From Human Nature to Moral Judgments : Reframing Debates about Disability and Enhancement

My goal in my dissertation is to develop an account of how a theory of human nature should be integrated into bioethics and to show what bioethics can gain from using this account. I explore the relevance of human nature for moral argumentation, and especially for bioethics. Thereby, I focus on debates about enhancement and disability. Bioethics is in need of a discussion of conceptions of human nature, as I argue, to better justify and to understand moral judgments in bioethics. I begin the development of the theoretical framework in by identifying the very different conceptions of the human being implicit in discussions of ‘human nature.’ Once one distinguishes between naturalistic, metaphysical, and normative conceptions of the human being, it becomes clear that one cannot simply choose one of these conceptions to employ in a moral argument. These conceptions are not directly comparable to each other, because they are not simply alternatives for each other. I also show that conceptions of the human being can—and, in effect, do—play a role in moral arguments. These roles go beyond the much-criticized idea that approaches to human nature can serve as a sufficient basis for making moral judgments. In particular, as I show, there are several indirect argumentative functions for conceptions of human nature in moral arguments. Next, the theoretical framework is applied to three debates about disability and enhancement. These chapters assess the extent to which employing my framework improves the moral debate in question or allows better arguments to be made. The applications clarify the meaning, relevance, and implications for bioethical debates of the theoretical distinctions and insights developed in the theoretical framework. I start with a real-life case in which a decision has to be made concerning the treatment of an individual. This case concerns Ashley, a severely disabled girl. She received a controversial medical intervention to keep her child-sized and to restrict her female bodily development, with the intention of improving her long-term quality of life. The next chapter challenges the common assumption in debates about disability, which is that as soon as we know what the correct ‘model of disability’ is, we have an answer to the question of what justice for disabled people entails. Models of disability are taken to have strong normative implications. Lastly, I discuss a more general moral debate: the fascinating debate about designer babies. By discussing these three case studies, I show how my theoretical framework can help to illuminate three debates in bioethics, how it clarifies misunderstandings between scholars holding different positions in those debates, and how it is necessary to understand the arguments put forward in the debates. The choice of a particular account of human nature makes a difference when dealing with practical moral issues. We need such an account to make sensible moral judgments, but also to understand discussions properly and to understand disagreements about moral issues at all

The Ashley Treatment: Improving Quality of Life or Infringing Dignity and Rights?

The ‘Ashley treatment’ (growth attenuation, removal of the womb and breasts buds of a severely disabled child) has raised much ethical contro- versy. This article starts from the observation that this debate suffers from a lack of careful philosophical analysis which is essential for an ethical assessment. I focus on two central arguments in the debate, namely an argument defending the treatment based on quality of life and an argument against the treatment based on dignity and rights. My analysis raises doubts as to whether these arguments, as they stand in the debate, are philosophically robust. I reconstruct what form good arguments for and against the treatment should take and which assumptions are needed to defend the according positions. Concerning quality of life (Section 2), I argue that to make a discussion about quality of life possible, it needs to be clear which particular conception of the good life is employed. This has not been sufficiently clear in the debate. I fill this lacuna. Regarding rights and dignity (section 3), I show that there is a remarkable absence of references to general philosophical theories of rights and dignity in the debate about the Ashley treatment. Consequently, this argument against the treatment is not sufficiently developed. I clarify how such an argument should proceed. Such a detailed analysis of arguments is necessary to clear up some confusions and ambiguities in the debate and to shed light on the dilemma that caretakers of severely disabled children face