Introduction 

By Maria Sinaci and Stefan Lorenz Sorgner

PART I. GENERAL ETHICAL CHALLENGES OF EMERGING (BIO)TECHNOLOGIES 

- CHAPTER 1 -

Genes, CRISPR/Cas 9, and Posthumans 

Author(s): Stefan Lorenz Sorgner

Abstract: The following three re-evaluations lead to a radical paradigm shift which has occurred at least since Darwin’s times:

- A move from a dualist anthropology towards a non-dualist one

- A radical increase of anthropotechniques with the power of enhancing human capacities so that the likelihood of the posthuman coming about can be increased

- The posthuman can come about by means of digital technologies or with the help of biotechnologies whereby the field of genetics, on which I focus here, is particularly relevant

These three basic insights lead to a massive number of intellectual, social, political, ethical, and economic challenges. In the following reflections, I will present a selection of emerging bioethical issues concerning gene technologies, in particular CRISPR/Cas 9, and how they can be addressed in an appropriate manner within a wider cultural context.

- CHAPTER 2 - 

Can Ethics Govern Technology? Bioethics in the Age of Techno-Science 

Author(s): Corrado Viafora

Abstract: One of the premises behind bioethics is the conviction that ethics can govern technology. But is this conviction still tenable? In trying to answer this question, we cannot evade the line of thinking inspired by Heidegger that continues to be wholeheartedly sceptical about the chances of ethics steering technology. Battling against this scepticism, the aim of this chapter is to demonstrate that a different relationship between ethics and technology is feasible. This is done by referring on the one hand to Habermas, to debunk the theory that the powerlessness of ethics is a natural necessity, and on the other to Ladrière, to identify the conditions for technology to become an element of moral creativity.

- CHAPTER 3 -

The Moral Relationship of the Human and the Non-Human Animals in Light of Ethology 

Author(s): Alexander Krémer

Abstract: Animal suffering is an obvious consequence of different animal experiments and factory farming. Everybody can observe the terrible online data and images on this issue. From the birth of bioethics in the 1960s, it has become clear that animals should get more clear-cut defence than human beings since they cannot protest and give informed consent. The Animal Rights Movement became stronger when Peter Singer published Animal Liberation in 1975. Tom Regan went further than Singer with his speciesism when he claimed that animals are “subject of a life” and they have moral rights. This chapter will show, in the light of modern ethology, that these views (Singer and Regan) cannot be founded philosophically, and that we should return to Immanuel Kant’s standpoint. It is good enough to determine our moral relationship to animals, and above all, it is a provable standpoint.

PART II. ETHICS OF ENHANCEMENT TECHNOLOGIES 

- CHAPTER 4 - 

Neuroethics and Moral Enhancement: The Path to a Moral World? 

Author(s): Maria Sinaci

Abstract: A central theme in the bioethical debates of the 21st century is human enhancement, approached from different perspectives, such as cognitive or aesthetic enhancement – however, the most provoking approach is that of moral enhancement. A society with a majority of moral people is a historial dream of humankind, and some researchers argue that we may be nearing it. This chapter discusses several conceptual and ethical issues resulted from moral enhancement. It aims to show that today’s direct interventions of moral enhancement, which are supposed to make man more moral, fail in their aim to make the world a better place.

- CHAPTER 5 -

Public Deliberation and Biomedical Enhancements 

Author(s): Ivan Mladenović

Abstract: This chapter will consider the significance of public deliberation for decision-making on bioethical issues. In the past couple of decades, deliberative democracy has become the dominant point of view in democratic theory. There is no doubt that bioethics is the field marked by numerous reasonable disagreements. However, some authors have expressed a view that it is precisely because of this that deliberative democracy can be of immense importance in this context. In this chapter, I will primarily discuss the role of public deliberation on human biomedical enhancements. This is the reason why I will discuss the view of Alan Buchanan, who maintains that in order to face problems associated with biomedical enhancements, it is crucially important that there be an appropriate institutional framework.

PART III. SPECIFIC MEDICAL ETHICAL ISSUES 

- CHAPTER 6 -

On the Ethical Issues of Bilateral and Contralateral Risk-Reducing Mastectomy 

Author(s): Gergely Tari, Gábor Braunitzer

Abstract: The principles of beneficence and patient autonomy can clash in various ways; this is the case of bilateral risk-reducing (BRRM) and contralateral risk-reducing mastectomy (CRRM). Mastectomy, however, is rarely treated as an ethical issue. The literature of BRRM and CRRM is dominated by the topic of risk-assessment. In this chapter, we are going to analyze BRRM and CRRM from a moral point of view. We are going to argue that patients’ autonomy and women’s self-determination over their own bodies can be considered as an indication of risk-reducing mastectomies.

- CHAPTER 7 -

Haematological Patients’ Perception of Their Quality of Life 

Author(s): Alciona Sasu, Mircea Onel, Cristina Ghib-Para, Ligia Piroş, Alin Greluş, Coralia Cotoraci

Abstract: The therapeutic management of haematological patients dramatically changes the lives of patients. Quality of life is a modern concept which tries to help the patient and refocuses doctors on improving not only the patient’s symptoms and disease itself, but also the patient’s overall well-being. This chapter will highlight the most important factors which can modify the onco-haematological patient’s quality of life, stressing the importance of biological, psychological, and social factors.  In identifying these factors, we used two standard questionnaires which evaluate the quality of life on various fields. The results showed that physical status, mental health, and social factors influence patient quality of life.

PART IV. END OF LIFE ETHICAL ISSUES

- CHAPTER 8 - 

Is Death the Enemy? The Normative Power of Metaphor in Bioethics 

Author(s): Assya Pascalev

Abstract: This chapter explores the role of metaphors in biomedical ethics. It maintains that metaphors have an important normative function in medical and moral deliberation: they affect thought and guide actions. We use as a case study the dominant metaphors of death and dying employed by critical care physicians. We identify three prevalent metaphors in end-of-life care: the WAR, TORTURE, and ART metaphors, and demonstrate their normative functions. The metaphors shape physicians’ attitudes towards the dying, guide their reasoning and conduct, and influence their decisions on end-of-life care. We trace the moral implications of each metaphor for the treatment of the critically and terminally ill patients and show how the metaphors shape and constrain the moral deliberation of physicians. Our conclusions have far-reaching implications for bioethical reasoning and education, and could be applied in resolving ethical conflicts between patients and providers by identifying the conflicting metaphors, analysing their normative implications and actively constructing new shared metaphors.

- CHAPTER 9 - 

Philosophical-Ethical Alleviation of Perceptive Experience of Corporeality in Terminally Ill Sufferers 

Author(s): Florin Lobonţ, Ionuţ Mladin

Abstract: On existential level, the diagnosis of terminal illnesses which affect corporeal integrity also affects the perceived identity of sufferers. The physiological disorders occurred induce disruptive neuropsychological changes in their body scheme. For example, subjective awareness of corporeality includes, in various degrees, elements of perception and representation of the body parts configuration and their spatial arrangement. Our suggestion is that philosophical counselling is arguably capable to improve therapists’ communication with those who live with these illnesses and develops ways of alleviating the latter’s existential suffering. This can be done by helping them change the perception of their condition in general and of their corporeality in particular.

PART V. BIOETHICS AND REGIONAL EDUCATION 

- CHAPTER 10 - 

Bioethics Education in Western Romania 

Author(s): Antoanela Naaji

Abstract: In recent decades, the study of bioethics has widely spread all over the world, especially in medical schools. In Romania, Bioethics was introduced later and there are no comprehensive studies on its impact on medical practice and biomedical research. The aim of this research is to evaluate how the utility and relevance of bioethics courses is perceived within specialized academic programs in western Romania. As methodology, a questionnaire was created and applied to 154 respondents, from 4 counties of western Romania. The data obtained was collected and processed using simple statistic tools and the SPSS (Statistical Package for the Social Sciences) program. We measured simple distributions, different correlations, based on calculation of r and p coefficients, cross-tabulations, and the results were analysed, some correlations being established.

- CHAPTER 11 - 

(Bio)ethical Education for Young People in Macedonia 

Author(s): Dejan Donev

Abstract: Since 1998, a campaign has been going on for including ethical and bioethical education in Macedonia. After years of struggle with the Ministry and the Bureau of Education, this process is finally completed. Bioethical education was introduced as part of ethical education, as a practical pedagogical activity in different schools and on different educational levels - from kindergarten to master and doctoral studies. Furthermore, the method used for the ethical-bioethical education of young people proved to be very interactive and, at the same time, it discovered the route for the contemporary ethical education of the youngest children.

PART VI. LEGAL, POLITICAL, AND SOCIAL BIOETHICAL ISSUES

- CHAPTER 12 -

Ethical Concerns Regarding Mandatory Influenza Vaccination in Healthcare Practitioners 

Author(s): Miroslav Radenković, Ivana Lazarević, Marko Stojanović, Tanja Jovanović

Abstract: An escalating international geographical mobility enhances and facilitates the promptness of infectious disease spreading across large regions. The transmission of influenza to healthcare practitioners, as a result of nosocomial influenza outbreaks, has been well documented. Consequently, healthcare institutions have devoted extensive efforts to the large-scale prevention of nosocomial transmission of influenza through vaccination programmes of healthcare personnel. Nevertheless, despite well-aimed endeavours of voluntary vaccination, sustained augmented-level annual immunization percentages are low. Moreover, many ethical challenges regarding vaccination are still very much present.

- CHAPTER 13 -

Legal and Ethical Rules of Performing Medical Professions in Poland 

Author(s): Jakub Berezowski

Abstract: The scope of the regulation of medical professions in Poland is relatively wide. On the one hand, it refers to the medical activity, which consists of the provision of health services; while on the other hand, it refers to competences appropriate for particular medical professions. In the Polish legal system, some medical professions benefit from corporate freedom. These occupations include: doctor, dentist, nurse, midwife, and - until recently - physiotherapist. The tasks of corporations in the medical professions are extensive and consist primarily in the pursuit of the profession of custody. Adherence to professional self-government means that a medical profession is self-reliant in the decision-making process and providing health care services. There seems to be a legitimate postulate of work to increase the scope of regulation of medical procedures. On the one hand, procedures will increase the safety of patients; on the other, they will increase the safety of people performing medical occupations.

- CHAPTER 14 - 

A New Pro-Natalist Tool: Parenthood as a Form of Public Employment 

Author(s): János I. Tóth

Abstract: Low fertility rates currently represent a serious problem across Europe and East Asia. A possible solution to this crisis is the radical increase of fertility rates. I suggest that we distinguish between classical (3-child) pro-natalist and radical (5-child) pro-natalist policies, because their logic is different. Classical pro-natalism tries to harmonize childbearing and employment for the mother, while radical natalism considers bearing 5-6 children as work, as a kind of public employment. In this chapter, I elaborate on a possible radical pro-natalist institution: parenthood as a form of public employment. This institution, complete with classical pro-natalist measures, could best secure the fertility rate of 2.1 by 2030.

- CHAPTER 15 - 

Cultural and Ethical Aspects of Social Desirability in Psychological Research 

Author(s): Maria Ancuta Gurza

Abstract: This study is part of an exploratory work on the child-parent relationship from the perspective of attachment theory and parenting styles. In the context of an increased interest in psychological research on foster parenting, the implications of social desirability for psychological assessment are discussed. This chapter aims to answer the following questions: what is the difference in social desirability between biological and foster parents? What is the effect size of the different correlations between social desirability and other psychological characteristics in the two groups of parents? The research sample was formed of 216 dyads, of which 108 parent-biological child and 108 foster parent-foster child. The ethical aspects of clinical research and the cultural influences associated with social desirability are discussed.