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This research paper focuses on the role that the concept of identity has for framing, approaching, and possibly resolving moral dilemmas in bioethics. First, it introduces some of the key questions pertaining to the philosophical debate about identity. Second, it provides a synthetic overview of the main philosophical accounts of identity. Finally, it charts the most representative issues that arise in bioethics in relation to questions about identity.
Historically, philosophers have always considered identity to be a fruitful subject of reﬂection, as well as an endless source of disagreement. Unsurprisingly, there is not a single problem about identity but rather a plurality of loosely connected issues that include, inter alia, the following questions: who am I? when did “I” begin, and when will “I” end? If someone transplants my brain and successfully implants it into another debrained body, who would be “me” after the operation? If I commit a crime but then I lose all my memories of it, am I still morally accountable for what I have done? These are just a tiny portion of the many questions arising at the crossroads of the philosophical accounts of identity and (bio)ethics.
Against this background, some preliminary remarks are required. First, the following discussion is limited to those aspects of the debate about identity that are of relevance for bioethics and applied ethics.
Second, this research paper discusses the concept of identity only insofar as it applies to moral questions related to a very speciﬁc kind of entities, namely, human beings.
Third, at the outset it is preferable to speak of human identity rather than of personal identity. This terminological choice requires an explanation. Within the contemporary ethical debate, it is common to present the questions about human identity as being coextensive with the questions about personal identity. However, the view that “human beings” are essentially “persons” is controversial. Several scholars have argued that the idea of personhood is not required, and sometimes even detrimental, for illuminating issues of identity in bioethics (Olson 1997; DeGrazia 2005; Boniolo 2013). Accordingly, this research paper will be about “human identity” rather than “personal identity.”
Fourth, while there are a lot of different questions that can be asked about identity, most of the ongoing bioethical discussion is centered around two key problems:
(i) The “what” or “ontological” question (the who problem). In its most general formulation, it asks: What are the properties that make this entity different from any other? If applied to human beings, this question asks: What is the set of characteristics (the organism as a whole, the mind, the brain, the soul, the memories, etc.) that makes that entity a human being? Depending on the answer that one gives to this question, one would endorse a different theory of what is our “essence” as human beings. Likewise, if we believe that we are essentially persons, the ontological question would ask what a “person” is, and thus what set of properties is necessary and sufﬁcient to deﬁne “personhood.”
(ii) The “identity-over-time” or “persistence” question (the persistence problem). This asks what does it takes for an entity to retain its identity over time. The answer may depend on the meaning attributed to the term “identity.” Suppose that it is possible to perfectly duplicate an object, a. After the duplication, there will be two objects, a and b, with the same properties; but if a is destroyed, b will still continue to exist. So it would be possible to say that a and b are in a sense “identical,” because they possess the same properties and also that a and b are in a sense not “identical,” because they are two distinct objects, not one. In order to separate these two senses of “identical,” many scholars distinguish between qualitative and numerical identity, so that it is possible to say that although a and b are qualitatively identical, yet they are numerically distinct. Thus, an adult is numerically identical to the child that she once was but at the same time qualitatively different from her. Most of the questions about identity over time refer to identity in its numerical sense.
The Psychological View
The most popular answer to the identity-over-time question is the psychological view (Shoemaker 1970; Parﬁt 1984). Roughly speaking, those endorsing this view share the intuition that if it were possible to transplant our brain in another decerebrated body, after the operation “we” will wake up in the new body. On this view, our identity consists in the holding of some psychological or mental properties, and thus, we persist just as long as the relevant ensemble of mental properties persists. What mental properties are relevant, and how they should be related, is, however, controversial.
Historically, the psychological view dates back to Locke. Refuting the traditional view that identity consists in sameness of substance, in the Essay Locke argued that a person is “a thinking intelligent being, that has reason and reﬂection, and can consider itself as itself, the same thinking thing, in different time and places” (1975, p. 335). In this view, what counts for personal identity is the capacity to connect past and present experiences through memory. One advantage of the memory criterion is that it ﬁts well with common intuitions about personal identity, moral responsibility, and prudential concerns. How can someone be held accountable for her deeds? The memory based criterion provides an intuitive and straightforward answer: someone is accountable for what she has done if and only if she can remember enough about what she has done. Furthermore, memory seems to be necessary for dealing with self-regarding practical concerns. Intentional action requires a sense of persistence over time, of being one and the same agent. Without the kind of psychological unity granted by memory, it would be impossible to make future plans and act accordingly.
Nevertheless, the memory criterion is liable to several critiques, including the one of being circular. For any of my memories to count as a memory of myself in the past, it seems necessary that both the present memory and the remembered experience must be referred to the same individual, that is, myself. Thus, Locke’s criterion of identity is circular: personal identity is deﬁned in terms of memory, but memory presupposes personal identity, as one can remember only her own experiences. Another potential objection is that Locke’s theory seems to imply that whenever someone falls asleep, faints, develops amnesia, or is otherwise unconscious, that someone is no longer “herself” for she cannot remember her past. Finally, there are delusional pseudo-memories: not everyone who claims to remember Napoleon’s life experiences is (or was) really Napoleon.
In the face of these and other critiques, advocates of the psychological view have substantially modiﬁed Locke’s view. In what is perhaps the most inﬂuential contemporary account of personal identity in psychological terms, Parﬁt (1984) has proposed, following Shoemaker (1970), to substitute the concept of “memory” with the wider concept of “quasi-memory.” In this view, I have an accurate quasi-memory of a past experience if “(i) I seem to remember having an experience; (ii) someone did have this experience; (iii) my apparent memory is causally dependent, in the right kind of way, on that past experience” (Parﬁt 1984, p. 220). This account avoids the critique of circularity because the relevant criterion for personal identity is no longer the identity of the remembering and experiencing subject, but the causal chain of quasi-memories.
Aside from the replacement of memory with quasi-memory, Parﬁt’s view amends and expands on Locke’s view in other important ways. First, Parﬁt endorses an explicit reductionist view about persons, according to which “A person’s existence just consists in the existence of a brain and body, and the occurrence of a series of interrelated physical and mental events” (1984, p. 211). For Parﬁt, a person is not something distinct from what goes on in his brain and body; in other words, to deﬁne and explain personhood, we must not appeal to any “further fact,” like an immaterial substance, a soul, or a Cartesian ego. Second, in Parﬁt’s view personal identity can be deﬁned as the conjunction of what he calls “Relation R” (psychological continuity and/or psychological connectedness with the right kind of cause) plus a “non-branching” requirement for uniqueness. This conception, as well as one of its most important implications, can be illustrated in reference to a thought experiment that has played a key role in the contemporary philosophical debate about identity: ﬁssion.
Suppose that it is possible, via some futuristic technology, to separate the two hemispheres of A’s brain, so that each of them is then transplanted into another body, B or C, which is still present in one of B or C’s previous hemispheres. As a result, A’s two hemispheres will be paired in one case with one of B’s hemispheres and in the other case with one of C’s hemispheres. After the “ﬁssion,” what would happen to A’s identity? It seems that A would be psychologically continuous and connected to both AB and AC. However, since AB and AC are two distinct individuals, a contradiction would ensue: if identity is a transitive relation, then it is not possible that A is identical with AB and AC but that AB is not identical with AC. To avoid this conclusion, Parﬁt deﬁnes “personal identity” as Relation R plus uniqueness, so that we can say that in the “ﬁssion” or in other “identity-branching” scenarios, A’s personal identity is not preserved, but Relation R, instead, branches and survives in both AB and AC. Parﬁt thus argues that what really matters in survival is not the preservation of our personal identity, but Relation R, i.e., our psychological continuity. This conclusion may strike some as being counterintuitive.
Yet, even Parﬁt’s reﬁned theory is still liable to the objection that psychological views do not account for our relationship with our biological nature. For example, it is normally believed that humans develop from embryos. However, at least in the ﬁrst phases of gestation, embryos do not possess the kind of psychological continuity that persons display; hence, if we are essentially persons in a numerical sense and persons are deﬁned in psychological terms, then “we” could not have been embryos or, by the same token, newborns: a counterintuitive conclusion. A related difﬁculty is the so-called “too-many-thinkers” problem. It is hard to deny that our organism is a thinking being. But if “you” are not your organism but something essentially distinct – say, a thinking person – then it follows that there are two thinking entities within yourself: perhaps one too many. These and other problems have led many to abandon the psychological view in favor of other alternatives.
The Biological View
Psychological views have difﬁculties in reconciling their criterion for identity with the strong intuition that human beings are essentially biological organisms or animals. This is because most psychological views are more or less explicitly committed to the claim that we are essentially persons. This thesis, known as person essentialism, seems to be incompatible with the idea that we are essentially human animals (Olson 1997; DeGrazia 2005; Boniolo 2013). An increasingly popular alternative to avoid this counterintuitive conclusion is to deny that we are essentially persons and to claim instead that we are essentially animals or rather biological entities belonging to the species Homo sapiens who, depending on their stage of development and their particular physiological conditions, may or may not have the capacity to think or to qualify as persons.
Advocates of the biological view (sometimes called animalism) share the intuition that the criterion for retaining numerical identity lies in some form of physical continuity. This view has several advantages. First, it easily avoids the “too-manythinkers” problem: at any time we are just a single entity, a human thinking animal. Second, this view readily explains the relation with our biological precursors: simply put, we were the fetuses and the newborns from which we have later developed. Third, biological views also account for the intuition that we are still “ourselves” even if we fall asleep, incur into amnesia, or fall into a permanent vegetative state.
What about personhood, then? According to biological views, we are human animals, and this “we” extends to all other entities that belong to our biological kind. This set includes anencephalic children or severally demented people who have lost or will never possess the relevant mental properties for being “persons.” In this view, personhood is thus better conceptualized as a category containing all those entities that possess the relevant traits above a certain threshold (e.g., the capacity for autonomous self-determination), rather than as a substance concept. Thus, not every human being is a person, and in principle there could be persons who are not humans – for example, nonhuman animals such as chimpanzees, future supercomputers, angels, etc.
Biological views, however, have their share of problematic issues too. First, they are incompatible with any system of belief for which we retain some form of numerical identity after death. Since our numerical identity persists just as long as it persists our biological continuity, if our organism die then we also cease to exist. By contrast, psychological views are more open to the possibility that after our biological death, we might still persist in some form – for example, as reincarnated souls or as “uploaded minds” in futuristic supercomputers. Since the question of our persistence over time has always been closely linked to the question of what will happen after our death, this conclusion may appear unpalatable for anyone believing that after death we persist as something that is numerical identical to ourselves.
Secondly, biological views have trouble explaining what happens to our identity in transplant cases. Suppose that it is someday possible to transplant someone’s cerebrum from one body to another. The cerebrum is that part of the brain responsible for higher-cognitive functions, including consciousness. Suppose also that in the donor body it remains the brainstem, which is the part of the brain responsible for cardiopulmonary functions, digestion, etc. A body without a cerebrum but that still retains its brainstem would still be alive, for it would carry on many of its basic biological functions and would thus retain a substantial biological continuity with the entity that it was before the operation. Now, assuming that the operation succeeds and that someone wakes up in the body with the transplanted cerebrum, will that person be numerically identical to you or not? In these cases, our intuition strongly suggests that we will follow our consciousness and, as we have seen, this is one of the main reasons justifying the embracing of a psychological view. By contrast, supporters of biological views seem to be compelled to say, instead, that after the operation we would be numerically identical with the living body that “stayed behind.”
A common reply to this counterintuitive conclusion is to acknowledge its force but, at the same time, to stress that this kind of thought experiments that appeal to our intuition and involve sci-ﬁ scenarios with technologies, such as teleportation, whole-brain transplant, Kafka-like scenarios, etc., may not provide adequate tools for judging the merits of an account of human identity – especially if this account must cope with pressing and actual practical concerns like those of bioethics. For example, Boniolo and Testa (2012) have proposed a reﬁned account of the biological view for which a human being is, in any instant of his/her life, nothing but the results of all the epigenetic processes that, in the course of time, have causally shaped all of his/her phenotypic modules, i.e., his/her whole phenotype (Boniolo 2013). This notion of human identity is explicitly grounded in contemporary biomedical knowledge, and it stems from a perspective according to which a good theory of human identity should be limited to what we can understand through science. In this view, we should thus discard as utterly irrelevant questions concerning any sci-ﬁ scenario.
Still, one can challenge biological views precisely on the ground that they do not seem to deal well with people’s everyday practical concerns. Even if we believe that psychological continuity cannot exist without biological continuity, it still seems that when we reﬂect about moral responsibility, or future prudential concerns, what we have in mind is our psychological continuity. In this respect, as noted by Olson (1997), one option for those advocating a biological view could be that of holding that only biological continuity (rather than personhood) should provide the criterion for numerical identity over time, but then to concede that it is only in reference to our psychological continuity that most of our everyday practical concerns make sense. However, there are scholars who disagree and maintain that by choosing the appropriate biological substrate, it is indeed possible to grasp all the relevant features of psychological views from a purely biological and scientiﬁc perspective (Boniolo and Testa 2012; Boniolo 2013).
Both the psychological and the biological views lead to seemingly counterintuitive conclusions in the ﬁssion and the brain-transplant case. In addition, each view has its own problems. For these reasons, other scholars have elaborated a plethora of alternative solutions.
One popular strategy is to defend a psychological view but to avoid the “biological objection” by reconceptualizing the relationship between the psychological continuity of mental contents (or personhood) and our biological organism (see, e.g., Baker 2000). However, it is unclear to what extent these proposals succeed in avoiding the objection that unless we are essentially biological entities, then we cannot be biological entities at all (for a discussion of this point, see DeGrazia 2005). Another option is to rely on four-dimensionalism, the metaphysical theory according to which persons are constituted not only by spatial but also by temporal parts (see, e.g., Lewis 1976). This theory allows saying that as a result of ﬁssion, there exist two persons who previously coexisted as temporal parts of the original pre-ﬁssion subject; but such a theory has been criticized on its own (see, e.g., van Inwagen 2001). Finally, there is the traditional option of embracing some form of substance dualism, and with that the problem of explaining how two different substances can simultaneously exist within the same subject. This latter position, though, is at best marginal within the contemporary bioethical debate.
A radically different option is that of upholding a narrative account of identity. Usually, aside from continuing to persist, people want also to fulﬁll their desires and aspirations, making sense of their choices with respect to what befalls on them. This is why an answer to the “who am I?” question usually concerns one’s self-narrative rather than one’s criterion for numerical identity. Schechtman (1996) has aptly called the “who am I?” question a characterization question, for it asks one to deﬁne one’s identity with respect to a series of actions, experiences, values, beliefs, or traits that characterize her life story.
In one inﬂuential account of narrative identity for bioethics, DeGrazia (2005, p. 106) has deﬁned “narrative identity” as “one’s sense of oneself as the protagonist in one’s own life story or self-narrative.” The reference to the act of writing highlights three important elements in this deﬁnition. First, both the questions and the answers pertaining to narrative identity (“who am I?,” “I am a person who has had a difﬁcult life,” etc.) seem to make sense only from a ﬁrst-person perspective. Narrative identity concerns not just the writing of someone’s story, but the writing of a story with which one is willing to self-identify. Second, narrative identity is closely tied to the concept of self-creation, that is to say, to the possibility that one has to deliberately shape her future life in the light of her desires and motivations. In this latter sense, the concept of narrative identity is thus naturally related to another key concept for bioethics, namely, personal autonomy. Third, the shaping of one’s present narrative identity can be both a prospective and a retrospective act. Just as like authors can keep on writing other chapters for their stories, so they can also edit those that have already been written, deleting or inserting certain parts, as well as highlighting or downplaying certain aspects to better ﬁt with the unfolding story. Narrative identities are therefore potentially ﬂuid, and they can signiﬁcantly change over time.
Similarly to the psychological criterion, the narrative criterion ﬁts well with our everyday prudential and moral concerns. For example, making long-term life plans, a practice that is normally considered constitutive of one’s identity, requires a subject who knows not only that she will persist over time but also what are the things that she ﬁnds worth achieving and preserving. Likewise, narrative identity seems to provide a useful criterion for attributing moral responsibility, for anyone who is able to author her own life story is also someone who can likely qualify as a moral agent and can thus be held morally accountable for her actions.
But is narrative identity a viable criterion for numerical identity besides the psychological and the biological one? Currently, most scholars would answer negatively. The reason is that an account of narrative identity seems to presuppose a theory of numerical identity, rather than to provide a substitute for it (DeGrazia 2005). If this is correct, then an account of narrative identity could be something important – or necessary – to provide a satisfactory account of human identity but not something that could be sufﬁcient on its own.
There is, however, another sense in which narrative identity intersects with bioethics – and especially with clinical ethics. This aspect, which has been almost entirely overlooked, concerns the role of patients’ narratives in clinical contexts. As doctors are well aware of, sometimes it is hard to take clinical decisions because the dilemma at stake has a clinical as well as an ethical component. For example, often there can be more than one therapeutic path for treating the same disease. However, different therapeutic paths may appear to be more or less optimal depending on the patients’ values, desires, life objectives, goals, or beliefs. In these cases, the making explicit of patients’ narratives may aid both the patient and the doctors in selecting the best clinical option. Traditionally, the decision of taking into account patients’ narratives in clinical contexts has been delegated to doctors’ individual sensibility. In recent years, however, the articulation of patients’ narratives has been conceptualized and variously targeted by a series of new professionalized services under the guise of “clinical ethical consultation” or “ethical counseling” (Boniolo and Sanchini 2016). The increasing popularity of these services suggests that to provide a good account of narrative identity is an endeavor that may have theoretical as well as practical implications in clinical contexts.
Issues Of Identity In Bioethics
Identity is a prominent concept in many contemporary bioethical debates. Often, the main question at stake concerns numerical identity over time, that is to say, the question of whether two spatiotemporally related entities are one and the same. In bioethics issues of identity over time arise because some attribute different moral status to different entities. However, things change over time. Thus, it might be unclear whether something that changes should also loose or acquire a different moral status. Other times, instead, the main question concerns what matters to us the most in survival scenarios.
As the space for this research paper is limited, this section brieﬂy explores only one exemplar case and then charts the other major bioethical problems that arise in relation to questions about identity. What follows thus leaves aside two important aspects of the contemporary debate, that is, (i) the problem of justifying how normative claims can be derived from a metaphysical theory of identity and (ii) a discussion of the many implications that the ethical debate about human identity and personhood has for policy making.
An Exemplar Case: Attributing Moral Values To Human Early Developmental Stages
One of the classical bioethical problems concerns abortion: is it morally permissible to interrupt a pregnancy? This question involves a question of identity over time, because we know that a human being develops from a fetus, that a fetus develops from an embryo, and that an embryo develops from a zygote. So if it is prima facie wrong to kill a human being, is it also prima facie wrong to kill a fetus, an embryo, or a zygote? Notice that there are two different issues at stake here: (a) one concerns whether we are numerically identical or not to our biological precursors, and (b) one concerns the moral implications that can be drawn from us having a certain relationship of sameness/ difference with these entities.
As for (a), different conceptions of identity yield different answers to the question “when do we begin?” If we hold that we are essentially persons (or authors of our life story), then we can only be numerically identical to other entities that possess the relevant traits for personhood (or authorship). As noted above, this view leads to the counterintuitive conclusion that we have never been a zygote, an embryo, a fetus, and perhaps not even a newborn. If, instead, we hold that we are essentially human animals, then we can say that we are numerically identical to all our biological precursors that came into being after it was no longer possible for them to further divide in two (or more) individuals – an event that occurs around the second week of gestation. Endorsing this criterion provides a clear answer to the question concerning the origin of our numerical identity, and it implies that any abortion performed after the second week involves the killing of a human being.
Now, answering to (a) does not solve the moral issue of abortion, for one cannot derive an ought from an is. Thus, a useful way of seeing many positions within the contemporary debate over the morality of abortion is to consider them as a function of both one’s (i) theory of identity and of one’s (ii) moral sensibility. By “moral sensibility” we refer here to the general attitude that one would endorse with respect to the moral permissibility of abortion. Importantly, sometimes (i) and (ii) might prima facie conﬂict or lead to unwanted consequences. For example, one can be morally contrary to abortion but philosophically in favor of a psychological view for which embryos and fetuses are not persons. Likewise, one can morally endorse a liberal position about abortion – and even about postnatal abortion – but be a philosophical supporter of a biological criterion of identity for which every abortion after the second week entails the killing of a human being.
In such cases, one must ﬁnd a complementary theory either to resolve the conﬂict or to avoid the unwanted conclusions. For example, those endorsing a psychological criterion but who are morally contrary to abortion may argue that even though our biological precursors are not “us,” they nonetheless have the “potential” to become us or that abortion is morally wrong because, similarly to killing, it precludes to an entity of the possibility of having “a future like ours” (Marquis 1989). Likewise, one might accommodate a liberal position about abortion with a commitment to a biological criterion by endorsing an “interest-over-time account” for which one’s moral value depends not only on her identity but also on how much she has “invested” in her future up to that point (DeGrazia 2005). Unsurprisingly, none of these alternatives is uncontroversial.
Other Bioethical Problems That Raise Questions About Our Identity
The moral problem of abortion well exempliﬁes the way in which philosophical and metaphysical claims about identity may get interwoven with moral and ethical considerations. However, there are at least ﬁve other bioethical issues that are usually identiﬁed as being closely tied to philosophical questions about human identity. Here it is possible to provide only a synthetic charting of these complex problems:
- The Authority of Advance Directives. Consider the case of a woman who, in the earliest stage of Alzheimer’s disease, signs an advance directive stating that if she becomes unable to make fully autonomous and competent choices, then she also does not want to receive any lifesaving measure (De Grazia 2005). By the time she is in a demented state, she gets pneumonia. Aside for her diseases, however, she seems to still enjoy some experiences (e.g., the company of her dogs and relatives, eating, etc.), and if asked if she wants to live, she answers “Yes”. In the light of her advanced directives, should the doctors administer or withhold the antibiotics needed to treat the pneumonia? Our answer to this moral question may depend on how we answer the following identity-related questions: (i) In which sense is the woman who signed the advance directive identical to the woman who is now in a demented state? (ii) What matters in our survival? (iii) Should different persons be free to select for themselves different criteria of identity and survival?
- Providing a Criterion for Death. When do we die? Though this question is presumably important for everyone, answering this interrogative is also crucial to deal with many practical issues, such as those related to the morality of (i) burying or cremating someone, (ii) explanting organs, and (iii) withholding life-support treatments.
Here there are at least two macro-problems. The ﬁrst is methodological: one might ask whether it is needed to have a criterion and a deﬁnition of “death” for answering the above questions and/or what ideal features a criterion and a deﬁnition of death should possess to be practically useful (Boniolo 2007; Boniolo and Di Fiore 2008).
The second problem, instead, concerns the chosen criterion of death and its implications for the above questions. Here the answer to the question “when do we die?” may depend on the answer to the question “who (or what) are we?” Supporters of biological views tend to hold that we die when our organism dies. Consistently with current medical standards, “organismic death” is then usually equated with the irreversible cessation either of our circulatory and respiratory functions (the cardiorespiratory standard or CR) or with the irreversible cessation of all functions of the entire brain, including the brainstem (the whole-brain standard or WB). However, it is currently debated whether the CR or the WB can provide, either alone or in combination, a satisfactory criterion for death (Boniolo 2007; DeGrazia 2005). Another option, favored by philosophers and typically associated with psychological and narrative views, is to opt instead for the higher-brain standard and to argue that we die when we incur in an irreversible and permanent cessation of the capacities for consciousness. This view, however, has never been adopted in clinical contexts and entails that people in permanent vegetative states are already dead, a conclusion that sounds counterintuitive to many. So far, none of the proposed criteria for death has won universal recognition, and the debate is still ongoing.
- Treating Patients with Dissociative Identity Disorder (DID). The treatment of patients with DID presents some interesting puzzles about personal identity and morality. Suppose that a patient, Bill, suffers from DID and has three different personalities, each of which takes periodically control of his behavior. Furthermore, each personality is oblivious as to what the others do. In the cases of patients with DID, does each personality correspond to a separate person or not? To what extent is a therapy ﬁnalized at eliminating one or more personalities morally permissible? To what extent is Bill, or any other of his personalities, morally accountable for the actions that Bill performed under the control of one of his other personalities?
- Prenatal Genetic Interventions and Enhancement. Suppose that it is possible to modify the human genome with a prenatal intervention – a possibility that, in the light of recent technological advances, may soon become available. Such prenatal genetic interventions could be used as therapies (e.g., removing an aberrant mutation predisposing the carrier for a certain disease) and/or as enhancements (e.g., selecting a certain allele to ensure better physical performances). But would it be ethical to use this kind of intervention? In answering this moral question, it is common to refer to the philosophical problem of identity at least under two respects. First, those who object to this kind of intervention usually justify their position by explaining that these technologies would unduly modify some core features of our human nature, i.e., of our human identity. Second, it is prima facie unclear to what extent the use of such interventions would impact the identity of the newborn: in which respect will the child born after the use of such interventions be different from the child that would have otherwise been born? As in the case of abortion, also in this case metaphysical and moral considerations are closely intertwined, and thus, one’s answer to these questions may depend on one’s theory of identity and on one’s moral sensibility with respect to the modiﬁcation of core features of human nature or individual identity.
- The Nonidentity Problem. One of the most notorious puzzles involving identity and morality relates to the obligations that we think we have toward people that, because of our acts, come into being but have existences that, though still worth having, are somehow ﬂawed (Parﬁt 1984). Suppose that a woman is advised by her doctor to avoid pregnancy until she has completed her current medical treatments, for otherwise she will give birth to a child with some mild cognitive impairment. She decides to ignore the doctor’s advice; she remains pregnant and, accordingly, she gives birth to a child who is mildly cognitively impaired. Our intuition suggests that this woman has done something wrong; however, it is surprisingly hard to justify this intuition. One cannot say that she has wronged her child for, had she delayed her pregnancy, this particular child would have not been born. On the other hand, it seems equally hard to maintain that she has wronged the child that would have been born had she delayed pregnancy, as it is unclear how someone that does not yet exist may be “harmed.” Among other things the nonidentity problem thus seems to challenge our widely shared intuition that beneﬁcence must be always constructed in reference to someone, rather than impersonally.
The concept of identity plays an important role in several bioethical debates. Depending on which conception of human identity one endorses, one might then use different argumentations to support or object to the moral permissibility of certain practices.
Yet, before concluding, it is important to mention two other senses in which the debate about identity is currently impacting bioethics. First, some scholars have argued that it is possible to deconstruct the genealogy of contemporary bioethics, revealing it as the more or less implicit expression of a speciﬁc cultural, racial, and gendered identity, typically, as the historical by-product of a Western, White, and male value system and perspective. Second, in the last decades, several scholars have proposed alternative conceptual frameworks whose common aim is that of overcoming the perceived shortages and biases of current mainstream bioethics. Examples of such alternative conceptual frameworks include, among others, Christian bioethics, Islamist bioethics, Buddhist bioethics, or feminist bioethics. Despite their differences in scope and methodology, all these conceptual endeavors share the common intuition that bioethics is not an identity-neutral enterprise and thus that the answer to the “who are we?” question may also determine the kind of bioethics that we would be prepared to endorse and recognize as appropriate in different contexts.
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