Tag: racism

Bioethics Blogs

Responsibility in the age of precision genomics

by Alexa Woodward

Alexa is a fellow in the Precision Medicine: Ethics, Policy, and Culture project through Columbia University’s Center for the Study of Social Difference. The following is her reflection on the ongoing discussion around the Precision Medicine Initiative that has been the subject of recent political, social, and popular media attention. A recent presentation by Sandra Soo-Jin Lee, PhD, from the Center for Biomedical Ethics at Stanford University spurred our multi-disciplinary discussion of some of the following themes.

What is normal, anyway?

Genetically speaking, that’s precisely the question that the Obama administration’s Precision Medicine Initiative (PMI) seeks to answer. In recruiting and collecting comprehensive genetic, medical, behavioral, and lifestyle data from one million Americans, the scientific and medical communities will be better able to understand what constitutes normal genetic variation within the population, and in turn, what amount of variation causes or contributes to disease or disease risk.[1] Using this data, researchers could potentially create tailored approaches for intervention and treatment of an incredible range of diseases.

The PMI has a secondary aim: to increase the representation of previously underrepresented populations in research – primarily African Americans and Hispanics/Latinos. Inclusion of these groups in research has been a challenge for decades, with lack of access, distrust in the medical and research systems, and institutionalized racism all playing exclusionary roles. More broadly, outside of the government initiative, the promise of precision medicine ultimately seeks to alleviate disparities by finding and addressing supposed genetic differences, and empowering people with information to take responsibility for their health.

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

The Ethics of In Vitro Gametogenesis

Françoise Baylis comments on the ethics of using gametes derived from human induced pluripotent stem cells for future human reproduction.

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A recent New York Times article, provocatively titled “Babies from Skin Cells? Prospect is Unsettling to Some Experts,” has once again drawn attention to controversial research by scientists at Kyushu University in Japan who succeeded in making fertile mouse pups using eggs created through in vitro gametogenesis (IVG). This is a reproductive technology that involves creating functional gametes (sperm and eggs) from induced pluripotent stem cells. Induced pluripotent stem cells are cells derived from adult body cells (such as skin cells) that have the ability to become other body cells including reproductive cells (sperm and eggs).

Supporters of this reproductive technology eagerly anticipate similar research in humans. Indeed, enthusiasts are quick to trumpet the potential benefits of in vitro gametogenesis. These benefits fall into three general categories.

First, we are told that research to derive human gametes from induced pluripotent stem cells is important for basic science. It will advance our understanding of gamete formation, human development, and genetic disease. In turn, this increased understanding will create new options for regenerative medicine.

Second, we are told that this research will allow clinicians to improve fertility services. For example, with in vitro fertilization (IVF), women typically have to undergo hormonal stimulation and egg retrieval. This can be onerous in terms of the time required for interviews, counseling, and medical procedures. It can also be harmful. Potential psychological harms include significant stress and its sequelae.

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 & Society Newsfeed: May 5, 2017

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Politics

What Obama’s Former Ethics Counsel Thinks of Trump
Norm Eisen, former ethics counsel to President Obama and co-founder of Citizens for Responsibility and Ethics in Washington (CREW) discusses the ethical issues of the Trump administration’s first 100 days.

White House aims for Thursday signing of religious liberty executive order
A win for conservatives, especially the Vice President, the new religious liberty executive order is expected to be signed Thursday.

Ethics office says it wasn’t consulted about Ivanka Trump job
Ivanka Trump was brought on as a White House adviser without consulting the Office of Government Ethics.

State Department Promotes Ivanka Trump’s Book In Another Ethics Blunder
A State Department office retweeted post promoting Ivanka Trump’s new book despite federal rule that bars the use of public office for private gain.

Bioethics and Medical Ethics

This New App Is Tinder For Sperm And Egg Donors
“The ethical and legal complexities of egg-shopping.”

Jimmy Kimmel’s powerful, poignant Obamacare plea crystallizes the GOP’s dilemma
Late-night host Jimmy Kimmel made an emotional plea to lawmakers to fund health-care spending for preexisting conditions, discussing his newborn son Billy’s heart condition on his show.

Firestorm brewing as scientists work to create synthetic human DNA
Scientists say that synthesized human DNA could be a reality in as little as 5 years, invoking ethical questions and concerns.

Informed Consent Becoming More Difficult?
“The recent decision in Ike White v. David Beeks, M.D., has threatened to turn this consent process on its head, especially if it were to be adopted in other states.”

5 things to know about infertility treatments
Treatment for infertility can be expensive and clinics are scarce, calling into question ethics issues.

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: What Makes Discrimination Wrong? Written by Paul de Font-Reaulx

This essay was the winner in the Undergraduate Category of the Oxford Uehiro Prize in Practical Ethics 2017

Written by University of Oxford student, Paul de Font-Reaulx

 

The question of this essay is this: What makes discrimination wrong? Most of us intuitively take discrimination based on gender or ethnicity to be impermissible because we have strong rights to be treated on the basis of merit and capacity rather than e.g. ethnicity or gender. I argue that this suggestion is indefensible. I show that well-informed discrimination can sometimes be permissible, and even morally required, meaning we cannot have absolute rights not to be discriminated against. In the last part I suggest an alternative account, arguing that acts of discrimination are wrong because they violate individuals’ weak right to be treated fairly and create negative externalities which – analogously to pollution – there is a collective responsibility to minimize. These results are counterintuitive, and require further attention.

1.     What is Discrimination?

I take discrimination to be to treat someone very differently based on an irrelevant trait. A trait is relevant if and only if it by itself provides reasons for different treatment in some instance, such as constituting a difference in merit or capacity. Otherwise it is irrelevant. For example, in the case of boxing the trait of weighing 70kg is relevant for finding opponents, while as the trait of hair colour is not. Of the two, only different treatment on the basis of the latter would constitute discrimination[1].

Discrimination based on bigotry such as racism is often indefensible simply because it rests on ungrounded beliefs about the relevance of traits such as ethnicity.

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

40th Annual Health Law Professors Conference

If you teach health law, come to the 40th Annual Health Law Professors Conference, June 8-10, 2017, at Georgia State University College of Law in Atlanta.  Here is the schedule:


Thursday, June 8, 2017
8:00-12:00 AM Tour of the Centers for Disease Control and Prevention (Separate registration is required. Participants meet in the lobby of Georgia State Law to take a shuttle to the CDC.)


9:45 – 11:15 AM Tour of Grady Health System (Separate registration is required. Participants meet in the lobby of Georgia State Law and will walk over to Grady as a group.)


2:00 – 5:00 PM Conference Registration – Henson Atrium, Georgia State Law


3:00 – 5:00 PM Jay Healey Teaching Session – Knowles Conference Center, Georgia State Law
Experiential Teaching and Learning in Health Law
The format for this session is World Café roundtables, with plenty of opportunity for the collegial exchange of teaching ideas and insights among your colleagues. Come prepared for a lively, interactive workshop.
World Café Hosts:
Dayna Matthew, University of Colorado Law School
Charity Scott, Georgia State University College of Law
Sidney Watson, Saint Louis University School of Law
Invited Discussants and Participants:
Rodney Adams, Virginia Commonwealth University School of Health Administration
Christina Juris Bennett, University of Oklahoma College of Law
Amy Campbell, University of Memphis Cecil C. Humphreys School of Law
Michael Campbell, Villanova University Charles Widger School of Law
Erin Fuse Brown, Georgia State University College of Law
Cynthia Ho, Loyola University of Chicago School of Law
Danielle Pelfrey Duryea, University of Buffalo School of Law, State University of New York
Jennifer Mantel, University of Houston Law Center
Elizabeth McCuskey, University of Toledo College of Law
Laura McNally-Levine, Case Western Reserve University School of Law
Jennifer Oliva, West Virginia University College of Law and School of Public Health
Thaddeus Pope, Mitchell Hamline School of Law
Lauren Roth, St.

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

Luhrmann and Marrow’s Our Most Troubling Madness by Murphy Halliburton

Our Most Troubling Madness: Case Studies in Schizophrenia Across Cultures

T.M. Luhrmann and Jocelyn Marrow, editors

University of California Press, 2016, 304 pages

 

A key premise of this volume of ethnographic case studies is that schizophrenia, or the various conditions we label as schizophrenia and related psychoses, varies in crucial ways in terms of experience, prognosis and outcome in different sociocultural contexts. Tanya Luhrmann’s introduction to the volume, which features twelve articles presenting twelve individuals diagnosed with schizophrenia (including three cases presented by Luhrmann), casts doubt on the biomedical model of schizophrenia, or at least the strong biomedical model where an individual’s biology is the determining factor in the pathogenesis of schizophrenia. Support for this critique comes from within the fields of psychiatry, psychology and related disciplines, and not just from anthropology, the disciplinary home base of many of the authors in this compilation. This supports the volume’s efforts to speak to an audience beyond the contributors’ own disciplines and “serve as a positive catalyst for change” in how we treat psychosis, especially in European and North American settings (5).

The introduction also briefly traces the history of theories of schizophrenia in psychiatry and anthropology, including moments when the two fields overlapped as with Gregory Bateson’s theory that schizophrenia results from a “double bind” that develops in a person’s psyche from conflicting social cues. This theory, put forth by an anthropologist, had a significant place in psychiatrists’ understanding of pathogenesis until the rise of the medical model deflected the blame from families toward “random bad genetic luck” (16).

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

Mari Mikkola, The Wrongs of Injustice: Dehumanization and its Role in Feminist Philosophy, Oxford University Press, 2016

Mari Mikkola identifies three primary forms of social injustice—oppression, domination, and discrimination—and asks what makes them wrong. She argues that feminist philosophy has thus far focused heavily on gender as a lens or anchor through which to understand and respond to injustice. In Mikkola’s view, this orientation around gender (and what she terms “the gender controversy”) is limiting feminist philosophers’ theoretical engagement with the roots of injustice. To remedy this problem, she builds a case for moving toward a more broadly humanist conception of injustice. The humanist feminism that she puts forth centers dehumanization as a way to theorize injustice; dehumanization, for Mikkola, is the very foundation of injustice.

Following an introductory chapter that frames Mikkola’s approach and argument, the book is divided into two parts. The first part of the book is dedicated to articulating Mikkola’s argument for moving beyond the “gender controversy” in feminist philosophy. She explains that the perspectives debated in the gender controversy produce two kinds of puzzles: one semantic, the other ontological. The semantic puzzle asks: “Given that ordinary language users tend not to distinguish sex and gender (treating ‘woman’ largely as a sex term, or a mixture of social and biological features), what precisely are feminists talking about when they talk about ‘women’? What are the necessary and sufficient conditions that the concept woman encodes, if any such conditions exist to begin with?” (28). The ontological puzzle, by contrast, is concerned with: “How should we understand the category of women that is meant to undergird feminist political solidarity, if there are no necessary and sufficient conceptual conditions underlying our gender talk?

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

Web Roundup: Moral enhancement by Jane Roberts

This month’s web round up focuses on notions of treatment as enhancement…or vice versa? I’ve recently come off a stretch of spending quite a lot of time reading up on debates surrounding behavioral disorders in children. One issue that seems to crop up repeatedly is whether the use of medications in these young populations, particularly those living with ADHD, is merely treatment for the problem, or increasing the normalization of enhancement in an era where, for many, being ‘enough’ just isn’t enough anymore .

A recent article proposed that the millennial generation is more concerned with self- improvement and holds higher self-expectations than any generation before. Academic and social pressures, especially in those who have spent more of their formative years on social media, play into a wider societal expectation that one should be the best that they can possibly be using whatever means are available. The use of medications like Adderall for treatment of ADHD has long been indicated, but in this era of striving for self- improvement, such medications have moved from the realm of treatment to that of performance enhancer. The rise of the good grade pill is how the New York Times characterized a trend in high school students taking Adderall to gain an academic edge, while a growing percentage of doctors are willing prescribe Adderall to help in school, especially to those kids who are at an economic disadvantage.

This idea of academic performance enhancement via pharmaceutical means has been with us for a while, but what seems to be having its moment now is the notion of moral enhancement- the very sci-fi sounding possibility that behavior can be changed to something more morally acceptable through the use of a pill.

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

Cross Post: Liberal or conservative? Most of our beliefs shift around

Written by Prof Neil Levy,

Senior Research Fellow, Uehiro Centre for Practical Ethics, University of Oxford

This article was originally published on The Conversation

What? Okay, that sounds good. Justin Lane/EPA

One common reaction to the election of Donald Trump (and perhaps to a lesser extent, the Brexit vote) among liberals like me is an expression of dismay that some of our fellow citizens are more racist and more sexist than we had dreamed. It seems many were prepared, if not to support openly racist comments and sexist actions, then at least to overlook them. It looks as though battles we thought we had won, having to do with a recognition of a basic kind of equality, need to be fought all over again. Many have concluded that they were never won at all; people were just waiting for a favourable climate to express the racism and sexism they held hidden.

This story is surely at least partially true. Anyone who has recently come out in support of Richard Spencer – the “leader” of the alt-right movement – for example, was likely just waiting for the right opportunity to express their racism. But I suspect the story is quite different with regard to most of the people who voted for Trump or Brexit. They never were strongly anti-racist, and they are not really and deeply racist now. Insofar as they had views on these matters at all, they were and are pretty undeveloped.

In fact, our beliefs are often quite vague and malleable. This is particularly true with regard to moral and political beliefs.

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

The Knick by Gregory Clark

“The More Things Change, The More They Stay The Same”

When I first watched The Knick two years ago, it seemed like a show about the past and the rapid pace of medical discoveries in the early days of modern medicine, before antibiotics, when patients were still brought into the hospital on an ambulance pulled by horses. When I watched the fictional Dr. Thackery using electricity for the first time in his operating room, I couldn’t help but sit back smugly and marvel at how far we have come since those early days of modern medicine.

Now, re-watching the first season of The Knick as a first year medical student in NYC, I’ve found myself focusing more on the similarities between medicine at the turn of the 20th century and today than the differences. Part of my excitement is particular to being in NYC. I get a thrill when I recognize street names, or when they mention the hospitals where I am slowly learning how to be a doctor. In a deeper way though, I no longer see the characters in The Knick as distant, historical figures. The problems that they confront are many of the problems we face in our medical culture today: the pervasiveness of racism; the stigma surrounding mental health issues; birth control rights for women; doctors becoming addicted to their own drugs; and even how to pay for the treatment of uninsured patients.

Now when I watch The Knick, I wonder how could it be possible that we are no closer to solving these problems a full century later.

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.