Confronting deep moral disagreement: the President's Council on Bioethics, moral status, and human embryos.

The report of the President's Council on Bioethics, Human Cloning and Human Dignity, addresses the central ethical, political, and policy issue in human embryonic stem cell research: the moral status of extracorporeal human embryos. The Council members were in sharp disagreement on this issue and essentially failed to adequately engage and respectfully acknowledge each others' deepest moral concerns, despite their stated commitment to do so. This essay provides a detailed critique of the two extreme views on the Council (i.e., embryos have full moral status or they have none at all) and then gives theoretical grounding for our judgment about the intermediate moral status of embryos. It also supplies an account of how to address profound moral disagreements in the public arena, especially by way of constructing a middle ground that deliberately pays sincere respect to the views of those with whom it has deep disagreements.

Preimplantation diagnosis.

Preimplantation genetic diagnosis is a valuable addition to the repertoire of reproductive medicine because it gives individuals with a documented history of a genetic disorder the opportunity to begin a wanted pregnancy with little or no fear that they are transmitting this disorder to their offspring. An outstanding example of this is the recent report of PGD being successfully used to avoid the conception of a child that could have inherited a predisposition to early-onset Alzheimer disease. However, if this service becomes embroiled in the detection of conditions having little or nothing to do with health and disease in order to satisfy patient demand or to be a profitable business, its activities will be much more ethically suspect.

Respect for the developmentally disabled and forgoing life-sustaining treatment.

A developmentally disabled person should be treated at all times as a unique individual and not as some anonymous "disabled person." The developmentally disabled should not be subjected to invasive medical treatment that is unduly burdensome or nonbeneficial, or be forced to endure a quality of life not meaningful to them as individuals. They have a right to refuse or accept treatment that a surrogate must exercise on behalf of each individual in a responsible and careful manner. Three cases and a preliminary approach to the ethical analysis of decisions to allow developmentally disabled persons to die by forgoing medical treatment are offered. The "best interests" of a developmentally disabled individual, properly understood, can serve as a useful and ethically defensible standard for determining the ethical propriety of surrogate decision making about forgoing life-sustaining medical treatment of the disabled.