When philosophers address personal identity, they usually explore numerical identity: what are the criteria for a person's continuing existence? When non-philosophers address personal identity, they often have in mind narrative identity: Which characteristics of a particular person are salient to her self-conception? This book develops accounts of both senses of identity, arguing that both are normatively important, and is unique in its exploration of a range of issues in bioethics through the lens of identity. Defending a biological view of our numerical identity and a framework for understanding narrative identity, DeGrazia investigates various issues for which considerations of identity prove critical: the definition of death; the authority of advance directives in cases of severe dementia; the use of enhancement technologies; prenatal genetic interventions; and certain types of reproductive choices. He demonstrates the power of personal identity theory to illuminate issues in bioethics as they bring philosophical theory to life.

The enhancement of human traits has received academic attention for decades, but only recently has moral enhancement using biomedical means -moral bioenhancement (MB) -entered the discussion. After explaining why we ought to take the possibility of MB seriously, the paper considers the shape and content of moral improvement, addressing at some length a challenge presented by reasonable moral pluralism. The discussion then proceeds to this question: Assuming MB were safe, effective, and universally available, would it be morally desirable? In particular, would it pose an unacceptable threat to human freedom? After defending a negative answer to the latter question -which requires an investigation into the nature and value of human freedom -and arguing that there is nothing inherently wrong with MB, the paper closes with reflections on what we should value in moral behaviour.

Placebos are often used by clinicians, usually deceptively and with little rationale or evidence of benefit, making their use ethically problematic. In contrast with their typical current use, a provocative line of research suggests that placebos can be intentionally exploited to extend analgesic therapeutic effects. Is it possible to extend the effects of drug treatments by interspersing placebos? We reviewed a database of placebo studies, searching for studies that indicate that placebos given after repeated administration of active treatments acquire medication-like effects. We found a total of 22studies in both animals and humans hinting of evidence that placebos may work as a sort of dose extender of active painkillers. Wherever effective in relieving clinical pain, such placebo use would offer several advantages. First, extending the effects of a painkiller through the use of placebos may reduce total drug intake and side effects. Second, dose-extending placebos may decrease patient dependence. Third, using placebos along with active medication, for part of the course of treatment, should limit dose escalation and lower costs. Importantly, provided that nondisclosure is pre-authorized in the informed consent process and that robust evidence indicates therapeutic benefit comparable to that of standard full-dose therapeutic regimens, introducing dose-extending placebos into the clinical arsenal should be considered. This novel prospect of placebo use has the potential to change our general thinking about painkiller treatments, the typical regimens of painkiller applications, and the ways in which treatments are evaluated.

This book distinguishes itself from much of the polemical literature on these issues by offering the most judicious and well-balanced account yet available of animals' moral standing, and related questions concerning their minds and welfare. Transcending jejune debates focused on utilitarianism versus rights, the book offers a fresh methodological approach with specific and constructive conclusions about our treatment of animals. David DeGrazia provides the most thorough discussion yet of whether equal consideration should be extended to animals' interests, and examines the issues of animal minds and animal well-being with an unparalleled combination of philosophical rigor and empirical documentation. His book is an important contribution to the field of animal ethics and will be read with special interest by all philosophers teaching such courses, as well as biologists, those professionally involved with animals, and general readers concerned about animal welfare.

In the traditional 'fix-it' model of medical decision making, the identified problem is typically characterized by a diagnosis that indicates a deviation from normalcy. When a medical problem is multifaceted and the available interventions are only partially effective, a broader vision of the health care endeavor is needed. What matters to the patient, and what should matter to the practitioner, is the patient's future possibilities. More specifically, what is important is the character of the alternative futures that the patient could have and choosing among them so as to achieve the best future possible, with the ranking of outcomes determined by the patient's preferences. This paper describes the fix-it model, presents and defends the outcomes-based model, and demonstrates that the latter is useful in developing normative conceptions of informed consent and decision making and in establishing a basis for societal involvement in the decision making process. Finally, several shortcomings of the model will be acknowledged.

As the President's Council on Bioethics emphasized in a recent report, rapid growth of biotechnologies creates increasingly many possibilities for enhancing human traits. This article addresses the claim that enhancement via biotechnology is inherently problematic for reasons pertaining to our identity. After clarifying the concept of enhancement, and providing a framework for understanding human identity, I examine the relationship between enhancement and identity. Then I investigate two identity-related challenges to biotechnological enhancements: (1) the charge of inauthenticity and (2) the charge of violating inviolable core characteristics. My thesis is that a lucid, plausible understanding of human identity largely neutralizes these charges, liberating our thinking from some seductive yet unsound objections to enhancement via biotechnology.

Some people contend that fetuses have moral status but less than that of paradigm persons. Many people hold views implying that sentient animals have moral status but less than that of persons. These positions suggest that moral status admits of degrees. Does it? To address this question, we must first clarify what it means to speak of degrees of moral status. The paper begins by clarifying the more basic concept of moral status and presenting two models of degrees of moral status. It then sketches several significant considerations in favor of, and several against, the assertion of degrees of moral status. The paper concludes by drawing lessons from the discussion.

A person can be true to oneself even while transforming and even creating the person one is. One's self is not something merely waiting to be discovered, after all. To some extent, part of the human endeavor is deciding and trying to become who we want to be.