Tag: harm

Bioethics Blogs

Radical Technology, Bodyhacking, & Medicine

Michele Battle-Fisher calls on conventional medical to consider how acts of healing will change in the context of transhumanism.

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Humanness is in flux as human bodies are being hacked (altered) by transhumanists and others in their quest for super wellness, super intelligence and super longevity.

Bodyhacking refers to changing the human body in appearance and function using a “device, technique or procedure that an individual CHOOSES to utilize, augment, modify or improve their body.” Examples of bodyhacking include implanting magnets under one’s skin to be able to open a garage door, and implanting an engineered human ear on one’s arm to gain hypersensory abilities. Typically, such ‘hacks’ are not approved by governmental agencies or traditional medical insurance. According to Body Hacking Con, while bodyhacking is typically considered fringe, bodyhackers are “simply people who hack (alter) their bodies.”

Bodyhacking is part of a counterculture movement that is often called transhumanism. Transhumanists believe that the body is obsolete and that death is a cruel end to be avoided. In their view, the time is ripe for taking advantage of fast-paced technologies to improve our imperfect bodies and eventually cheat death.

Recent revolutionary innovations such as CRISPR/Cas9 gene-editing technology are helping to further push the boundaries of bodyhacking by fighting the genetic causes of death. While the medical community has accepted the idea of somatic cell gene editing, germline gene editing remains controversial.  There is much excitement in the transhumanism community that biohacks such as CRISPR will move from the purvue of controlled medical settings to the at-home, do-it-yourself labs.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Putting A Lid On Waste

Needless medical tests not only cost $200B – they can do harm. This overly aggressive care also can harm patients, generating mistakes and injuries believed to cause 30,000 deaths each year

Source: Bioethics Bulletin by the Berman Institute of Bioethics.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

How you’ll grow up, and how you’ll grow old

By Nathan Ahlgrim
Nathan Ahlgrim is a third year Ph.D. candidate in the Neuroscience Program at Emory. In his research, he studies how different brain regions interact to make certain memories stronger than others. In his own life, he strengthens his own brain power by hiking through the north Georgia mountains and reading highly technical science…fiction.

An ounce of prevention can only be worth a pound of cure if you know what to prevent in the first place. The solution to modifying disease onset can be fairly straightforward if the prevention techniques are rooted in lifestyle, such as maintaining a healthy diet and weight to prevent hypertension and type-II diabetes. However, disorders of the brain are more complicated – both to treat and to predict. The emerging science of preclinical detection of brain disorders was on display at Emory University during the April 28th symposium entitled, “The Use of Preclinical Biomarkers for Brain Diseases: A Neuroethical Dilemma.” Perspectives from ethicists, researchers conducting preclinical research, and participants or family members of those involved in clinical research were brought together over the course of the symposium. The diversity of panelists provided a holistic view of where preclinical research stands, and what must be considered as the field progresses.
Throughout the day, panelists discussed different ethical challenges of preclinical detection in the lens of three diseases: preclinical research and communicating risk in the context of Autism Spectrum Disorder (ASD), interventions and treatment of preclinical patients in the context of schizophrenia, and the delivery of a preclinical diagnosis and stigma in the context of Alzheimer’s disease.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Agreement and disagreement about experimental treatment. The Charlie Gard Appeal

by Dominic Wilkinson and Julian Savulescu

@Neonatalethics

@juliansavulescu

Tomorrow, the UK Court of Appeal will review the controversial case of a British infant, Charlie Gard. Charlie’s parents are appealing a recent High Court decision that gave doctors permission to withdraw his life support. They have raised money for Charlie to travel to the US for an experimental medical treatment.

 

Best Interests

The legal decision for Charlie will be based upon an assessment of his best interests. He has a rare genetic disorder affecting his muscles and his brain. He has been on life support since last October and has been progressively deteriorating. A neurologist in the USA has suggested that experimental nucleoside treatment might, in theory, offer some benefit, though it has never previously been tried in this situation.

The central ethical question is whether it would be best to provide the experimental treatment and continue intensive care for Charlie for several months more, or to withdraw treatment and allow him to die. How should we weigh up the risks and benefits of those two alternatives?

We have previously written about this difficult question. In a pair of editorials in the Lancet medical journal, we expressed different points of view. Dominic Wilkinson argued that the proposed course of treatment would do more harm than good. In his view, it is likely that Charlie would experience pain and discomfort from continued treatment; it is also unlikely, given what is known about it, that Charlie would benefit from nucleoside treatment. In contrast, Julian Savulescu argued that it is not clear that continued mechanical ventilation in intensive care is so terrible a life that it would not be worth living.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Mailbag

Brief comments on four short articles from this week, on disparate topics:

James Capretta of the American Enterprise Institute (meaning he is politically right of center) pleads in the Journal of the American Medical Association (JAMA) for compromise between Republicans and Democrats on further healthcare policy reform.  Arguing that the House-passed American Health Care Act (AHCA) may never pass, he believes that a better result politically and for public policy would be if legislators could, in essence, split the difference between the AHCA and current law, the Affordable Care Act (ACA, aka “Obamacare”) on some points where he sees some agreements in principle.  He proposes: 1) a hybrid approach between the ACA’s income-based tax credits for health insurance purchase and the AHCA’s age-based approach; 2) ensuring continuous insurance coverage for people with pre-existing conditions by modifying the ACA’s penalties for not being insured to fall more heavily on higher-income people; 3) setting limits on the favorable tax treatment of employer-paid health insurance premiums; 4) automatically enrolling uninsured people into a bare-bones, no-premium plan from which they could opt out in favor of re-enrollment in a different plan (a proposal that sounds to me a lot like the Democrats’ “public option” with a guaranteed fight over scope of coverage); and 5) limiting Medicaid expansion to tie it to reform of the program (something that sounds to me a lot like what I understand is currently in the AHCA).  Mr. Capretta knows a lot more about health policy than I, and has been at it a lot longer.  His ideas seem reasonable.  But he admits that bipartisan compromise “may be wishful thinking,” and I must confess that my reaction to his article is, “when pigs fly.”

The editors of Nature smile on Pope Francis’s meeting with Huntington’s disease researchers and patients.  Many of the latter group, they note, are poor Venezuelan (who there is not poor—and oppressed—these days?) Catholics who greatly aided research with tissue donations “with little tangible reward.”  The editors further cite the Pope’s encyclical Laudato si, with its acceptance of the existence of anthropogenic climate change, as a hopeful sign that the Catholic Church will one day use its considerable influence to compromise on “sensitive issues” such as sanctity of human life from conception, and embryo selection.  Still, “there is a chasm between religion and science that cannot be bridged.  For all its apparent science-friendliness, Laudato si sticks to the traditional Vatican philosophy that the scientific method cannot deliver the full truth about the world.”  The editors call for “fresh dialogue” between science and religion—by which they mean capitulation of the latter to the flawed-on-its-face epistemology of the naturalist.  I’m not buying.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Analytics and the Prevention of Suicide

Greg Horne describes how data on social media can be used to identify and concentrate resources on groups who are at risk of suicide.

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Suicide is the second leading cause of death among youth in Canada. According to Statistics Canada, in 2011, it accounted for approximately 20% of the deaths of people under the age of 25. The Canadian Mental Health Association claims that among 15 – 24-year-olds the percentage of deaths caused by suicide is even higher, a frightening 24%– the third highest in the industrialized world. Recent reports also suggest that the suicide rates for First Nations and Inuit youth in Canada are from five to eleven times higher than the National average. Yet, despite these disturbing statistics, it is difficult, if not impossible, for health care providers (or friends and family) to identify whether a young person plans to injure themselves or die by suicide.

The warning signs leading up to a suicide can be easy to miss. For example, consider the recent spate of suicides at the University of Guelph. Was there a possibility of identifying the warning signs of increasing mental health issues at the University? Were there indications of a potential spike in suicides?

Some warning signs may be found online. Many people use social platforms like Facebook and Twitter to post detailed personal information about their health and their mental wellbeing. This information could help to identify groups who are at risk of self-harm or suicide.

SAS Canada, a data management, software development, and analytics company, is using a new artificial intelligence software solution to identify social groups that are at increased risk of suicide.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Oxford Uehiro Prize in Practical Ethics: Global Warming & Vegetarianism: What should I do, when what I do makes no difference? By Fergus Peace

This essay received an Honorable Mention in the Graduate Category of the Oxford Uehiro Prize in Practical Ethics 2017

Written by University of Oxford student, Fergus Peace

  1. The Problem of Cumulative Impact

In large, integrated societies, some of the most important moral challenges we face can only be resolved by large-scale collective action. Global poverty and climate change are problems which won’t be solved unless large numbers of people act to address them.

One important part of our response to these problems is to avoid fallacious ‘futility thinking’, a cognitive bias which makes people less likely to act when they see the problem as being too large for them to solve. You aren’t going to end world poverty alone, but that doesn’t mean there’s nothing you should do about it. Your individual donations can make an enormous difference.

Other problems, however, are more philosophically and practically challenging. Sometimes morally significant outcomes are driven by an aggregate which your individual action is powerless to meaningfully affect. In these cases, it’s not just that your individual action won’t completely solve the problem: it won’t do any moral good at all.

Consider a few examples.

  • Voting: No election of any real size is decided by a margin of one vote, so it’s true of your vote that it makes no difference: if you don’t vote and your candidate loses, your vote wouldn’t have made them win; if you do vote and they win, withdrawing your vote wouldn’t have made them lose.
  • Vegetarianism: Butchers don’t respond to every small change in their customers’ purchasing; wholesalers don’t respond to every change in one butcher’s purchasing; abattoirs and farms don’t respond to every change in wholesale orders.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Undermining the USPSTF: The most important stakeholders are the patients

A strange “health care” drama plays out daily in our clinics and hospitals. A healthy person has a medical test done (even though he or she is healthy): a blood test, a chest x-ray or mammogram, maybe an ultrasound of some body part. The test comes back abnormal. The patient (for she has now gone from being a healthy person to being a patient) is struck with worry, and undergoes a further round of testing to determine whether the initial, “screening” test was accurate. This more invasive, risky definitive testing causes the patient pain, complications, infections, further procedures to fix the complications. But the testing shows that the original screening test was wrong, and the patient is relieved of their worry and overcome with a sense of gratitude: “Yes, the follow-up surgery was painful, but at least it’s not cancer.” However, notice what caused the worry in the first place: not some symptom that they were experiencing, but a test that was performed on a healthy person. What a marvelous bit of sorcery: we take a happy patient, create unnecessary worry, then win their undying gratitude by performing risk-laden procedures on them to remove their worry!

There is something very intuitive about the concept that detecting a disease (especially cancer) early leads to better outcomes, that screening tests are inherently good. Yet when one studies the actual outcomes of implementing mass screening programs in a population of people who have no signs or symptoms of a particular disease, one finds to one’s surprise that, not infrequently, more people are harmed by our screening test than are helped (See: PSA testing, carotid ultrasounds, annual stress tests, etc).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Ethics, sexuality, and dementia in long-term care

Alisa Grigorovich and Pia Kontos suggest that long-term care residents with dementia can benefit from leisure and social activities that are supportive of sexual expression and the formation of intimate and romantic relationships.

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Recently, media stories on dementia have focused on the sexualities of persons living with dementia in residential long-term care settings, such as nursing homes. This media attention has been predominantly negative, consisting of descriptions of sexual violence, and apocalyptic warnings of the legal, ethical, and moral dangers of allowing persons with dementia to express their sexuality.

Often the primary criterion used to determine whether sexual encounters between residents with dementia are involuntary is the cognitive ability of the female resident. Frequently, she is characterized as globally incapable of agreeing to sexual activity because of cognitive impairment.

Consider, for example, the now infamous case of Henry Rayhons. He was accused (and ultimately acquitted) of sexually assaulting his wife who had dementia. As well, there is the lawsuit filed in a case involving two residents with dementia who had intercourse while living in Windmill Manor. While such stories highlight the importance of protecting vulnerable persons from sexual abuse, they ignore the need to also ensure that persons with dementia have opportunities to pursue intimate and romantic relationships.

Sexual expression is a universal human need that transcends age and disability. It has many positive health and wellness benefits, including the opportunity to experience pleasure, decreased pain sensitivity, and increased relaxation. However, older persons living in nursing homes often experience reduced sexual freedom.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Oxford Uehiro Prize in Practical Ethics: Prostitution: You Can’t Have Your Cake and Sell It*. Written by Simon-Pierre Chevarie-Cossette

This essay received an Honorable Mention in the Graduate Category of the Oxford Uehiro Prize in Practical Ethics 2017

Written by University of Oxford student, Simon-Pierre Chevarie-Cossette

Abstract:        I offer a new** argument for the thesis that prostitution is not just a normal job. It has the advantage of being compatible with the claim that humans should have full authority over their sexual life. In fact, it is ultimately the emphasis on this authority that leads the thesis that prostitution is a normal job to collapse. Here is the argument: merchants cannot (both legally and morally) discriminate whom they transact with on the basis of factors like the ethnicity or the religion of their client; but if prostitutes are ‘sex merchants’, then they cannot (both legally and morally) discriminate whom they have sex with on the basis of these factors. Yet everyone should have the full discretionary power to refuse to have sex under any circumstances.

1. Introduction

You have made it thus far: the wedding preparation is almost over. You enter your local bakery, cheekily anticipating the moment when you’ll order a wedding cake for ‘John & John’. But to your dismay, the baker turns you down because your marriage goes against his ‘Christian beliefs’.

This is a true story and it is a recurrent one. In 2013, Administrative Law Judge Robert N. Spencer found the owner of Masterpiece Cakeshop guilty of discrimination on the basis of sexual orientation.[1] The decision was then maintained by the Colorado Civil Rights Commission[2] and again by the Court of Appeal[3].

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.