Moral enhancement requires multiple virtues.

Some of the debates around the concept of moral enhancement have focused on whether the improvement of a single trait, such as empathy or intelligence, would be a good in general, or in all circumstances. All virtue theories, however, both secular and religious, have articulated multiple virtues that temper and inform one another in the development of a mature moral character. The project of moral enhancement requires a reengagement with virtue ethics and contemporary moral psychology to develop an empirically grounded model of the virtues and a fuller model of character development. Each of these virtues may be manipulable with electronic, psychopharmaceutical, and genetic interventions. A set of interdependent virtues is proposed, along with some of the research pointing to ways such virtues could be enhanced.

Ethical considerations regarding early liver transplantation in patients with severe alcoholic hepatitis not responding to medical therapy.

A recent study proposed that liver transplantation may represent life-saving treatment in patients with severe alcoholic hepatitis not responding to medical therapy. In this pilot experience, stringent patient selection resulted in major improvement of short-term survival with low rates of post-transplant alcohol relapse. In the context of organ shortage, which imposes a need for strict selection of transplant candidates, these results raise major ethical questions. Reluctance to perform liver transplantation in alcoholics is based on the fact that alcoholism is frequently considered to be self-inflicted and on fears of harmful post-transplant alcoholism recurrence. A minimal interval of sobriety lasting at least 6 months is a widely adopted criterion for the selection of patients with alcoholic liver disease for liver transplantation. In severe alcoholic hepatitis, the disastrous short-term prognosis in patients not responding to medical therapy does not allow one to reasonably impose an arbitrary period of 6-months of abstinence. This means that these patients must be either systematically excluded from transplantation or selected according to other criteria. Without significant pre-transplant abstinence, it might be argued that these patients do not merit a graft as they have not demonstrated their ability to gain control over their disease through durable modification of their behaviour. Consequently, this procedure could have a negative impact in the public, affecting organ donation and confidence in the fairness of transplant programs. In contrast, ethical principles recommend active treatment of patients, without discrimination, according to the best scientific knowledge. At this stage, we propose that there are no major ethical barriers for further evaluation of this new therapeutic option. The next steps should include transparent communication with the public and further studies to reproduce these results and identify the selection criteria that provide the best long-term outcomes.

Does participation in an alcohol administration study increase risk for excessive drinking?

It has long been thought that research protocols involving alcohol administration may exacerbate problem drinking in alcoholic subjects following their participation in such a study. However, recent studies suggest that involvement in an alcohol administration study does not, in fact, have a negative impact on subsequent drinking behavior. In the present study, 27 non-treatment-seeking alcohol-dependent subjects and 32 social drinkers participated in an alcohol administration study designed to investigate the effects of repeated doses of alcohol on craving, mood, and alcohol-seeking behavior. The volume of alcohol administered to the subjects was calculated in such a way that their blood alcohol concentration would reach a peak of 0.08 g/dl midway through testing. Before their release, alcohol-dependent subjects were given feedback regarding their level of alcohol consumption and provided with information about the potential harmful effects of their drinking behavior. Percentage of days abstinent (PDA), drinks per drinking day (D/DD), and percentage of heavy drinking days (PHDD, defined as >or=4 drinks per occasion for females and >or=5 drinks per occasion for males) were recorded for the 6 weeks preceding laboratory testing and for the 6 weeks following participation in the study. The alcohol-dependent subjects exhibited a significant increase of 24% in PDA during the poststudy period compared to the prestudy period. They also decreased their D/DD by 2.4 drinks per occasion, and decreased their PHDD by 21.6%. There were no differences in PDA or D/DD for the social drinkers between pre- and poststudy periods. There was, however, a small but significant increase of 3.5% in PHDD for the social drinkers following laboratory testing. These data suggest that participation in an alcohol administration study does not put alcoholic subjects at risk for increased alcohol consumption following study participation. In fact, participation in such studies may actually precipitate at least a temporary decrease in alcohol consumption, especially when paired with a brief intervention session. Thus, non-treatment-seeking alcoholics can be safely included in alcohol administration studies to provide results that are most relevant to the population of interest.