The promise of xenotransplantation: a challenge.

According to many scholars, kidney xenotransplantation promises to mitigate the organ supply shortage. This claim has a certain obviousness to it: by flooding the market with a new source of kidneys, xenotransplantation promises to be a panacea. Our goal is to challenge this claim. We argue that xenotransplantation may increase rather than decrease demand for kidneys, may reduce kidney allotransplants, and may be inaccessible or otherwise unused. By offering the challenge, we hope to show deeper reflection is needed on how xenotransplantation will affect the dearth of available organs.

Genetic disenhancement and xenotransplantation: diminishing pigs' capacity to experience suffering through genetic engineering.

One objection to xenotransplantation is that it will require the large-scale breeding, raising and killing of genetically modified pigs. The pigs will need to be raised in designated pathogen-free facilities and undergo a range of medical tests before having their organs removed and being euthanised. As a result, they will have significantly shortened life expectancies, will experience pain and suffering and be subject to a degree of social and environmental deprivation. To minimise the impact of these factors, we propose the following option for consideration-ethically defensible xenotransplantation should entail the use of genetic disenhancement if it becomes possible to do so and if that pain and suffering cannot be eliminated by other means. Despite not being a morally ideal 'solution', it is morally better to prevent unavoidable pain until a viable non-animal alternative becomes available.

Xenograft recipients and the right to withdraw from a clinical trial.

Preclinical xenotransplantation research using genetically engineered pigs has begun to show some promising results and could one day offer a scalable means of addressing organ shortage. While it is a fundamental tenet of ethical human subject research that participants have a right to withdraw from research once enrolled, several scholars have argued that the right to withdraw from xenotransplant research should be suspended because of the public health risks posed by xenozoonotic transmission. Here, we present a comprehensive critical evaluation of the claim that xenotransplant recipients should be required to waive their right to withdraw from lifelong biosurveillance. We conclude that if xenotransplantation requires participants to waive their right to withdraw, then clinical trials may not be justifiable, given the ethical and legal obstacles involved with doing so. Consequently, if clinical trials are permitted with a right to withdraw, then they may pose a significant public health risk.

In defense of xenotransplantation research: Because of, not in spite of, animal welfare concerns.

It is envisioned that one day xenotransplantation will bring about a future where transplantable organs can be safely and efficiently grown in transgenic pigs to help meet the global organ shortage. While recent advances have brought this future closer, worries remain about whether it will be beneficial overall. The unique challenges and risks posed to humans that arise from transplanting across the species barrier, in addition to the costs borne by non-human animals, has led some to question the value of xenotransplantation altogether. In response, we defend the value of xenotransplantation research, because it can satisfy stringent welfare conditions on the permissibility of animal research and use. Along the way, we respond to the alleged concerns, and conclude that they do not currently warrant a cessation or a curtailing of xenotransplantation research.

Xenotransplantation Clinical Trials and Equitable Patient Selection.

Xenotransplant patient selection recommendations restrict clinical trial participation to seriously ill patients for whom alternative therapies are unavailable or who will likely die while waiting for an allotransplant. Despite a scholarly consensus that this is advisable, we propose to examine this restriction. We offer three lines of criticism: (1) The risk-benefit calculation may well be unfavorable for seriously ill patients and society; (2) the guidelines conflict with criteria for equitable patient selection; and (3) the selection of seriously ill patients may compromise informed consent. We conclude by highlighting how the current guidance reveals a tension between the societal values of justice and beneficence.

The virtue of compassion in compassionate conservation.

The role of ethics is becoming an increasingly important feature of biodiversity conservation dialogue and practice. Compassionate conservationists argue for a prohibition of, or at least a strong presumption against, the adoption of conservation policies that intentionally harm animals. They assert that to be compassionate is to care about animals and that it is antithetical to caring for animals to intentionally harm them. Compassionate conservationists thus criticize many existing conservation practices and policies. Two things together challenge the philosophical foundation of compassionate conservation. First, compassionate conservationists ground their theory in virtue ethics, yet virtue ethics permits exceptions to moral rules, so there cannot be an in-principle prohibition on adopting intentional harm-inducing policies and practices. But not all compassionate conservationists advocate for a prohibition on intentionally harming animals, only a strong presumption against it. This leads to the second point: compassion can motivate a person to adopt a harm-inducing conservation policy or practice when doing so is the best available option in a situation in which animals will be harmed no matter what policy or practice is adopted. Combining these insights with the empirical observation that conservationists regularly find themselves in tragic situations, we arrive at the conclusion that conservationists may regularly advocate for harm-inducing policies and practices from a position of compassion. Article Impact Statement: Compassionate conservationists should accept that the virtuously compassionate person may adopt harm-causing conservation policies.

La Virtud de la Compasión en la Conservación Compasiva Resumen El papel de la ética es una función cada vez más importante para el diálogo y la práctica de la conservación. Los conservacionistas compasivos alegan a favor de la prohibición, o al menos una presunción legal robusta en contra, de la adopción de políticas de conservación que dañan intencionalmente a los animales. Los conservacionistas compasivos afirman que ser compasivo es cuidar a los animales y que es contrario a esto el querer dañarlos intencionalmente. Por lo tanto, estos conservacionistas critican muchas prácticas y políticas de conservación existentes. Hay dos cosas que en conjunto cuestionan el fundamento filosófico de la conservación compasiva. La primera es que los conservacionistas compasivos basan su teoría en la ética de las virtudes, pero esta ética permite excepciones a las reglas morales, por lo que no puede haber una prohibición en principio de la adopción de políticas y prácticas que dañan intencionalmente a los animales. Pero no todos los conservacionistas compasivos abogan por la prohibición del daño intencional a los animales, sino que abogan sólo por una presunción legal robusta en su contra. Esto nos lleva al segundo punto: la compasión puede motivar a una persona a adoptar políticas o prácticas de conservación que causen daño intencional cuando esto es la mejor opción disponible en una situación en la que los animales serán dañados sin importar cuál práctica o política se adopte. Con la combinación de estas percepciones y la observación empírica de que los conservacionistas regularmente se encuentran a sí mismos en situaciones trágicas, llegamos a la conclusión de que los conservacionistas pueden abogar con frecuencia por políticas y prácticas que inducen daños desde una posición compasiva.

Why appeals to the moral significance of birth are saddled with a dilemma.

In 'Dilemma for Appeals to the Moral Significance of Birth', we argued that a dilemma is faced by those who believe that birth is the event at which infanticide is ruled out. Those who reject the moral permissibility of infanticide by appeal to the moral significance of birth must either accept the moral permissibility of a late-term abortion for a non-therapeutic reason or not. If they accept it, they need to account for the strong intuition that her decision is wrong as well as deny the underlying normative principle that killing a viable fetus requires good reason, and not wanting to care for the child when the child could be easily placed for adoption is not a good enough reason to abort. If they reject the moral permissibility of the late-term abortion, they need to explain why her decision is wrong. Doing so, however, will undermine their own project of denying infanticide by appeal to birth. Walter Veit argues that the dilemma relies too much on intuition and does not live up to biological continuity. We explain why his criticisms are unconvincing.

A critical examination of the false hope harms argument.

Marleen Eijkholt presents a new argument in healthcare ethics, the false hope harms (FHH) argument. In brief, false hope promotes a host of individual harms (e.g., financial, physical, and psychological harms) and system-level harms (e.g., distrust of medical practitioners, increased complexity of care and the associated costs), all of which provide reason for healthcare providers to stop promoting false hope in medicine. The goal of this paper is to show that the FHH argument is unsuccessful.

Orphans and the relational significance of birth: a response to Singh.

Prabhpal Singh has defended a relational account of the difference in moral status between fetuses and newborns. Newborns stand in the parent-child relation while fetuses do not, and standing in the parent-child relationship brings with it higher moral status for newborns. Orphans pose a problem for this account because they do not stand in a parent-child relationship. I argue that Singh has not satisfactorily responded to the problem.

Dilemma for appeals to the moral significance of birth.

Giubilini and Minerva argue that the permissibility of abortion entails the permissibility of infanticide. Proponents of what we refer to as the Birth Strategy claim that there is a morally significant difference brought about at birth that accounts for our strong intuition that killing newborns is morally impermissible. We argue that strategy does not account for the moral intuition that late-term, non-therapeutic abortions are morally impermissible. Advocates of the Birth Strategy must either judge non-therapeutic abortions as impermissible in the later stages of pregnancy or conclude that they are permissible on the basis of premises that are far less intuitively plausible than the opposite conclusion and its supporting premises.

Risky first-in-human clinical trials on medically fragile persons: owning the moral cost.

The purpose of a first-in-human (FIH) clinical trial is to gather information about how the drug or device affects and interacts with the human body: its safety, side effects, and (potential) dosage. As such, the primary goal of a FIH trial is not participant benefit but to gain knowledge of drug or device efficacy, i.e., baseline human safety knowledge. Some FIH clinical trials carry significant foreseeable risk to participants with little to no foreseeable participant benefit. Participation in such trials would be a bad deal for participants, and the research is considered justifiable because of the promise of significant potential social benefit. I argue that there is an ethical tension inherent in risky FIH research and that researchers should fairly compensate risky FIH trial participants. This does not make the risk-benefit outcome more favorable for participants; rather, it amounts to a collective reckoning with the ethical tension inherent in the research.

A Rule-Based Solution to Opaque Medical Billing in the U.S.

Patients and physicians do not know the cost of medical procedures. Opaque medical billing thus contributes to exorbitant, rising medical costs, burdening the healthcare system and individuals. After criticizing two proposed solutions to the problem of opaque medical billing, I argue that the Centers for Medicare and Medicaid Services should pursue a rule requiring that patients be informed by the physician of a reasonable out-of-pocket expense estimate for non-urgent procedures prior to services rendered.

Animal rights, animal research, and the need to reimagine science.

What would it look like for researchers to take non-human animal rights seriously? Recent discussions foster the impression that scientific practice needs to be reformed to make animal research ethical: just as there is ethically rigorous human research, so there can be ethically rigorous animal research. We argue that practically little existing animal research would be ethical and that ethical animal research is not scalable. Since animal research is integral to the existing scientific paradigm, taking animal rights seriously requires a radical, wholesale reimagining of science.Trial registration: ClinicalTrials.gov identifier: NCT05340426.