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Preface | |
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Introduction | |
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Challenges of the Genetic Age | |
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Previews of Perplexities | |
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Genetic Communitarianism | |
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Personal Choice or Public Health Concern? | |
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The Quest for the Perfect Baby | |
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Health Care in the Age of Genetic Intervention | |
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The Genetic Enhancement Certificate | |
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The Need for Systematic Ethical Thinking | |
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Genomic Research and Genetic Intervention | |
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The Human Genome Project and Related Genetic Research | |
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Modes of Genetic Intervention | |
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The Shadow of Eugenics | |
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Two Models for Genetic Intervention | |
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The Public Health Model | |
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The Personal Service Model | |
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A Third Approach | |
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Ethical Analysis and Ethical Theory | |
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Principles for Institutions | |
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Justice | |
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Preventing Harm | |
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Limits on the Pursuit of "Genetic Perfection" | |
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The Morality of Inclusion | |
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Ethical Theory and Public Policy | |
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Science Fiction Examples, Reflective Equilibrium and the Ideological Uses of Genetic Determinism | |
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The Risk of Reinforcing "Gene-Mania" | |
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Genetic Determinist Fallacies | |
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Ideological Functions of Genetic Determinism | |
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Eugenics and its Shadow | |
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The Relevance of Eugenics | |
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Optimism and Anxiety | |
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Eugenics as a Cautionary Tale | |
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Eugenics: A Brief History | |
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Origins and Growth | |
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Varieties of Eugenics | |
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The Nazi Debacle | |
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Decline and Fall | |
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Common Themes of Eugenicists | |
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Degeneration | |
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Heritability of Behavioral Traits | |
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Eugenic Ends | |
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Ethical Autopsy | |
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A Creature of Its Time | |
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Why Was Eugenics Wrong? Five Theses | |
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The Public Health and Personal Service Models | |
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Cost-Benefit Justifications for Genetic Intervention | |
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The Social Dimension of Genetics | |
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Genetics Constrained by Justice | |
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Genetics in Pursuit of Justice | |
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Conclusion | |
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Genes, Justice, and Human Nature | |
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Distributive Justice Issues Raised by Genetic Intervention | |
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Including the Distribution of Natural Assets in the Domain of Justice | |
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The Traditional View: Natural Inequalities Are Not a Concern of Justice | |
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Challenging the Traditional View | |
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Equality of Opportunity | |
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Two Variants of the Level Playing Field Conception | |
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Resource Egalitarianism and the Domain of Justice | |
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Individual Liberty and Genetic Intervention | |
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Genetic Equality? | |
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A "Genetic Decent Minimum"? | |
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Points of Convergence | |
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The Colonization of the Natural by the Just | |
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Blurring the Distinction Between the Subjects and Objects of Justice | |
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Justice, Human Nature, and the Natural Bases of Inequality | |
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Three Conceptions of the Relation of Human Nature to Ethics | |
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Genetic Causation, Freedom, and the Possibility of Morality | |
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Human Nature and the Idea of Moral Progress | |
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Genetic Intervention in the Name of Justice | |
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Intervening to Prevent Limitations on Opportunity | |
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Regulating Access to Interventions to Prevent a Widening of Existing Inequalities | |
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Ratcheting Up the Standard for Normal Species Functioning | |
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Tailoring Environments to Special Genetic Needs | |
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The Obligation to Prevent Harm | |
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Conclusions | |
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Positive and Negative Genetic Interventions | |
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Old Distinctions in New Clothes | |
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Positive and Negative Eugenic Goals for Populations | |
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Positive and Negative Interventions and the Health and Welfare of Individuals | |
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Moral Boundaries and the Positive/Negative Distinction | |
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Treatment Versus Enhancement: Wide Use, Hard Cases, Strong Criticism | |
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Insurance Coverage and "Medical Necessity" | |
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Treatment/Enhancement and Moral Hazard | |
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Treatments and the Limits of Obligations | |
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Hard Cases and Expansion of Obligations | |
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The Microstructure of the Normal and Moral Arbitrariness | |
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Two Objections to the Treatment/Enhancement Distinction | |
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A Limited Defense of the Treatment/Enhancement Distinction and Its Circumscribed Use | |
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Treatment/Enhancement and the Obligatory/Nonobligatory Boundary | |
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The Primary Rationale for Medical Obligations | |
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Hard Cases and Expansive Views of Medical Obligations | |
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Three Philosophical Models of the Relationship Between Equal Opportunity and the Goals of Health Care | |
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The Normal Function Model as Better Public Policy | |
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Is the Normal Function Model a Moral "Second-Best"? | |
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Is the Treatment/Enhancement Distinction a Natural Baseline? | |
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Positive Versus Negative Genetic Interventions and the Permissible/Impermissible Boundary | |
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A Reminder about Science Fiction | |
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Negative and Positive and the Permissible/Impermissible Boundary | |
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Treatment/Enhancement and Moral Warning Flags | |
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Why Not the Best? | |
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Having the Best Children We Can | |
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What Could Be More Natural Than Parents Seeking the Best? | |
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Environmental Versus Genetic Pursuits | |
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What Is the Best and Who Decides? | |
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A Moral Distinction Between Actions | |
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Pursuing the Best for the Child | |
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Harms, Benefits, and General-Purpose Means | |
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The Right to an Open Future | |
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Limits on Pursuit of the Best | |
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Pluralism and Liberalism | |
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Virtues and the Best | |
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Constraints on Permissions Allowed Parents | |
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Enhancements, Coordination Problems, and Harms to Others | |
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Enhancements and Fairness | |
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Uncertainty and the Risks of Pursuing the Best | |
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Cloning | |
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Conclusion | |
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Reproductive Freedom and the Prevention of Harm | |
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The Wider Context: Conflicts Between Liberty and Harm Prevention | |
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What Is Reproductive Freedom? | |
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Rights and Freedoms | |
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Positive and Negative Freedom | |
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Summary of the Scope of Concern | |
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The Interests and Values That Determine the Moral Importance of Reproductive Freedom | |
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Self-Determination | |
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Individual Good or Well-Being | |
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Equality of Expectations and Opportunity | |
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Use of Genetic Information to Prevent Harm | |
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Distinguishing Cases | |
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Post-Conception Interventions to Prevent Harms Compatible with a Worthwhile Life | |
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Prevention of Harms across Many Generations | |
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Pre- and Post-Conception Interventions to Prevent Harms Incompatible with a Worthwhile Life | |
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Pre-Conception Interventions to Prevent Conditions Compatible with a Worthwhile Life | |
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Conclusion | |
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Genetic Intervention and the Morality of Inclusion | |
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Objectives | |
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The Morality of Inclusion | |
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Neglect of the Morality of Inclusion in Ethical Theory | |
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The Allegation That the New Genetics is Exclusionary | |
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The Public Promise of the New Genetics: Better Lives for All Through Medical Genetics | |
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Challenging the Rhetoric: The Radical Disabilities Rights Advocates' Complaints | |
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Sorting Out the Concerns of Disabilities Rights Advocates | |
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The Loss of Support Argument | |
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The Justice Trumps Beneficence Argument | |
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The Expressivist Objection | |
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The Deaf Culture Argument | |
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The Social Construction of Disability and the Morality of Inclusion | |
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Distinguishing Disabilities from Impairments | |
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Options for Eliminating Disabilities | |
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Choosing a Dominant Cooperative Framework | |
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The Concept of a Dominant Cooperative Framework | |
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Why the Choice Is a Matter of Justice | |
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How Genetic Interventions Might Affect the Character of the Dominant Cooperative Scheme | |
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Knowledge of Genetic Differences and the Morality of Inclusion | |
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Conclusion | |
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Policy Implications | |
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Where Does the Shadow of Eugenics Fall? | |
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The Inevitable Comparison | |
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Public Concern about Genetic Research | |
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Beyond Rules of Thumb | |
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Distributive Justice | |
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The Right to Health Care | |
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Additional Arguments for Access to Genetic Interventions | |
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Securing Equality | |
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If People Are Not Equal Should We Treat Them So? Should We Make Them So? | |
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Will Human Genomic Research Push Society to the Right? | |
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Must Everyone Have Access to Enhancements? | |
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Enhancements versus Treatments | |
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Families | |
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Reproductive Freedom and Coercive Eugenics | |
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Restrictions on Parental Choice | |
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Citizenship and Inclusion | |
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A Ghetto Walled by Data | |
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Devaluing the Less Than Perfect | |
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Reducing the Risk of Exclusion | |
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State, Society, Individual, and Markets | |
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The Threat of the Eugenic State | |
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Eugenics as a Moral Obligation? | |
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Eugenic Public Policy? | |
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Utopian Eugenics? | |
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Markets and Individual Liberty | |
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Commercial Genetics | |
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Liberal Neutrality and Democratic Decisionmaking | |
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The Permissibility of Rights-Respecting Genetic Perfectionist Policies | |
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The Meaning of Genetic Causation | |
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Three Modes of Intervention | |
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Four Key Questions | |
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Do Genes Causally Contribute to the Trait? | |
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How Much Do Genes, as Opposed to Environment, Contribute to the Trait? | |
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Which Genes Contribute to the Trait? | |
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How Do These Genes Contribute to the Trait? | |
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Conclusion | |
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Acknowledgments | |
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Methodology | |
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The Method of Reflective Equilibrium | |
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The Charge of Parochialism | |
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The Communitarian Challenge | |
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The Limits of "Principlism" | |
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A Liberal Framework | |
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Negative and Positive Rights: Freedom and Well-Being | |
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Justifying the Liberal Framework | |
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References | |
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Index | |