that we should first of all pursue virtue. Let us also agree that the excessive pursuit of fame or material goods damages this pursuit. However, it is by no means clear that using balanced Aristotelian moderation in pursuit of these goods will damage our pursuit of virtue. Accepting the above means that in normal circumstances that we have no clear reasons to accept or reject Stoicism.

 

At this point someone might object I am misunderstanding the stoic idea of happiness. I am confusing stoic ideas with Epicurean ones. An Epicurean is concerned with hedonistic happiness whilst to a Stoic happiness is concerned to living our lives in accordance with essential nature as rational creatures. For the sake of argument let us accept my objector’s point. Let us also accept that stoics believe that if someone leads his life in accordance with his essential nature that he will flourish.

 

I now want to examine what is meant by flourishing. Flourishing is a slippery concept. For instance, could it really be said that a creature, which leaves behind plenty of descendants, flourishes? Using a Darwinian idea of flourishing it certainly does. Moreover, it might be argued evolution means leaving behind plenty of descendants is selected for and hence is part of the nature of all living things. However, a Darwinian idea of flourishing, at best, plays only a small part in most people’s idea of flourishing. A stoic idea of flourishing seems to depend on the essential nature of a creature which defines it. For instance it is part of the nature of bees to collect nectar to make honey and a bee flourishes if it makes lots of honey. It is part of bee eater’s nature to eat bees and it flourishes if it eats lots of bees. The stoics emphasise it is an essential part of human nature to act rationally. According to the stoics a human being who acts completely rationally should flourish. Let us now consider a rational person who is virtuous, ratiomal, rich and healthy but lacks any positive affection for any of these things. According to a stoic this person flourishes. However intuitively we would not say such a person was flourishing. Indeed, we might feel that there is something defective about him. He lacks something that is necessary for flourishing. Perhaps one of the things he lacks is happiness and we should leading a stoic life can lead to happiness. I won’t pursue this point any further here. However, I would suggest one of the things a stoic lacks is a caring attitude to things in general.

 

Let us accept that stoics belief it is our nature to be rational. I have suggested above that such a belief is too simplistic and that other things are an essentIAL part of our nature. I will now present two arguments in an attempt to show that caring about things is An essential part of our nature. First, let us accept that someone’s ideals are defined by what he cares about. Now according to Harry Frankfurt,

“a person without ideals, there are no volitional laws he has bound himself to respect and to which he unconditionally submits. He has no inviolable boundaries. Thus he is amorphous with no fixed shape or identity.” (1)

Someone without fixed shape or identity is still of course a human being but she isn’t really a person. Almost all human beings develop into persons. Being a person is part of our nature. It follows caring about something must also be part of our nature. Secondly let us assume that caring about things is not part of our nature. If this is so being rational becomes pointless. It is impossible to apply rationality unless we care about something; it is impossible for rationality to get any purchase if we don’t care about anything. All our rational decisions are equally good and we have no basis to choose between competing options. It follows if caring about something is not an essential part of our nature then it isn’t possible to act rationally without caring about some things. Rationality is one of these things but isn’t sufficient. In the rest of this posting I will assume that caring about something is an essential part of our nature.

 

Even if we accept that caring about things is an essential part of our nature this give us reason why we should reject stoic ideals. A stoic might point out that he cares about virtue and rationality. The question is not whether a stoic cares about things but whether he cares about enough things. I will argue that he doesn’t. In order to make my argument I must make it clear what I mean by ‘care about’. David Hume famously argued reason is the slave of the passions. However, I want to argue what we care about doesn’t simply means that we feel passionate or emotional about something. Indeed, I would agree with the stoic idea that reason can control our emotions, at least to some degree. Reason can sort out our conflicting emotions and add stability to our sense of ever changing emotions. However, let us accept that reason alone cannot cause us to act. Our actions are based on what we will which is based on what we care about. According to Frankfurt “the formation of a person’s will is most fundamentally a matter of his coming to care about certain things, and of his coming to care about some of them more than others” (2). Also according to Frankfurt cares about’ something then he, “identifies himself with what he cares about in the sense that he makes himself vulnerable to losses and susceptible to benefits depending upon whether what he cares about is diminished or enhanced”. (3) A similar but slightly different approach concerning identity is taken by Bennett Helm who argues we are identified by what we love (4). If we accept the above definition of ‘caring about’ it can be regarded as a form of loving. In the rest of this posting I will use the word love to mean ‘caring about’ as defined above. It is important to note the use of the word love in this way is using a broader definition of love than simple romantic or erotic love. Let us accept that loving is an essential part of our nature, let us now also accept that to love something or someone means to identify oneself with that thing or persin and that to identify with something makes one vulnerable.

 

I want to argue that if someone leads a stoic and limits his love to virtue and rationality that he stunts himself and denies himself of the opportunity to lead a good life. First however I must introduce the stoic idea of an indifferent. Sometimes being indifferent to something may be the only sensible attitude. I for instance am indifferent to my grandson’s Aspergers, see Aspergers, Autism and Love . Sometimes being indifferent can be admirable as when a patient bears his illness with great stoicism. However, I will argue someone cannot remain indifferent to some things without causing serious damage himself as a person. What then is an indifferent? If we accept the above then a stoic only really cares about virtue and being rational and he tries to be indifferent to everything else. Stoics of course don’t deny other things such as health and even wealth might help us to flourish.  However even though these other things usually contributed to someone’s flourishing they might not do so in all circumstances. Stoics split indifferents into two types. Things such as health and wealth, which usually contributed to flourishing, are called preferred indifferents. Dispreferred indifferents are things that usually damage our flourishing such as disease or poverty.

 

The idea of a preferred indifferent appears at first sight to be nonsensical. How can someone prefer something but be indifferent to it at the same time? The answer is of course he can’t. Nonetheless it is possible to prefer something in some circumstances and be indifferent to it others. For instance, someone may prefer cream cakes normally but not if he is on a diet. I will now argue that whilst the idea of preferred indifferents may make sense when applied to cream cakes that it makes no sense when applied to the things we care about or love.

 

Let us consider a mother fleeing across the Sahara desert from persecution together with her children. Let us assume on the way one of her children dies from lack of water. A stoic would argue that this mother should be indifferent to her child’s fate. He might point out that in these circumstances the mother cannot change the fate of her child so reason dictates she should indifferent towards its fate. Of course in different circumstances she would have preferred her child to live. However I would argue such a mother cannot suddenly become indifferent to her child’s fate because she loved him and still loves him because love doesn’t suddenly die. Moreover because she loves him she identifies herself with him and someone cannot change her identity suddenly. Lastly because she loves him she makes herself vulnerable to what benefits and harms him. She feels grief. According to a stoic grief is both harmful and pointless. I have argued that love is impossible without the possibility of grief and that if we seek to limit our ability to grieve we limit our ability to love, see grief . It follows if we love something we cannot suddenly become indifferent towards it even if its circumstances change and we cannot alter these circumstances.

 

If we accept the above then stoics have a problem with love because as I have argued loving is essential to being a person. A stoic might respond that stoics can love but that this love is restricted to virtue and reason.I accept that someone who only loves virtue and reason could be a person. But I would suggest she would be a deficient or incomplete sort of person. She would lack true friends because to have friends you must love your friends see Helm (4).She might of course have friends of utility, people she uses, or friends of pleasure, people who please her, but I would not class these as true friends. A stoic might respond that she can love other things but I would argue the same problem remains. For instance if a stoic loved a childhood home in which she was happy she cannot immediately become indifferent towards it if it is burnt down..

It seems to me in trying to make themselves less vulnerable to fate stoics damage that which makes us persons; the ability to love. Persons are by their very nature vulnerable and if we try to remove this vulnerability we damage our personhood. We become soulless people somewhat akin to virtuous robots. Accepting the above would explain why a stoic who loves only virtue is a deficient or incomplete sort of person. The stoic belief that the only thing which is necessary and sufficient for someone to flourish is for her to be virtuous is wrong, for someone to flourish she must be able to love. It would appear that sometimes stoic ideas damage persons.  A stoic might respond to the above by pointing out that our turbulent emotions are equally damaging to our personhood. She might then suggest that because stoicism dampens down our turbulent emotions without the need for drugs such as anti-depressants that far from damaging our personhood stoicism actually enhances it. I have two responses to my stoic First, I would suggest that most people should be cautious about dampening down their emotions and should instead use their rationality to judge how appropriate they are and if nessary to control them. Secondly I would suggest experiencing emotions is part of being a person as we regard sociopaths as being deficient persons in some way.

In conclusion I have argued that in most circumstances the stoic’s quest to reduce or eliminate his unhappiness damages his capacity to love which in turn damages his ability to experience happiness and I wouldn’t recommend a stoic life. However for a few people who live in extremely deprived circumstances a stoic life might be the best option,

1. Harry Frankfurt, 1999, Necessity, Volition and Love, Cambridge University Press, page 114
2. Harry Frankfurt, 1988, The Importance of What We Care About. Cambridge University Press, page 91.
3. Frankfurt, 1988, page 83.
4. Bennett Helm, 2010, Love Friendship & the Self, Oxford University Press, page 122.
5. Bennett Helm, chapter 8.

Physician Assisted Suicide and the Slippery Slope Argument

Permitting physician assisted suicide for those with terminal illnesses seems to be becoming acceptable in some countries. However many remain opposed to assisted suicide and employ two main arguments against the practice. First, there are the Deists who believe it is wrong to help someone die because only God should be able to do so. I won’t address this argument in this posting. Secondly there are those who believe that permitting assisted suicide for the terminally ill would lead to a slippery slope which would over time lead to assisted suicide becoming accepted in areas in which it shouldn’t be permissible. In the past I have argued that prisoners serving life sentences and those who are going to suffer from Alzheimer’s disease have a right to assisted suicide. It might be suggested my own arguments show that assisted suicide does indeed lead to a slippery slope. In this posting I will argue that provided our underlying motivation for the introduction of assisted suicide doesn’t change that its introduction should not lead to a slippery slope.

Before proceeding we need to be clear about exactly what we mean by a slippery slope. According to the Cambridge English Dictionary a slippery slope is “a bad situation or habit that, after it has started, is likely to get very much worse.” The starting point of the slippery slope is itself bad. If we accept this definition it by no means clear that we can use a slippery slope argument when discussing assisted suicide. Let us agree that a terminally ill patient who desires to die is in a bad situation, but assisted suicide isn’t of necessity bad in this situation, even if assisted suicide can’t remedy the bad situation it might bring it to an end peacefully. I find this definition unsatisfactory and a better definition of a slippery slope might be employed. According to the Oxford Dictionary a slippery slope is “a course of action likely to lead to something bad or disastrous.” I will adopt this definition in the rest of this posting. Adopting this definition means that the starting point of the slippery slope need not be in itself bad. For instance it might be argued that allowing terminally ill patients to die peacefully is a good thing by itself, but if this slips into permitting assisted suicide for terminally ill children, adults who have mental illness, dementia patients and those who are simply tired of living, it becomes a bad thing, see Daniel Callahan in Hasting Centre's blog . A consequentialist might respond by arguing that provided the initial good outweighs the anticipated bad that assisted suicide can be justified even if it leads to a slippery slope. I won’t pursue this argument here. Instead I will argue that if motivation for permitting assisted suicide for the terminally ill remains constant then we have no need to worry about any slippery slope.

A proponent of the slippery slope argument might be prepared to accept that allowing terminally ill patients assisted suicide is in itself is a good thing but argue that this initial good is outweighed by the bad things it introduces. For instance he might argue whilst helping someone with terminal cancer die peacefully by itself is indeed a good thing, however if the slippery slope means helping grandma to die because she feels she is a burden to her family, it becomes a bad thing. The slippery slope means any good done is outweighed by the inevitable bad. I now want to question exactly what is slipping, changing. I am going to suggest what is slipping in such cases is our underlying motivation for supporting assisted suicide. Let us consider the above example. What motivates us to support assisted suicide for someone suffering from a terminal illness? Our motivation might be based on caring about the patient’s suffering or our sense of empathy caused by this suffering. Let next consider the motivations underlying grandma’s desire for assisted suicide. Grandma doesn’t want to be burden to anyone. It seems to me if we aid grandma commit assisted suicide that our motivation is different from our motivation for aiding someone with a terminal illness to die peacefully. Our motivation for helping someone with a terminal illness die with dignity is that we care about him if our motivation remains the same for grandma then because we care about her we aren’t going to help her commit suicide because we care about her. If we accede to grandma’s wish what has changed is our motivation. I will now argue that if the motivation for permitting assisted suicide for the terminally ill doesn’t change then permitting assisted suicide will not lead to a slippery slope.

One possible motivation for assisting someone to die is that we care about their suffering. We care about the suffering of someone who is suffering from a terminal illness. One response to our caring about might be to assist him to die peacefully. However there is another possible response, perhaps palliative care might permit him to end the last days of her natural life peacefully. I’m doubtful whether palliative care can always reduce suffering to an acceptable level. It seems to me that some supporters of palliative care try to derive ‘an is from an ought.’ For instance some might believe we ought not to permit assisted suicide, for various reasons, and because of this belief also come to believe that palliative care can always reduce suffering to acceptable levels. If palliative care cannot always reduce suffering then the fact that we care about someone’s suffering due to a terminal illness means we have reason to permit assisted suicide. Our motivation is based on our caring about someone suffering or feel empathy for her. I have argued that provided our motivations don’t slip opponents of assisted dying cannot appeal to the slippery slope argument.

However it might be objected the above conclusion flies in the face of the facts. Anywhere where assisted suicide has been introduced for the terminally ill has led to an expansion of the domain of assisted suicide, see for instance a report of the American Medical Association . Indeed I might be accused inconsistency by previously arguing that some prisoners serving life sentences should also have the right to assisted suicide. I now want to argue that simply expanding the domain of those who should be able to avail themselves of assisted suicide is not an example of a slippery slope. Let us recall our definition of a slippery slope as a course of action likely to lead to something bad or disastrous. If a prisoner has committed some terrible rape and murder which torments him and for which he will spend the rest of days in prison wishes to die is helping him to do so a bad or disastrous thing? Is preventing an unhappy 104 year scientist, see bioedge , from dying peacefully also bad and disastrous? If we accept that the above aren’t bad and disastrous then we can’t say they are examples of the slippery slope in action. It follows simple expansion of the domain in which assisted suicide might be applicable does not automatically lead to a slippery slope. For some course of action to be part of a slippery slope it must lead to some bad or disastrous consequences, mere expansion of the domain by itself won’t do the job. Of course extreme care must be taken to ensure that assisted suicide doesn’t lead to bad or disastrous consequences but this isn’t the same as a simple expansion of its domain. I have argued that our reason to permit assisted suicide is that we care about those suffering from terminal illness. Provided our motivation remains the same then any expansion of the domain of assisted suicide should not lead to bad and disastrous consequences and any attempt to apply a slippery slope argument to such an expansion is a failure to grasp fully the definition of a slippery slope.

I have argued that permitting assisted suicide does not lead to a slippery slope provided our motivation is one of caring. It follows that provided our motivations don’t change, don’t slip, the slippery slope argument is an ineffective argument against the permissibility of physician assisted suicide for the terminally ill.

Two Types of Pharmacological Cognitive Enhancement

It is suggested by Anders Sandberg that the use of cognitive enhancing drugs under medical supervision might achieve more overall learning and academic achievement and this is preferable to being driven into illicit use by bans, see practical ethics . In a previous posting I argued that the use of cognition enhancing drugs in examinations should be permissible subject to two conditions, see cognition enhancing drugs . In this posting I will firstly argue that there are two types of pharmacological enhancement. I will then consider such enhancement should be permissible, I will suggest that they should in some circumstances. Some of my conclusions might also apply to brain zapping, trans-crainial direct current stimulation, which might increase memory and as a result enhance cognition. I will not consider brain zapping directly.

Let us assume some drugs effectively enhances cognition. Any such drugs need to satisfy two further conditions for its use to be permissible.

1. Any cognition enhancing drugs must be safe to use without any major side effects. In certain circumstances some of these drug must be safe for long term use.
2. In certain circumstances the users of a cognition enhancing drugs must be prepared to continue using these drugs.

Commenting on Sandberg’s posting Dennis Tuchler worries about how long the effect of cognition enhancing drugs will last. He worries if cognition enhancers only work for a short time that their use will mislead employers and graduate schools about someone’s cognitive abilities. For instance let us assume someone gains a job in the diplomatic service due to her superb powers of concentration. Let us further assume that these powers are due to her taking cognitive enhancers. Lastly let us assume that once she gains this position she stops taking the enhancers and her powers of concentration fall away. In these circumstances someone else who failed to obtain the post due to the drug takers previous powers of concentration might feel he has been treated unjustly. Moreover the diplomatic service might be disappointed with the appointment. Whether Tuchler’s worries are justified depends on exactly what is involved with cognitive enhancement. Cognitive enhancement might occur in two ways. Firstly cognitive enhancement might be an ongoing process and secondly cognitive enhancement might be the end result of a process. It follows there are two types of cognitive enhancer. The first type of enhancers would result in an ongoing change in the user even after she has ceased to take the drug. Let us call such an enhancer type 1. An example of type 1 enhancer might be some drug which increases our ability to remember and what we remembered is retained even after we cease taking the enhancer. Type 1 enhancers might be likened to a scaffold round a building, the scaffolding supports the building during construction but once the building is finished there is no further need for the scaffolding and it can be removed. The second type of enhancers would require their ongoing use to be effective, let us call this type of enhancer type 2. An example of a type 2 enhancer might be some drug which helps our brains to concentrate. In the case of type 2 enhancer if use of the enhancer ceases the enhancement disappears, if the scaffolding is removed the building falls down.

Let us first consider the use of type 1 cognitive enhancers briefly. Let us assume that type 1 enhancers increase our power of memory. Sandberg believes memories enhanced by drugs will presumably endure regardless irrespective of whether the enhancer continues to be taken. Whether Sandberg’s belief is correct is open to experiment and cannot be answered by doing philosophy. However provided Sandberg’s belief is confirmed experimentally and a type 1 enhancer has no untoward side effects then philosophically there appears to be no reason why someone shouldn’t take such an enhancer. Indeed Nick Bostrom and Toby Ord’s reversal test seem to support this conclusion (1). According to this test if we accept that giving someone a drug to diminish her cognitive ability is wrong and we argue giving someone a drug to enhance her cognitive abilities is also wrong then we must be able to explain why enhancement is wrong or be accused of having a status quo bias. It appears to follow that provided a type 1 cognitive enhancer is safe that we have no reasons to prohibit the use of such an enhancer. Such a conclusion is premature and reasons might be found to support the status quo. If such an enhancer is prohibitively expensive and available only to a few due to cost then it might lead to social injustice. For instance if the use of cognition enhancing drugs was useful in the diplomatic service and these drugs were prohibitively expensive then people from disadvantaged backgrounds might be discriminated against in their attempts to join the service. The above conclusion might be amended as follows. If a type 1 cognitive enhancer is safe and not prohibitively expensive then we have no reasons to prohibit the use of such an enhancer.

Let us now examine the use of type 2 cognitive enhancers. If this type of enhancer is to be effective it must continue to be taken. Such an enhancer would affect one or more of our physiological processes and this affect would result in increased cognitive ability. Drugs that affect our physiological processes seem to require continuous use. For instance someone taking a drug to reduce his blood pressure must continue to do so. A drug which enhances someone’s ability to concentrate would be an example of a drug that has a temporary physiological affect which temporarily enhances her cognitive capabilities. It might be argued Bostrom and Ord’s reversal test gives us no reason to ban type 2 cognitive enhancers. However once again reasons might be found to support the status quo.

Perhaps the use of type 2 cognitive enhancers might mislead employers or universities about someone’s cognitive capabilities. For instance the examination grade obtained by a student taking a type 2 cognitive enhancer might not accurately reflect his cognitive abilities if he ceases taking the enhancer. However if he continues taking the enhancer then the examination should reflect his cognitive abilities in a similar way to how examinations reflect students abilities without the use of cognitive enhancers of any sort. It appears possible that the use of type 2 cognitive enhancers might be permissible subject to certain conditions. The first of these conditions is that the user of type 2 enhancers must continue taking the enhancer or else any supposed benefit will be illusory. The second condition is that the use of type 2 enhancers will not lead to social injustice.

I will deal with each of these conditions in turn. If we are to permit the use of type 2 cognitive enhancers we must be able to assure ourselves that users of these enhancers continue taking them. How might this be achieved? Let us consider this question in conjunction with safety. I will consider the question first in cases where the issue of safety is clear cut. If such an enhancer has major safety issues then its use should simply be prohibited. If such an enhancer is completely safe and the cost is reasonable then I would question if we need any such assurance. Someone with hypertension will take a safe drug to control his condition without a second thought because it benefits him and carries minimal risk. He has a reason to take the drug and no reason not to. It might be argued by analogy that much the same applies to someone taking completely safe cognitive enhancers. It seems safe to assume if someone has a reason to continue taking a cognitive enhancer and none not to that he will continue to do so. Unfortunately not all cases are so clear cut and most drugs have some side effects. In these circumstances Anders Sandberg suggestion that the use of cognitive enhancing drugs should only occur under medical supervision seems sensible. If the use of type 2 cognitive enhancers takes place under medical supervision then once again we have no reason to question their continued use. It appears to follow that provided type 2 cognitive enhancers are completely safe or only used under medical supervision that we have no reason to question their continued use.

I now want to consider whether the use of type 2 cognitive enhancers might lead to injustice? Someone opposed to cognitive enhancement might argue that the prohibitive cost of such enhancers might make them unavailable to some people leading to social injustice. I will consider this objection in two specific contexts, first jobs depending on good cognitive skill such as the diplomatic service and secondly in higher education. First let us consider type 2 cognitive enhancers in the context of jobs requiring high cognitive skills. It is in employers’ interests to provide employees with the tools to work efficiently. It seems probable that if type 2 enhancers increase efficiency in some contexts that in these contexts it is in the interests of employers to provide them for free. Of course some might not do so. If a significant number of employers do not provide type 2 cognitive enhancers for free when these enhancers have been proved to be safe and increase efficiency then some legislation might be necessary. A similar argument might be advanced with regard to higher education. Universities provide students with the tools to help them learn, libraries, lectures halls and lecturers. If type 2 cognitive enhancers are safe but too expensive for most students then provided they are a useful learning tool perhaps universities should supply them.

The above leads to some tentative conclusions which might need modifying in the light of experience. Firstly provided a type 1 cognitive enhancer is safe and not prohibitively expensive then we have no reasons to prohibit the use of such an enhancer. Secondly even if the cost of type 2 cognitive enhancers is high the use of such enhancers should be permissible in higher education and jobs requiring high cognitive skills. The permissibility of more widespread type 2 cognitive enhancers is dependent on the availability and price of these enhancers.

1. https://nickbostrom.com/ethics/statusquo.pdf 

Autonomy and Toleration

 

In this posting I want to examine the relationship between autonomy and toleration. This examination will highlight the tension between respecting autonomous decisions and autonomous persons. I will argue that the concept of autonomy we adopt affects how tolerant we should be. Toleration will be defined as accepting choices we believe to be wrong and have the power to change, provided that these choices don’t harm others. John Stuart Mill famously argued that “the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.” (1) Mill was discussing liberty but the liberty to choose can be described as a primitive form of autonomy. Mill believed if we accept the above then we must also accept that “if all mankind minus one, were of one opinion, and only one person were of the contrary opinion, mankind would be no more justified in silencing that one person, than he, if he had the power, would be justified in silencing mankind. (2) It follows that if we equate autonomy with the liberty of Mill that toleration and autonomy are automatically linked and that we should tolerate any behaviour, which we disapprove of and have the power to change, provided that this behaviour doesn’t harm others.

It might be objected that it is overly simplistic to equate autonomy with liberty and that a more nuanced account of autonomy is needed. How then might we better define autonomy? Let us first consider autonomous decision making. Of course the freedom to choose is a necessary condition for autonomous decision making but it might not be a sufficient one. My objector might suggest that the simple freedom to choose is an insufficient condition for two reasons. Firstly she might suggest that for someone’s decision to be an autonomous one that it must accord with certain accepted norms in addition to the norm of not harming others. For instance if someone made decisions about what she should to do today based solely on her horoscope we might question if she was truly self-governing. My objector might then argue that our concept of autonomy must contain a substantive element and that that there is no meaningful content neutral account of autonomy. Secondly she might suggest that for someone’s decision to be autonomous he must accept Kant’s hypothetical imperative and always choose means that are likely to deliver the ends he seeks. For instance we might question whether someone was really self-governing if one of the ends he desired was increased learning and he sought to acquire this increase by prayer. In the light of my objector’s suggestions two arguments might now be advanced as to why autonomy and toleration need not be linked. Firstly if we accept a substantive account of autonomy which includes some accepted norms then we have no reason, based on respecting autonomous decisions, to accept those decisions which don’t concur with those norms and hence be tolerant.  Secondly it might be argued we have no reason based on respect for autonomy to respect, tolerate, those who choose means that are unlikely to achieve the ends they seek.

I have outlined a possible more nuanced definition of autonomous decision making. However we can respect autonomous decisions or autonomous people. Let us now turn our examination to respecting autonomous people. I will suggest that that respecting an autonomous person means accepting all of her decisions including ones that appear to have been made in a non-autonomous manner. My objector might argue that it is possible to respect someone as an autonomous person without respecting all of her decisions. In order to consider this objection I will first consider what sort of person is an autonomous person and how is she connected to autonomous decision making. It might be suggested that an autonomous person is simply one who always make autonomous decisions. If we accept this definition then we should have no problem in accepting all the decisions made by an autonomous person. However if we accept this suggestion it might be argued that it would be much simpler if we only respected autonomous decisions and ignored the concept of an autonomous person altogether. Moreover most people don’t always make decisions which conform to conditions outlined above for autonomous decision making, indeed it might be suggested that they rarely do so. It follows that if we accept the above that we are only going to respect an extremely small set of human beings as autonomous persons. In the light of the above should we simply respect human beings and forget about respecting autonomous people? I would suggest we shouldn’t. A three year old and an adult in the prime of her faculties differ in their capacities and intuitively the idea of self-control, self-government or autonomy seems central to this difference. Perhaps a better way to define an autonomous person would be to define her as a human being who has the capacity to make autonomous decisions. Such a definition would satisfy most adults because they want to be defined as the kind of creatures who can make their own decisions rather than simply being defined as human beings. Such a definition would also be useful because it defines a meaningful subset of human beings in contrast our previous definition which only defined a narrow subset. Lastly such a definition roughly concurs with Mill’s idea that liberty is “meant to apply to human beings in the maturity of their faculties”. If we accept this definition of an autonomous person then what does it mean to respect such a person? I have suggested above that this means accepting all her decisions which don’t harm others. Let us assume that we don’t respect all the decisions of someone who has the capacity to make autonomous decisions. Which of her decisions should we respect, only the one that are autonomous ones? However doing so means respecting an autonomous person is equivalent to respecting autonomous decisions and the concept of an autonomous person seems to do no work. Let us accept that if the concept of an autonomous person is to be a meaningful one that respecting someone as an autonomous person necessarily means accepting all of her decisions. This position seems to concur with that of Mill. It follows that respecting someone as an autonomous person means respecting, or at the very least accepting, her autonomous decisions. Acceptance of the above and the previously outlined definition of toleration means that we will be tolerant automatically. It means accepting choices we believe to be wrong and have the power to change, provided these choices don’t harm others.

It might be objected that it is difficult to ascertain whether someone has the capacity to make autonomous decisions. She might point out that if we respect autonomous persons and this means that we must respect non-autonomous decisions that this respect causes difficulties for the doctrine of informed consent. My objector might proceed to argue that because of this difficulty it would be much better to assess whether some specific decision was an autonomous one rather than whether the person making it had the capacity to make autonomous decisions. For this reason she might suggest that when we respect autonomy we should only respect autonomous decisions. She might point out that adopting her suggestion would mean that it would be easier to act beneficently towards someone who seems to be making a decision which runs counter to his best interests. If we accept that respecting autonomy means respecting autonomous decisions and accept a substantive account of autonomy then respect for autonomy and toleration aren’t automatically linked. There are no reason based on respect for autonomy as to why we should accept the decisions of others which conflict with our accepted norms. In a western democracy if the wearing of the hijab goes against our accepted norms then there is no reason to accept it based on respect for autonomy not to ban it; similarly in an Islamic state if not wearing the hijab goes against the accepted norms then again then there is no reason to accept not wearing it based on respect for autonomy. It follows that there is no reason based on respect for autonomy, as conceived above, as to why we should be tolerant, unless of course one of our accepted norms is to be tolerant.

It would seem if we believe respecting autonomy means respecting autonomous persons then we should be tolerant, if we accept a substantive account of autonomy and believe respecting autonomy means respecting autonomous decisions then we have no reason based on autonomy to be tolerant. I will now present two arguments as to why we shouldn’t accept that respecting autonomy means respecting substantive autonomous decisions. Firstly I would argue if we do so then we might be accused of epistemic arrogance. Let us accept that any autonomous decision must accord with the hypothetical imperative. Let us assume someone makes a decision using this imperative but that we don’t accept her decision as an autonomous one. It follows that our rejection is based on rejecting the beliefs or norms her decision is based upon. Let us also accept that our beliefs and desires help define us as persons. It follows if we don’t respect someone’s decisions that whilst we might be respecting her as a human being in a caring way but that we aren’t respecting her as a person. Autonomy and the concept of a person are of necessity connected. Most people don’t want to be only respected as a human being but as a person. It follows that if we only respect autonomous decisions we erode the concept of a person. Secondly I will argue that if we only accept a substantive account autonomous decisions that the concept of an autonomous decisions also loses its usefulness. If we only respect substantive autonomous decisions we only respect what we regard as good decisions. It follows if we only respect what we regard as good decisions the idea of autonomous making is doing no useful work and becomes redundant. It follows that that if he concept of autonomy is to remain a useful concept that we should reject a substantive account of autonomous decision making.

I have argued that we should reject a substantive account of autonomy. Most applied philosophers seem wedded to a substantive account of autonomy perhaps, this is because of an unconscious desire to justify their discipline for after all if something is a primitive concept then there is less of a need for applied philosophy. If we reject a substantive of autonomous decision making and still believe autonomy remains important then we must accept that respecting autonomy means respecting those people who have the capacity to make autonomous decisions. Respecting those people who perhaps aren’t as we educated as some are and rely on their emotions more than most people do. If we do so we must still be able to define an autonomous decision. Clearly not all decisions are autonomous. For instance random decisions, coerced decisions or decision made under some internal compulsion, such as a patient refusing consent because of fear, aren’t autonomous decisions. I have argued above that we should reject a substantive account of autonomous decision making because it erodes the idea of a particular person and reduces the need for autonomous decisions by equating them with good decisions. It follows that we should adopt a content neutral or primitive account of autonomous decision making. An autonomous decision is one which is freely made by someone which is based on her own beliefs and is instrumentally rational enough to serve those beliefs. Respecting this primitive concept of autonomy entails that we will be naturally tolerant. Respecting autonomy means accepting choices we believe to be wrong and have the power to change provided that these choices don’t harm others. Lastly if we accept that informed consent is based on respect for patient autonomy then adopting a primitive account of autonomy means a larger number of people should be competent to give consent compared to the number if we adopt a substantive account.

1. Mill J S. (1974) On Liberty and Other Essays. Oxford University Press (Oxfords Worlds Classics), introduction.
2. Mill J S, chapter 2

Abating Anger

A posting in peasoup by Antti Kauppinen suggests that rage might be a moral emotion. Rage is uncontrollable anger. This posting will, for the most part, be concerned with more moderate anger and whether such anger can be justified and when it can ever serve any useful purpose. I will argue that whilst anger is dangerous that nonetheless controlled anger can sometimes serve some useful purpose. 

To the Stoics anger was a harmful emotion. Seneca describes the mischief anger does as follows,

“no plague has cost the human race more dear: you will see slaughterings and poisonings, accusations and counter-accusations, sacking of cities, ruin of whole peoples, the persons of princes sold into slavery by auction, torches applied to roofs, and fires not merely confined within city-walls but making whole tracts of country glow with hostile flame. See the foundations of the most celebrated cities hardly now to be discerned; they were ruined by anger. See deserts extending for many miles without an inhabitant: they have been desolated.” Sophia-project, Anger book 1.

What sort of anger was Seneca talking about? There is uncontrolled anger and anger that has been tempered or abated some degree. I would suggest that Seneca was talking about uncontrolled anger which I believe could be better characterised as rage. I will consider whether rage might be regarded as a moral emotion as suggested by Kauppinen at the end of this posting. I now want to consider whether tempered or controlled anger can ever be a useful emotion. 

Let us accept that anger has evolutionary roots. It might be argued that because of these roots anger must retain some purpose. However such an argument seems to be unconvincing. Evolution has given us a taste for sweet and fatty things. Such a taste might have been an advantage to a hunter gatherer but is a disadvantage to anyone living in an affluent city. Similarly anger might of advantage to a hunter gatherer but might be a disadvantage to a city dweller. Human progress may now be too rapid for evolution to keep pace with. Let it be accepted that emotions in general are useful to us. Hume argued that reason is slave of the passions. Nonetheless as suggested above the specific emotion of anger might no longer remain useful to us. It might be argued that in practice we cannot simply eliminate a single emotion which has ceased to be useful to us, such as anger, without damaging our capacity to feel the emotions which remain useful to us. If we eliminate all anger then perhaps we will damage our capacity to feel empathy, see anger and empathy. I will now offer two examples which suggest that it might be wrong to eliminate anger in all circumstances. Each example will suggest further reasons as to why we shouldn’t eliminate all anger because our anger can be useful in some circumstances.

My first example concerns anger at Donald Trump’s policies on immigration, his lying together with his underlying racist and misogynist views. Should we simply transmute our anger into useful actions aimed at combatting these evils as suggested by Martha Nussbaum? (1) I would suggest that we shouldn’t because if we do so our actions might be interpreted as a sign of weakness, this is especially true in the case of Trump. Sometimes when faced by wrongdoing we must signal our determination to fight that wrongdoing and perhaps retaining some anger helps in this signalling. A further example might be provide by those who lived under apartheid in South Africa and were unjustly disenfranchised perhaps their anger signalled their determination to oppose the apartheid. However caution is needed as excessive anger can damage rationality and degenerate into hate. In spite of this need for caution I would suggest that when fighting injustice that retaining some controlled anger is useful in this fight by signalling our determination to continue in this fight.

My second example comes from the Vietnam War. In this war Hugh Thompson’s anger helped him, to courageously save others from being massacred at My Lai. Was Thompson’s anger was justified? Was his anger useful in helping stop the massacre? Might not a calm rational moral person also have helped to stop the massacre? Intuitively his anger seems both to have been justifiable and useful.  However our intuitions are not always reliable and I will now attempt to show his anger was useful. Some emotions such as sadness don’t seem to have a clear focus or target. Some might class such emotions as moods and moods are hard to justify. Other emotions such as anger are intentional and are focussed on some target. Let us accept that morality matters. I will now argue intentional emotions can be justified by moral concerns and my argument will focus on anger. Intentional emotions can be seen as sending a signal that something is wrong and needs attending to. If I see someone forcefully pushing into a queue I might feel angry at the perceived injustice. If this person is unjustly trying to displace other members of the queue then my anger is justified because my anger focusses my in attention on the injustice. However if this person is attempting to join her partner in the middle of the queue then no injustice is taking place and my anger is unjustified. Let us accept that anger can be justified by focussing our attention moral concerns. However when anger focusses our attention we must ensure that we focus accurately on those whose wrong actions are the cause of our anger. Hugh Thompson accurately focussed his anger on the wrong actions of the perpetrators of the massacre at My Lai. The perpetrators of the massacre were also angry but their focus on the cause their anger was inaccurate. The villagers massacred were mere bystanders and did nothing wrong, did not cause the situation which lead to the perpetrators anger. The perpetrators anger was inaccurately focussed, resulting in them unjustly targeting innocent women and children. Let us accept anger can be justified by alerting us to some moral wrong. Let us also accept that once anger has alerted us to some wrong that our anger should be translated into actions which alleviate the wrong when this is possible targeting those who cause the wrong. However does translating our anger into action mean our anger should cease completely or continue at some lower level?

I have argued that anger can be justified by alerting us to some moral wrong. At this point I want to compare my position to that of the stoics. Stoics argue that because the cause of someone’s anger is some event in the past and because the past cannot be changed anger is irrational. More generally the stoics argued that emotions are irrational and that we should seek to master them. What do stoics mean by mastering anger? I have argued above that anger isn’t irrational because it alerts us to some wrongdoing. Some stoics might be prepared to accept that anger sometimes alerts us that to the fact that something is wrong. After all if they refuse to accept the above, are they prepared to accept that anger simply occurs at random without any meaningful reference to the context in which it takes place? In response to the above a stoic might suggest that emotions such as anger and rationality occupy completely separate domains and that we should only pay attention to reason and seek eliminate our anger. Plato also believed emotions and reason occupied separate domains and used the example of a charioteer controlling unruly horses as a metaphor for reason controlling the emotions. My stoic might argue whilst hunter gatherers found anger useful in alerting them to wrongdoing in the tribe that nowadays reason alone can alert us to wrongdoing, anger has become a redundant emotion. Stoics believed in cultivating virtue, but if reason alone can detect wrongdoing stoics might also have made good deontologists. A stoic might proceed to argue that reason always alerts us to wrongdoing and does so more reliably than unreliable anger. In the light of the above she might suggest that we should try to eliminate any anger because reason offers a better way to alert us to wrongdoing and anger might interfere with our rationality. To her mastering anger means eliminating anger. One response to the above might to suggest that emotions and reason do not occupy completely distinct domains, I will not pursue this response further here. A second response is to point out that whilst we are no longer hunter gatherers we are human beings and human beings cannot simply eliminate emotions such as anger. My stoic might concede that we cannot simply eliminate anger but argue that when we experience anger we should move on using reason and try to suppress our anger with reason. Mastering our anger now means suppressing it. Such a position is similar to that of Martha Nussbaum who argues we should transmute our anger into useful actions. I have some sympathy for such a position. However it might be better if we sought to control our anger rather than simply suppress it. If we merely suppress our anger rather than control it then our anger might suddenly reappear, indeed it is feasible suppressed anger might fester and grow. When we eliminate or suppress our anger we do not experience anger, the same is not true of controlling anger. To control anger we must retain some anger. However we must stop simply being angry and realise we are angry. Once we stop simply being angry and become aware we are angry we can reflect on and monitor our anger. Is our anger justified? Is our anger excessive? Is it useful? I would argue mastering our anger should mean controlling our anger. It seems that my stoic would argue that we should try not to become angry and if we do become angry we should suppress it, Nussbaum would argue that once we have become angry we should transform our anger into useful actions aimed at correcting the injustice which caused it, whilst I would argue that once we have become angry we should control our anger and use it to enable us to carry out useful actions aimed at correcting the injustice. In the above I have considered eliminating, suppressing and controlling anger from a purely theoretical viewpoint, it is possible that empirical research might mean my views should be amended.  My stoic and Nussbaum believe maintaining anger is both counterproductive and wrong, I believe maintaining some limited form of anger is justified because doing so helps in controlling anger.

I now want to argue that we have a further reason to maintain some anger. What sort of signal is an emotion sending? It is sending a signal that something needs attending to. Emotions are somewhat analogous to alarms. According to Michael Brady emotions facilitate understanding. They do so by facilitating,

“reassessment through the capture and consumption of attention; emotions enable us to gain a “true and stable” evaluative judgement. (2)

I accept that anger requires that we should reassess the situation. However I would argue anger not only captures our attention but in some circumstances help us to retain our attention, helps us to retain our focus. Let us assume that someone is angry because she has been bypassed for promotion due to sexism. Perhaps if she attends to the circumstances of her being bypassed for promotion she finds that the person selected really was better qualified for the position than her. In this scenario her anger might be judged to be inappropriate and should cease.  However let us assume her anger was justified but her employer tackles the injustice. A stoic would argue all her anger should be abated. It seems to me that by simply suppressing her anger she deprives herself of a useful tool for focusing on the injustice of more general sexism. At My Lai Hugh Thompson’s anger helped him maintain his focus on stopping the massacre. Perhaps if he hadn’t maintained his anger his attention might have wandered and he would have considered the dangers to himself, his future or the damage making the public aware of the massacre would do to the US army. Blind anger is never useful, but it seems plausible that some form of controlled anger might be useful in maintaining our focus on some injustice.

I have argued that anger is a useful emotion when it is controlled. However there are dangers associated with the use of anger. It has been suggested that emotions are somewhat analogous to alarms. Alarms are meant to be attended to and switched off. Anger should be attended to and if unjustified should cease. However I have argued that if anger is justified it should be attended to and controlled rather than simply suppressed. Nonetheless if someone simply remains angry and does not reassess her situation on becoming angry then her anger serves no purpose and is damaging. I would suggest there is some mean to anger in much the same way as Aristotle suggested there was a mean to the virtues. Someone might be excessively prone to anger causing her to focus her attention on trivial matters. She might also be very slow to anger and this slowness might deprive her of a better understanding her situation.

 Lastly I want to return to my starting point and consider Kauppinen’s suggestion that rage might be a moral emotion. Kauppinen suggests rage is a negative feeling that is a cousin of anger and hate. He argues rage motivates you to destroy, to get physical, preferably destroying what you see as the obstacle to justice. I have suggested that rage is simply unabated anger. According to the Cambridge Dictionary rage is a period of extreme or violent anger. According to the Oxford Dictionary rage is violent anger, fury, usually manifested in looks, words, or action. It would seem that rage is not a cousin of anger but an uncontrolled form of anger. I am quite happy to agree with Kauppinen that rage might be justified in some circumstances. Rage against apartheid, Trump’s policies and the perpetrators of the My Lai massacre can be justified. However I am not so happy to believe such rage is a useful emotion. I have argued above that anger needs to be abated and controlled it follows that if rage is a form of uncontrolled anger that rage is unproductive. Anger helps someone reassess her situation and take action. If rage is simply uncontrolled anger then whilst rage may be justified it is not a useful emotion. Indeed rage may be counterproductive because the enraged simply rages and fails to reassess her situation.

1. MARTHA C. NUSSBAUM, 2015, Transitional Anger. Journal of the American Philosophical Association, page 53.
2. Michael Brady, 2013, Emotional Insight; The Epistemic Role of Emotional Experience, Oxford University Press, page147.

Ectogenesis and the Abortion Debate

Ectogenesis means the gestation of a foetus in an artificial environment outside the mother’s womb. Recent research with raising premature lambs in gestation bags means there is some possibility that ectogenesis might be feasible. Let us assume that ectogenesis becomes possible. It has been suggested that such a possibility might lead to the end of the debate about the permissibility of abortion, see bioedge. In this posting I will argue that whilst the realisation of this possibility might reframe the debate it will not end it.

One of the classic arguments for the permissibility of abortion is that of Judith Jarvis Thompson . Thompson asks us to imagine that someone wakes up to find herself in bed connected to a famous unconscious violinist suffering from a fatal kidney disease. Her thought experiment assumes that she is the only one with the right physiological features to save the violinist. Thompson assumes she has not consented to being connected to the violinist and that he will automatically recover in nine months. She suggests that it is morally permissible for her to demand to be disconnected from the violinist even if this leads to his premature death. She then argues by analogy that a pregnant mother has a right to an abortion. A woman has a right to be disconnected from her unborn child even though this will lead to the child dying. If ectogenesis becomes a possibility, then Thompson’s argument by analogy fails. In Thompson example it is not possible to disconnect the person connected to the violinist without the violinist dying. However, if ectogenesis becomes possible then it might be feasible for a mother to become disconnected from her unborn child without the child dying. The child is then gestated/incubated in an artificial womb.

It might appear that if ectogenesis becomes feasible then abortion will become unnecessary. Let us reimagine Thompson’s thought experiment. In this reimagined scenario someone is still connected to the violinist for nine months in order to save his life and at the end of this time she is disconnected. Unfortunately, the violinist’s illness has greatly weakened him meaning he needs care for the next fifteen years. Equally unfortunately because she are a close relation of the violinist it is suggested that she is the ideal person to carry out this caring. Someone in this scenario has two reasons for wanting not to be connected to the violinist. Firstly, she simply doesn’t want to be connected, secondly she wants be disconnected so she doesn’t have to care for the violinist later on even if this causes his death.

Let us further reimagine our thought experiment. The violinist’s doctors come along with some good news, they have discovered some new treatment which means it is unnecessary for someone to be connected for nine months. However, the violinist will be greatly weakened and still need care for the next fifteen years and that because of your close relationship you remain the best person to provide that care. You now have no reason to cause the violinist’s death because you wish to be disconnected but you still have some reason to cause his death because you don’t want to care for him for next fifteen. This scenario seems analogous to that of a pregnant women wanting an abortion if ectogenesis becomes feasible. She now has no reason to cause the foetus’ death because she can be disconnected, she might even never be connected in the first place, but she does have a reason this death because she doesn’t want to be a mother. It might be objected that I am not realistically representing the situation. My objector might suggest that others can care for the violinist, even if as not as well as a close relative, and that an unwanted baby can be cared by the state or adopted. I accept her objection. She might conclude that there is no need for abortion if ectogenesis becomes available and that the state provides childcare for abandoned children.

The soundness of my objector’s conclusion depends on two factors. Firstly, exactly how ectogenesis works and secondly the State’s willingness to finance ectogenesis and the extra childcare involved. Let us consider the process of ectogenesis. It seems conceivable that one day ectogenesis might be used by couples who conceive using IVF and that there might be no need for women to gestate the foetus involved in IVF at all, but these are not the women seeking abortions. The women seeking abortions are already carrying the foetus involved. Might the process in removing the foetus from a women’s womb be much more invasive than a simple abortion? If so might the women involved prefer an abortion? I will put this question to one side and deal with the importance of the preferences of a women carrying a foetus later. Let now consider the State’s obligations. The philosopher Rousseau sent all his five children to the Paris Foundling Hospital immediately upon birth. It might be argued that if a great many people acted in the same manner as Rousseau that the cost of ectogenesis together with that of childrearing might place too great a burden on the state. I find such an argument unpersuasive and in the era of safe contraception think it unlikely that the State would find the burden of financing ectogenesis and extra childcare excessively burdensome.

In spite of the above many people would feel uneasy about the ease with which Rousseau gave away his children. It might be possible for a potential mother to have a preference not to have a child and a preference not to abandon any child she had. Let us assume abortion ceases to be an option open to women due to ectgenesis and state childrearing. Let us consider a pregnant woman who would prefer not to be a mother and also prefer that if she did indeed become a mother not to abandon her child. In the above scenario she could not have an abortion and would find herself unable abandon the child she didn’t want. I would find her preference not to abandon her child commendable for two reasons. First, she displays a caring attitude towards her child. Secondly she has a sense of personal duty, she believes some duties shouldn’t be delegated to the state. She might believe she doesn’t have a duty to cause a child to exist but that if she does cause a child to exist then she has a duty to rear that child.

It is important to be clear about the relationship between her two preferences. Her primary preference is not to become a mother. If she cannot satisfy her primary preference, then she has a secondary preference not to abandon her child and become a mother. She doesn’t want to be in a position in which she satisfies her second preference. She has a mega preference that she should be able to satisfy her first preference rather than her second. Her position is analogous to that of a soldier. Most soldiers would prefer not go to war but if they must do so most would prefer to act courageously, they have a mega preference that there will be no need for them to act courageously in battle. If we can ask whether we should satisfy her mega preference means that the possibility of ectogenesis would not end the abortion debate, but merely reframe it.

Should we try to satisfy her mega preference? It might be argued that someone’s inability to abandon her child means that at a later period she might be glad she became a mother. It might then be further argued because she later affirms having the child she must also affirm the conditions necessary for that child to exist, she must become glad she was unable to have an abortion and that as a result we had no reason to satisfy her mega preference. This situation is analogous to Parfit’s fourteen-year-old girl who has a child and later in her life her love for that child means she must affirm her decision to become pregnant at fourteen was a good decision for her. For an excellent treatment of these issues can be found in Jay Wallace’s ‘The View from Here’ (1). I would feel uncomfortable in endorsing the fourteen-year-old’s decision as a good decision and likewise would feel uncomfortable in failing to endorse someone’s mega preference to have an abortion as a good for her because she might later come to love her child. I would suggest in cases such as these result in the feeling of a deep sense of ambivalence and do not give us reason to regard the fourteen-year-old girl’s decision as a good decision or the denial of abortion as justified. If we accept the above, then the possibility of ectogenesis and State childcare doesn’t give us reason to ban abortion. I don’t believe the idea of souls should play any part in determining the permissibility of abortion. I do believe it is permissible for a woman have an abortion before the foetus becomes conscious. However, if science can determine when consciousness emerges this might change the time at which abortions ceases to be permissible.

1. See chapter 2 of, Jay Wallace, 2013, The View from Here; On Affirmation, Attachment, and the Limits of Regret, Oxford University Press.