Two protechnology arguments, the “hopeful principle” and the “automatic escalator”, often used in bioethics, are identified and critically analysed in this paper. It is shown that the hopeful principle is closely related to the problematic precautionary principle, and the automatic escalator argument has close affinities to the often criticised empirical slippery slope argument. The hopeful principle is shown to be really hopeless as an argument, and automatic escalator arguments often lead nowhere when critically analysed. These arguments should therefore only be used with great caution.

In a contribution to The Journal of Medicine and Philosophy, Professor Rosamond Rhodes argues that individuals sometimes have an obligation to know about their genetic disorders, because this is required by their status as autonomous persons. Her analysis, which is based on Kant's concept of autonomy and Aristotle's notion of friendship, is extended here to consequentialist concerns. These are of paramount importance if, as we believe and Professor Rhodes herself implies, the Kantian and Aristotelian doctrines can be helpful only in the sphere of private morality, not in the public realm. Better tools for assessing the right to genetic ignorance as an issue of public policy can, we contend, be found in Mill's ideas concerning liberty and the prevention of harm. Our own conclusion, based on the Millian way of thinking, is that individuals probably do have the right to remain in ignorance in the cases Professor Rhodes presents as examples of a duty to know.

In discussions among nonphilosophers, the ethical argument from naturalness frequently comes up. "Of course, cloning should be banned-it is unnatural." "Surely you cannot deny that homosexuality is unnatural (and hence it should be condemned)." "The immorality of gene technology is apparent because things like that do not happen in nature. Genes do not jump between species and crossbreeding produces infertile offspring." Even those who come from a philosophical background can catch themselves thinking, "That is unnatural!" and finding grounds for suspicion from the thought. But what do we mean when we talk about (im)morality and (un)naturalness? What interpretations can be given to the ideas of natural and unnatural in ethical discussions? What are the implications of these interpretations? Are there good grounds for assuming that naturalness is morally better than its opposite? The connection between (im)morality and (un)naturalness can be traced back at least to Aristotle. But many philosophers have viewed the alleged link with caution. Two powerful conceptual criticisms can be found from the eighteenthcentury works of David Hume and Jeremy Bentham. 1,2 What Does "Natural" Mean? Following Hume, I will start with three different interpretations of the word "natural." The basis of the distinction is that what is natural can be opposed to the "artificial," the "miraculous," or the "rare." 3 The concept of natural as everything that is not artificial seems like a promising idea. In the context of modern biotechnologies, especially when it comes to patenting genetic material, this distinction has been frequently used. It is usually held that people should not be allowed to patent natural living organisms. Further analyses have shown, however, that in gene technology the limits between the natural and the modified are difficult to set and that even if this could, by strict definitions, be done, the ethical questions would still remain open. Something made out of a human gene sequence can be classified as artificial, and hence patentable, but ethicists disagree on whether any living thing of human origin should be patentable in the first place. 4 This paper was first presented at the Fourth International Bioethics Retreat in Paris, May 2001. I wish to thank the participants for their comments on my paper. This paper was produced as a part of the project Genes, Information, and Business, financed in 2000-2003 by the Academy of Finland.

Within the latter half of the 30-year history of bioethics there has been an increasing pressure to address bioethical issues globally. Bioethics is not traditionally a theory-based enterprise, rather the focus has been problem related. With the introduction of the global perspective, theory has, however, become more important. One of the best known, probably the best known, theory of bioethics is the one presented by Tom L. Beauchamp and James F. Childress in their Principles of Biomedical Ethics in 1979. This theory is known as the “four principles” or the “Georgetown mantra” approach or “mid-level principlism.” It is the attempt to create a global framework for bioethics on the four principles—autonomy, justice, beneficence, and nonmaleficence—that I will scrutinize in this paper.

It is commonly held that respect for autonomy is one of the most important principles in medical ethics. However, there are a number of interpretations as to what that respect actually entails in practice and a number of constraints have been suggested even on our self-regarding choices. These limits are often justified in the name of autonomy. In this paper, it is argued that these different interpretations can be explained and understood by looking at the discussion from the viewpoints of positive and negative liberty and the various notions of a “person” that lay beneath. It will be shown how all the appeals to positive liberty presuppose a particular value system and are therefore problematic in multicultural societies.