Peter Singer interviewed about, well, everything

h/t Bioedge

The Journal of Practical Ethics recently posed 20 hardball questions to Peter Singer about his philosophy. It is a terrific insight into his thinking as his long career draws to a close.

About utilitarianism: Why do many intelligent and sophisticated people reject utilitarianism? Some people give more weight to their intuitions than I do—and less weight to arguments for debunking intuitions. Does that reduce my confidence in utilitarianism? Yes, to some extent, but I still remain reasonably confident that it is the most defensible view of ethics. I don’t know if everyone will accept utilitarianism in 100 years, but I don’t find the prospect frightening. It would only be frightening if people misapplied it, and I do not assume that they will.

On critics: There have been many critics of my views about euthanasia for severely disabled infants. I had some good discussions with the late Harriet McBryde Johnson, who was not a philosopher but a lawyer who had a rich and full life despite being born with a very disabling condition. As long as she was alive, when I wrote anything on that topic, I wrote with her potentially critical response in mind.

The objective truth of morality: You could just say “these are my normative views, and I’m going to treat them as if they were true, without thinking about whether moral judgements really can be objectively true.” If you do that, then in practice your decisions will be the same whether or not moral judgements can be objectively true. But given that I think morality is highly demanding, it becomes easier to say that, since morality is so highly demanding, and there is nothing irrational about not doing what morality demands, I’m not going to bother doing what I know to be right. If there are objective reasons for doing what morality demands, it’s more troubling to go against them.

On absolute moral standards: There are still absolutists. Some are proponents of the “new natural law” tradition, which has its roots in Catholic moral theology, even though it is presented as a secular position. Others are Kantians, many of them outside English-speaking philosophy. In Germany, for example, you would find wide support for the idea that we should not torture a child, even if (as in Dostoevsky’s example in The Brothers Karamazov) that would produce peace on earth forever. To me it seems obvious that if by torturing one child you could prevent a vast number of children (and adults) suffering as much or more than the child you have to torture, it would be wrong not to torture that child. 

On inconsistency: The view that I take in Practical Ethics and some other writings is not that not aiding is the same as harming in all respects... [So why not donate a spare kidney?]  don’t think I’m weak-willed, but I do give greater weight to my own interests, and to those of my family and others close to me, than I should. Most people do that, in fact they do it to a greater extent than I do (because they do not give as much money to good causes as I do). That fact makes me feel less bad about my failure to give a kidney than I otherwise would. But I know that I am not doing what I ought to do.

On adopting out a [hypothetical] Down syndrome child: For me, the knowledge that my [hypothetical] child would not be likely to develop into a person whom I could treat as an equal, in every sense of the word, who would never be able to have children of his or her own, who I could not expect to grow up to be a fully independent adult, and with whom I could expect to have conversations about only a limited range of topics would greatly reduce my joy in raising my child and watching him or her develop.

On dogs, pigs, and disabled babies: Most people think that the life of a dog or a pig is of less value than the life of a normal human being. On what basis, then, could they hold that the life of a profoundly intellectually disabled human being with intellectual capacities inferior to those of a dog or a pig is of equal value to the life of a normal human being? This sounds like speciesism to me, and as I said earlier, I have yet to see a plausible defence of speciesism. After looking for more than forty years, I doubt that there is one.

On bestiality and infanticide: I don’t put forward provocative views for the sake of doing so. I put them forward where I think they have a basis in sound argument, and where it serves a purpose to have them discussed. I hope that other philosophers will do the same.

On the future:  I worry that if people who think a lot about others and act altruistically decide not to have children, while those who do not care about others continue to have children, the future isn’t going to be good.

On moral bioenhancement: I have some practical concerns: will it work? Will there be unexpected negative side-effects? But suppose that we can put aside those worries and can be highly confident that the proposed bioenhancement will reduce suffering and increase happiness for all affected—then I have no problem with human bioenhancement. Indeed, it would be a very positive thing. As for moral bioenhancement specifically, I doubt that it will happen quickly enough, or spread widely enough, to solve the global moral problems like climate change that we face right now. But once again, if we could do it, that would be very good.

Catholics shouldn't totally reject human gene editing – but it still has ethical problems

h/t CNA

By Adelaide Mena

Washington D.C., Feb 23, 2017 / 02:50 am (CNA/EWTN News).- Recent American guidelines for human gene modification have raised important ethical questions, especially with regard to modifying the genes of unborn children and of reproductive cells.

The National Academy of Sciences last week released a 261-page report on guidelines for editing the human genome to treat diseases and other applications. The report covers a wide array of topics, from the editing of adult cells for therapies such as cancer treatment, to the editing of embryos and germ cells (reproductive cells, i.e. ova and sperm), to the question of human enhancement.

John DiCamillo, an ethicist at the National Catholic Bioethics Center, spoke to CNA about the perils and the promises of gene editing, as well as the oversights contained in the National Academy of Sciences' report.

“Gene editing generally can be morally legitimate if it has a directly therapeutic purpose for a particular patient in question, and if we’re sure we’re going to limit whatever changes to this person,” DiCamillo explained. In this regard, the report’s guidelines for laboratory treatment of somatic – or non-reproductive – cells and human trials of somatic cell treatments were reasonable, he noted.

DiCamillo pointed to upcoming clinical gene therapy trials for cancer and proposed gene therapy treatments for disorders such as sickle cell disease. However, it’s important to limit these trials to non-embryonic persons, to ensure that the modifications – intended as well as unintended – are not carried in the patient’s reproductive cells.

While this would mean that patients treated for inheritable diseases “could still transmit it to their children,” any children who then developed the disease could themselves be treated through the same process.

The question of transmission to descendants opens two more points discussed in the National Academy of Sciences report: the modification of ova and sperm, as well as edits to the genomes of embryos. Both changes would mean that people would maintain these edits in all of their cells for all of their lives – and could pass on these edited genes to new generations.  

“There could be limited situations that could exist where the germ line could be legitimately edited. In other words, making changes to sperm, to eggs, or to early embryos as a way of potentially addressing diseases – inheritable diseases and so forth,” DiCamillo stated.  

However, permitting edits to germ line cells could also be “very dangerous on multiple levels,” he warned.

There are considerable, and not yet fully controllable, risks to genetic manipulation. A person conceived with edited genes could experience a range of “unintended, perhaps harmful, side effects that can now be transmitted, inherited by other individuals down the line.” An embryo who experiences gene modification could also carry and pass on edited genes, particularly if edits were performed before his or her reproductive cells began to differentiate themselves.

The National Academy of Sciences' regulations surrounding germ cells and embryos are also problematic for what they overlook, DiCamillo commented.

Manipulating sperm and ova requires removing them from a person’s body; if conception is achieved with these cells, it is nearly always through in vitro methods. This practice of in vitro fertilization is held by the Church to be ethically unacceptable because it dissociates procreation from the integrally personal context of the conjugal act.

In addition, scientific researchers rarely differentiate between experimentation on sperm or ova – which are cells that come from a human subject – and embryos, which are distinct persons with their own distinct genomes, DiCamillo noted.

The National Academy of Sciences’ guidelines reflect this lack of distinction between cells and embryos. “That’s very misleading because embryos are not germ line cells; they are new human beings,” DiCamillo said.

For research on embryos to be ethical, he continued, therapies should be ordered to treating and benefitting that “that particular embryo, not just for garnering scientific knowledge or seeing what’s going to happen.” DiCamillo condemned policies that see destruction of embryonic persons as a back-up if research does not go as planned, as well as current policies that require destruction of embryos as standard procedure.

“We’d be in that area of very dangerous exploitation of human life and destruction of human life,” he warned.

While the guidelines stumble across ethical roadblocks in regards to gamete and embryo research, the new report’s rules regarding human enhancement are strong, DiCamillo said.

The ability to edit genomes could also be used for purposes other than medical treatment. A whole host of human traits could be enhanced or changed, such as vision, intelligence, or abilities. “There’s any number of things that we could do to change the qualities of human beings themselves and make them, in a sense, super-humans … this is something that would also be an ethical problem on the horizon,” he warned.

The existence of these gene altering therapies raises a question of how much modification and enhancement is permissible. DiCamillo praised the report for its recommendation “entirely against enhancement efforts and that these should not be allowed.”

Currently, gene editing of both germ cells and somatic cells is legal in the United States, including on embryos. However, various US government institutions have policies in place prohibiting federal funding of such research efforts on germ cells and on embryos.

Furthermore, Food and Drug Administration regulations prohibit gene modification on viable human embryos – meaning that human embryos who receive gene modification are always destroyed.

The new guidelines from the National Academy of Sciences are significant because they lay a groundwork for future policy on human gene modification. They cautiously welcome the use of gene therapy on human embryos who are not later targeted for destruction after experimentation concludes.

DiCamillo recalled, however, that “they are merely guidelines – they are advice from the National Academy of the Sciences to the government in regards to future policy. This is not itself a new regulation or policy that the government has established.”

The ethics of gene editing has been questioned for several years – the Congregation for the Doctrine of the Faith addressed the issue in Dignitas personae, its 2008 instruction on certain bioethical questions. It has become more pressing recently, however, because a new technique known as CRISPR is easier to use and less expensive than previous means of gene editing.

Although the ethical questions surrounding gene modification are many and there are a number of problematic applications of these technologies, DiCamillo cautioned Catholics not to renounce completely human gene modification: “We don’t want to be hyper-reactive to the dangers. We have to realize there’s a great deal of good that can be done here.”

He pointed again to the kinds of modifications that can treat deadly genetic diseases and treatments that can be done in an ethical manner, with full respect to the dignity of human persons.

“We do need to be attentive to where the dangers are,” he warned, “but we don’t want to … automatically consider any kind of gene editing to be automatically a problem.”

Is denying transgender rights a kind of torture?

h/t Bioedge

Street mural in Brussels    

A completely different way of viewing transgender issues comes from the Oxford Human Rights Hub. Geoffrey Yeung, a Hong Kong activist studying at Oxford, argued last year that restrictions on transgender people are banned by the United Nations Convention Against Torture (CAT). He pointed out that

Many countries ... impose heavy burdens (such as sterilisation, surgery, hormonal treatment and psychiatric diagnosis) on transgender people before they can legally be recognised in their preferred gender ... [The Committee Against Torture has] explicitly recommended the repeal of “abusive” preconditions to legal gender recognition and called for respect for transgender people’s “autonomy and physical and psychological integrity”. 

The UN’s Special Rapporteur on torture, Juan E. Méndez, has given this interpretation of the Convention his blessing. “We have a tendency to regard violations against these groups as ill-treatment even where they would more appropriately be defined as torture,” Mr. Méndez said in a report to the Human Rights Council about gender-based violence.

Even if transgenders are not getting the bastinado, Yeung points out that what they experience in many countries is a kind of psychological torture:

It is important to make clear that what constitutes systematic ill-treatment (and thus torture under the CAT) is the legal requirement that all transgender people must undergo certain forms of medical or surgical treatment — regardless of their personal desires or medical necessity — to be recognised in their preferred gender.

If sex reassignment surgery is the answer, what is the question?

Sex reassignment surgery requires the intervention of doctors. But what kind of treatment is it? Is it a therapy for a disease which should be offered only after psychiatric authorization? Or is it a biomedical enhancement which anyone can freely choose?

The answer to this theoretical question has practical consequences. If it is a therapy, then transgenderism is a disease. If it is an enhancement, then it hardly deserves to be funded by the government.

In a very interesting article in the Journal of Medicine and Philosophy, Tomislav Bracanović, of the University of Zagreb, in Croatia, analyses the competing conceptions.

Transgender scholars contend that sex reassignment surgery is not a therapy for gender identity disorder, because the feeling of being a man in a woman’s body or a woman in a man’s body is not a disorder. It is a “normal, albeit rare, human condition that is medicalized as a consequence of general discrimination of transsexual population. It should be removed, therefore, from all classifications of mental disorders, and sex reassignment surgery should be made available without medical “gatekeepers” deciding who qualifies for it and who does not.”

Their conclusion is that a sex change is no more a therapy than a “nose job”. They would prefer to describe sex reassignment surgery as an enhancement, like cosmetic surgery.

But is it plausible to describe it as non-therapeutic enhancement? Bracanović believes that it is not. “It does not improve, augment, or increase—above average—any trait or function typically mentioned in philosophical debates about enhancement. Intelligence, vision, hearing, physical strength, and immunity, for example, after sex reassignment surgery remain more or less the same as they were before.”

There is another way of framing enhancement, though: the welfarist model – does it enhance quality of life? At first blush this seems plausible because people who have had the operation report more satisfaction and a decrease in dissatisfaction. However, Bracanović  points out that the evidence for this is weak. There have been very few long-term studies of postoperative transsexuals’s quality of life.

... imagine the “sex change drug” that has the same risk–benefit ratio as sex reassignment surgery. Even if it improved the condition of many clinical trial subjects, it would probably not be approved by any regulatory agency (as either “therapy” or “enhancement”), if a large number of subjects mysteriously disappeared from the trial after taking the drug.

So Bracanović concludes that it would be wise to keep the gatekeepers for this type of surgery and to restrict access to it. Given the current state of knowledge, there is too great a risk of harm to the patients. Furthermore, if it is an enhancement which increases a person’s well-being, as transgender scholars contend, it is obviously more like enhancement for artistic ability rather than curing paraplegia. With limited resources, society would normally focus on paraplegia rather than gender dysphoria. The only way to prioritise it above paraplegia would be to medicalise it and describe it as a serious disorder – which theorists vehemently reject.

h/t Bioedge

Woman's bid to use deceased daughter's eggs continues

h/t BBC news website

• m the sectio

Image copyrightPA

A 60-year-old woman who wants to use her late daughter's frozen eggs to give birth to her own grandchild is continuing her legal battle.

The woman is appealing against the UK regulator's refusal to allow her to take her only child's eggs to a US clinic to be used with donor sperm.

Her daughter, who died five years ago, was said to have approved of the plan.

The mother lost a High Court case last year but was subsequently granted permission to challenge the decision.

The latest round of the case is being heard at the Court of Appeal in London, before a panel of three judges.

'Natural sympathy'

The UK fertility regulator, the Human Fertilisation and Embryology Authority (HFEA), said, in 2014, the daughter's eggs could not be released from storage in London because she had not given her full written consent before she had died, from bowel cancer at the age of 28.

But, in the latest legal proceedings, lawyers acting for the mother told the judges she wanted to fulfil her daughter's wishes to carry a child created from her frozen eggs and "raise that child".

Jenni Richards QC added the eggs would "simply be allowed to perish" if the court did not rule in her favour.

Meanwhile, Catherine Callaghan, appearing for the HFEA, said in a written argument before the court: "It is natural to feel sympathy for the appellants' loss and for their wish to keep their daughter's memory alive by trying to conceive a child using their daughter's eggs."

But it was not the court's role to decide whether it would have permitted the mother to undergo fertility treatment using her daughter's eggs.

Ms Callaghan added: "Rather its role is to determine whether Mr Justice Ouseley erred in concluding that the HFEA's statutory approvals committee acted lawfully and rationally in exercising its broad discretion to refuse to authorise export of the frozen eggs to a treatment centre in New York for use in the way proposed."

'Required consent'

During earlier High Court proceedings in June 2015, the court was told her daughter was desperate to have children and had asked her mother to "carry my babies".

Lawyers acting for the mother and her 59-year-old husband told Mr Justice Ouseley the daughter would have been "devastated" if she had known her eggs could not be used.

But the judge ruled that the HFEA was entitled to find the daughter had not given "the required consent" and said there had been no breach of the family's human rights.

Although she consented for her eggs to be stored for use after her death, she did not fill in a separate form outlining how she wished them to be used.

He said he was dismissing the case "conscious of the additional distress which this will bring to the claimants, whose aim has been to honour their daughter's dying wish".

It was thought if the case had been successful her mother could have become the first person in the world to become pregnant using a dead daughter's eggs.

In February 2016, when seeking permission to appeal, her lawyers argued there was "clear evidence" of what the daughter wanted to happen to her eggs when she died.

'Prospect of success'

Lord Justice Treacy said the case papers had left him doubtful as to whether there would be "sufficiently strong" reasons to allow the challenge to continue further.

But after hearing submissions in court, he concluded there was "an arguable case with a real prospect of success".

Absolute morality garners trust, says new study

In an innovative empirical study, researchers from Oxford and Cornell universities have found that people who hold to moral absolutes in certain ethical dilemmas are more trusted among their peers than those who engage in situational analyses.
Jim A.C. Everett, Oxford PhD student and Fulbright Scholar at Harvard University, worked with Molly Crockett from Oxford and David Pizarro from Cornell University to test whether our default reliance on moral rules has an evolutionary basis.
The researchers asked participants to consider several variations of moral dilemmas where one must decide whether or not to sacrifice an innocent person in order to save the lives of many others.
They then asked each participant a question about the others who took place in the study: did they prefer as social partners those who took a rule-based approach, or those who made cost/benefit moral judgements.
“Across 9 experiments, with more than 2,400 participants, we found that people who took an absolute approach to the dilemmas (refusing to kill an innocent person, even when this maximized the greater good) were seen as more trustworthy than those who advocated a more flexible, consequentialist approach”, said senior author Dr. Molly Crockett.
When asked to entrust another person with a sum of money, participants handed over more money, and were more confident of getting it back, when dealing with someone who refused to sacrifice one to save many, the researchers found.
However, simply deciding whether or not to sacrifice an innocent person was not the only thing that mattered: how the choice was made was crucial. Someone who had decided to sacrifice one life to save five but had found that decision difficult was more trusted than someone who had found the decision easy.
The scenarios used by the researchers included the famous Trolley Problem, as well as a thought experiment known as ‘the soldier’s dilemma’.

h/t Bioethics

Bioethics and natural law: an interview with John Keown

Bioethics discourse is often divided into two broad categories: utilitarian perspectives and so-called deontological or Kantian approaches to ethics. An alternative viewpoint that receives far less attention is a natural law perspective on ethics and medicine. The natural law approach emphasizes interests or ends common to all members of humanity, and offers a teleological account of morality and human flourishing.
Professor John Keown of Georgetown University’s Kennedy Institute for Ethics recently co-authored a book on natural law with the late Georgetown Professor Alfonso Gómez-Lobo. The book is entitled Bioethics and the Human Goods: An Introduction to Natural Law Bioethics. The Deputy Editor of BioEdge, Xavier Symons, interviewed Professor Keown about his latest work. 

Xavier Symons: What led you to write Bioethics and the Human Goods: An Introduction to Natural Law Bioethics?
John Keown: The book was largely written by my distinguished colleague and friend, the late Professor Alfonso Gómez-Lobo, who held the Ryan Chair in Metaphysics and Moral Philosophy at Georgetown. Before his untimely death at the end of 2011, he had submitted a manuscript to Georgetown University Press. With the kind permission of his widow, and with the approval of the Press, I completed the project, incorporating amendments that he had indicated, in his comments on the referees’ reports, that he wanted to make, and some amendments that I thought appropriate. About a third of the book is material I added to his original manuscript. I thought it important, given the regrettable dearth of introductory books on bioethics from a natural law perspective, that his manuscript should be enlarged, updated and completed
What contribution do you think natural law can make to the field of bioethics?
Natural law has made, and has the potential to make in future, a signal contribution to the ethics of healthcare and to bioethics more broadly conceptualised.  Natural law theory could be described as the most enduring and important moral tradition in Western thought, and it has had a profound influence on Western law, professional medical ethics, and culture.
Many laws and codes of ethics are grounded in the natural law articulation of certain fundamental moral principles that should always be respected, regardless of the consequences. For example, in relation to euthanasia, the prohibition on intentionally killing patients, which is still reflected in the law of the vast majority of jurisdictions, and in the ethics of the World Medical Association, is grounded on one such principle: the principle that it is always wrong intentionally to kill a person, even at that person’s request.
Unlike other approaches to bioethics, most notably utilitarianism, natural law theory can offer a coherent account of the intrinsic wrongness of treating patients in certain ways, such as intentionally killing them, lying to them, or exploiting them, however beneficial it might be to others or to society to do so.
Moreover, although utilitarianism and ‘principlism’, in their various forms, are undoubtedly dominant in bioethics education today, it is important for students to realise that there is an alternative ethical tradition, one which makes sense of much of contemporary law and professional ethics, and which offers a radically different approach to bioethical reflection. Indeed, it seems to me that no student can understand bioethics (or, indeed, biomedical law) properly without at least a basic grasp of natural law theory. Without such a grasp, they have at best a partial understanding of the field. I fear that the many students of bioethics who are unfamiliar with the natural law tradition do not even know what they do not know.
Unfortunately, although the literature on bioethics is vast, that literature largely either ignores natural law theory, mentions it only in passing, or misunderstands it. There is, therefore, an important and urgent need for this book, and more books like it.
I have lost count of the number of times I have been asked ‘Could your recommend a clear, introductory book on natural law bioethics, suitable for the college student or the general reader?’ Now, I have a ready answer. Previously, I recommended one or two books like Professor Gómez-Lobo’s Morality and the Human Goods (Georgetown University Press, 2002). However, although that book does touch on a number of bioethical issues (especially abortion and euthanasia), it is more an introduction to natural law ethics rather than natural law bioethics.  Still, it would make an excellent companion volume, and I think students would find it valuable to read it before reading Bioethics and the Human Goods.

Professor John Keown

The book mentions ‘basic goods’ and their importance for natural law theory. What are they and why are they so important?
The starting-point for natural law theory is to ask ‘What is the Good Life?’ It rejects standard utilitarian answers, whether in terms of pleasure or the satisfaction of desires, both of which could be used to justify obviously immoral acts. The answer given by natural law theory is that the Good Life is a life which involves true human fulfilment or flourishing. And what is a truly flourishing life? One in which one participates in the goods of life, health, friendship, knowledge, appreciation of art and beauty, work, play and practical reasonableness. (The precise formulation of basic goods may vary depending on which theorist one reads, but the theorists share the same, basic idea.) These goods are ‘basic’ in the sense that they are not merely instrumental goods, but are ends in themselves, worth pursuing for their own sake, and self-evidently so. (Of course, basic goods like health and knowledge can also be instrumentally valuable, but that does not reduce their worth to mere instrumentality. It is, for example, good for us to know about bioethics, or the history of the American Revolution, or one’s own personal history, even if one never uses that knowledge instrumentally.)
The basic goods form an objective basis for natural law ethics, but they need to be supplemented by intermediate moral principles, intermediate between the basic goods and our judgment about the ethics of particular conduct (‘Is it right for me to tell the patient he is fine when I know he is dying?’ ‘Should I allow the patient’s refusal of consent to prevent me from carrying out harmless and potentially ground-breaking research on her while she is anaethetised?’)  Much of Professor Gómez-Lobo’s book Morality focused on the key principles of ‘care’ and ‘respect’. In Bioethics he reformulates them in terms of ‘beneficence’ and ‘non-maleficence’. In doing so, he recognises the influential ‘four principles’ approach advocated by Professors Tom Beauchamp and Jim Childress, but he explains how those principles are conceived and applied from a natural law, rather than from a principlist, perspective. He rejected the ‘four principles’ approach on the ground that it failed to give a substantive account of the Good. Without such an account, he argued, it is impossible to judge what truly benefits or harms another.
In your book you suggest that, although natural law theory is compatible with major religious traditions, it is not grounded in religion. Can you explain?
Adherents of the great religions will find much in natural law that resonates with their teachings, such as its insistence that all human beings share a fundamental equality-in-dignity, including the most vulnerable, whether babies, people with profound intellectual disabilities, the comatose, the demented, the suffering and the dying.
For example, natural law theory’s opposition to infanticide (in contrast to its endorsement by leading utilitarians) resonates with the long-standing opposition to infanticide in the Judaeo-Christian tradition (in contrast to its endorsement by the ancient Greeks and Romans).  Natural law thinkers reject the ‘dualist’ notion of personhood, in which only some human beings, with certain mental abilities, count as ‘persons’ and others, like babies or elderly folk with severe dementia, do not.  Moreover, natural law theory is the philosophical tradition of the Catholic church.  Further, my brother Professor Damien Keown has, in his many publications, noted similarities between natural law ethics and Buddhist ethics.
Despite these resonances between natural law theory and teachings of the great religions, however, natural law theory remains a philosophy, not a theology. It traces its origins to pre-Christian Greek thinkers like Aristotle, and is reflected in contemporary human rights documents in what many would describe as our post-Christian world.  Anyone can, and many do, adopt natural law’s absolute prohibitions on, say, torture or euthanasia, without having any religious belief whatsoever. In short, natural law is grounded on reason, not faith.
Is there not some distance between natural law theory and a detailed practical ethics? How can a medical practitioner use it to address thorny ethical issues in clinical practice?
There is always a distance between theory and practice, whichever ethical theory one adopts. But, partly because of the centuries-long history of the natural law tradition, much of the intellectual heavy lifting about its application to practical situations has already been done. That rich storehouse of reflection has shaped our laws and codes of professional ethics, whether in relation to carrying out research on patients, to treating or withholding treatment, and to killing or not killing.
That is not to say that natural law has figured out definitive answers to all the bioethical questions clinicians face in the contemporary world, but many of these questions are largely old questions in a new form. For example, the question of the moral status of the human embryo in vitro may have seemed utterly novel to many, but natural law theorists have been reflecting on the moral status of human embryos in vivo for centuries.  Again, the question whether to withhold or withdraw tube-feeding from a patient in PVS may, again, seem completely new and to require us to invent new ethical principles, but to natural law thinkers the answer lies in applying established ethical criteria which ask whether tube-feeding is a medical treatment and, if so, whether it is disproportionate as being either futile or too burdensome. This is not to suggest that the answers to such questions are easy, and will always attract consensus (even among natural law theorists) but it is to say that even challenging, contemporary bioethical questions can be resolved by the intelligent application of well-established principles.
In any event, we should not forget that most clinicians, most of the time, are not confronted with complex, thorny bioethical issues.  Most bioethical issues they face in everyday practice are fairly easily resolved by the application of established principles and codes of bioethics, such as those requiring informed consent and respect for confidentiality. And those principles and codes often reflect, to a greater or a lesser extent, natural law thinking, which requires respect for the basic rights and equality-in-dignity of each patient, not least the vulnerable, and that patients never be used as a mere means to the good of others.
What would you say to natural law critics of the ‘new’ natural law theory which has been championed by philosophers like Grisez and Finnis?
Professors Grisez  and Finnis (and their collaborators, not least Professor Boyle) have been largely responsible for the exciting renaissance of natural law theory over the past 35 years or so. They would resist the label ‘new’ natural law on the ground that their theory is but a modern restatement of classical natural law theory. Not all natural lawyers would agree with that, but it seems to me that many of the criticisms are based on misunderstandings of the ‘new’ natural law project. This is one reason I co-edited (with Professor Robert P George of Princeton) a Festschrift in honour of John Finnis, (Reason, Morality and Law: The Philosophy of John Finnis) which was published by Oxford University Press in 2013, to allow both supporters and critics of his new classical theory to engage with him, and him with them.
In any event, college students and health care professionals interested in learning the basics of natural law bioethics may well find disagreements about whether and if so how the new classical theory of natural law differs from the old rather abstract and abstruse, and I would encourage them to start with some of the more introductory books and articles on natural law bioethics, written by scholars including Christopher Kaczor, Christopher Tollefsen, David Oderberg, Luke Gormally, David Jones, Helen Watt  and, of course, the late Alfonso Gómez-Lobo.