Tag: scarcity

Bioethics Blogs

In the Journals – August 2017 by Livia Garofalo

Here is the article round-up for August, put together in collaboration with Ann Marie Thornburg.  There is a special issue section of Social Science and Medicine out this month on Austerity, Health, and Wellbeing (abstracts below). Also of note is a recent ‘Takes a Stand’ statement on the End of AIDS published in Global Public Health by Nora Kenworthy, Richard Parker, and Matthew Thomann. You can take advantage of the article being temporarily free access and on early view here. Enjoy!

 

Cultural Anthropology (Open Access)

Tangles of Care: Killing Goats to Save Tortoises on the Galápagos Islands

Paolo Bocci

If calls to care for other species multiply in a time of global and local environmental crisis, this article demonstrates that caring practices are not always as benevolent or irenic as imagined. To save endemic tortoises from the menace of extinction, Proyecto Isabela killed more than two hundred thousand goats on the Galápagos Islands in the largest mammal eradication campaign in the world. While anthropologists have looked at human engagements with unwanted species as habitual and even pleasurable, I discuss an exceptional intervention that was ethically inflected toward saving an endemic species, yet also controversial and distressing. Exploring eradication’s biological, ecological, and political implications and discussing opposing practices of care for goats among residents, I move past the recognition that humans live in a multispecies world and point to the contentious nature of living with nonhuman others. I go on to argue that realizing competing forms of care may help conservation measures—and, indeed, life in the Anthropocene—to move beyond the logic of success and failure toward an open-ended commitment to the more-than-human.

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

More about Charlie Gard

Dr. Robert Truog, the bioethicist and transplant physician who has pushed the envelope on the definition of death, has weighed in on the Charlie Gard case in a “Perspectives” piece that is generally available (i.e., without a subscription) from the Journal of the American Medical Association (JAMA).   By all means read it.

Dr. Truog approaches the case from the standpoint of limiting medical research—indeed, that’s in the title of his article.  He says the case is about “the best interest of the patient, financial interest, and scientific validity.”  On the first point, he is cautious about the British courts’ assertions that it can assess how much pain and suffering Charlie is experiencing, and whether the courts know this better than the baby’s patients.  This caution seems wise.  As I have reflected further on this case it strikes me that I may be missing a legal distinction between Britain and the US; frankly, I am not well-versed on British law in these cases.  I do tend to think of the Gard case in terms of substituted decision-making in the case of severe or terminal illness.  My thought process runs through the checkpoints.  First, the patient’s wishes are paramount.  In this case, the patient cannot express wishes and may not be able to form them.  In that case, second, a surrogate decision-maker should speak for the patient using “substituted judgment” or “substituted perspective” to express how the patient might have approached the case if able to express wishes.  Here, the parents are available to speak for the patient. 

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

Ten years since the discovery of iPS cells. The current state of their clinical application

Photo Neurons derived from human iPS cells Stem Cells Australia

Background

Few biomedical discoveries in recent decades have raised so many expectations as the achievement of adult reprogrammed cells or induced pluripotent stem (iPS) cells.1

Pluripotent cells are obtained from adult cells from various tissues that, after genetic reprogramming, can dedifferentiate to a pluripotency state similar to that of embryonic cells, which allows for subsequent differentiation into different cell strains.2,3

In our opinion, this discovery is relevant not only to biomedical issues but also to ethical ones, given that iPS cells could replace human embryonic stem cells (see HERE) – whose use raises numerous ethical problems – in biomedical experimentation and in clinical practice. However, after the last 10 years, the use of iPS cells has still not been clarified. A number of expectations have been met, but other mainly clinical expectations are still far from being achieved.

Current research limitations with iPS cells

There is a notable low efficacy in the techniques employed for obtaining a sufficient proportion of iPS cells, which represents a difficulty in its clinical application.4  Another limitation is the incomplete reprogramming, which depends on the type of cell employed,5 and the problems of mutagenesis resulting from inserting exogenous transcription-factor coding genes, which can cause tumors in the employed cells used.6 Recent studies aim to mitigate this effect.7 A clinical trial for treating macular degeneration with retinal pigment epithelium cells derived from autologously obtained iPS cells has recently been halted.8 After an initially successful experience with the first treated patient, the genetic sequencing of the iPS cells obtained from the second patient revealed mutations in 3 different genes, one of which was classified as oncogene in the Catalogue of Somatic Mutations in Cancer.

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:In It To Win It: Is Prize-giving Bad for Philosophy? Written by Rebecca Buxton

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, Rebecca Buxton

INTRODUCTORY REMARKS
We live in a culture of prize-giving. The Nobel Prize, the Medal of Honour, the Man Booker and, not least, the Oxford Uehiro Prize in Practical Ethics. But, in giving such prizes, and indeed prize money, we operate under the assumption that prizes are ‘good’. However, the fact that I am offered a prize for writing
a practical ethics paper is itself a practical ethical conundrum. This essay takes a preliminary amble into the ethical problem of prize-giving with regards to Philosophy specifically, offering reasons as to why we should question current practice. Primarily, I will define what we mean by the term ‘prize’ noting its
necessary and sufficient features. Secondly, I discuss the impact of prize-giving on research, considering how the ramifications of ascribing value through prizes affects the course of academia, especially when focusing on the lack of diverse voices within the subject. I then consider the deeper question of philosophical value: does the very act of constructing an ethical argument for a prize diminish the value of the work?

THE IDEA OF ‘THE PRIZE’
Though prize-giving is prolific in our current institutional culture, we lack any analytically clear literature on what constitutes a ‘prize’. There is, however, some work focusing on the philosophical concept of ‘the gift’, most notably Derrida’s argument that the ‘true’ gift is impossible as we can never eliminate the possibility of the counter-gift.[1]

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

Ontario doctors back out of euthanasia

Some Canadian doctors who agreed to carry out euthanasia have withdrawn their names only months after legalisation, according to the National Post. “I can’t tell you how many, but I can tell you that it’s enough that it’s been noted at a systemic level,” says Dr Jeff Blackmer, of the Canadian Medical Association.

The figures are hard to obtain, but in Ontario, 24 doctors have removed their names permanently from a voluntary referral list of doctors who will help people die, and 30 have asked for a temporary hold. At the moment, there are 137 doctors in the province who have agreed to perform euthanasia.

“We’re seeing individuals, or groups of physicians who are participating and really feel like they’re alleviating pain, alleviating suffering,” Dr Blackmer told the National Post. “And then we’re seeing doctors who go through one experience and it’s just overwhelming, it’s too difficult, and those are the ones who say, ‘take my name off the list. I can’t do any more.’ ” Even if it is supposed to be a compassionate act, he says, “it doesn’t make the psychological impact of that final, very definitive act, any less than it would be for anybody.”

Moral misgivings and emotional distress are two reasons why doctors might be reluctant. But another doctor interviewed by the National Post suggested that bureaucracy, social stigma, paperwork and legal ambiguity are more to blame. Phrases in the legislation like “grievous and irremediable”, “enduring suffering” and “reasonably foreseeable” can be interpreted in different ways.

“Can you understand why people might be concerned and say, ‘maybe this isn’t for me’?”

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

Fee-for-service: an ethical conflict

Andrew Mitchell suggests that innovative institutional changes are needed to sustain universal healthcare in Canada.

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When Canadian provinces instituted universal healthcare, doctors were reluctant to become salaried employees, so a system of fee-for-service was developed. This payment model creates incentives for physicians to focus on quantity instead of quality of care and turns patients into bits of piecework. Indeed, most of us have experienced the whirlwind consultation with a doctor eager to get to the next patient.

Fees for specialist services are greater than those for family doctors. This encourages physicians-in-training to specialize and reduces the supply of family doctors. On average, doctors in Canada earn over $250,000 annually. Specialists often make twice this amount. Some specialists earn more than a million dollars a year. These kinds of salaries encourage individuals to enter medicine for reasons of high income and status, rather than a true desire to serve those who are sick.

Healthcare services are expensive and so they are rationed by provincial governments that restrict both the numbers of doctors and specialists, and the availability of operating rooms and diagnostic equipment. In this way, governments create an artificial, administered market for healthcare characterized by a scarcity of healthcare providers and high costs. This rationing often results in wait times for treatment, with some patients waiting for more than a year in pain and distress.

Physician associations have bargained with provincial governments and received benefits for doctors that usually would be considered employee benefits. In British Columbia, for example, the benefits include a disability plan and continuing education benefits.

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

Does Having Too Much Money Make Us Stupid?

As a science, economics does not always succeed at predicting how humans behave. The discipline assumes a level of rationality, and an ability to process complex information, that far exceeds human capacity. But as a standard for how people ought to behave, economics provides an excellent set of lessons. Consider the economic principle of consistency in financial trade-offs. If you are purchasing an appliance at a chain store, for example, and find out the product you are buying is $50 cheaper at the store across town, rational economic choice would ask you to ponder whether the time and expense and hassle of that cross town trip is worth the $50 in savings. That pondering – that economic decision – should be unchanged regardless whether the appliance you are purchasing will cost you $100 or $1000.

But of course when faced with this scenario, people are not economically or logically consistent. When imagining the purchase of a $100 appliance, far more people report being likely to travel to save $50 (a 50% savings!) than when they are asked to imagine that the original purchase price was $1000, and the $50 reduction feels barely noticeable.

Aren’t people cute? Isn’t inconsistency and sloppy economic reasoning adorable?

You might even wonder whether the people who exhibit this kind of inconsistent behavior simply do not understand the value of time and money. Maybe they don’t have enough economic savvy to think carefully about trade-offs, like this one between time/effort and money.

Or maybe they simply have too much money to bother to be consistent! 

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

Top of the Heap: Adia Benton by Hannah Gibson

For this installment of Top of the Heap, I was delighted to work with Assistant Professor Adia Benton from Northwestern University.

I think it’s probably common for people to talk about how large their book heap is. Mine is no different. I’m at the end of my sabbatical and the beginning of my maternity leave. The former should have left me ample time to read, the latter… not so much. I am juggling a couple of book projects right now, so the books I have at the top of the pile reflect those interests and the ideas spinning off from them. The ones that continue to rise to the top are On Being Included, by Sara Ahmed. The book is about diversity initiatives in a university setting. In addition to being a useful account of these efforts at a time when these conversations are taking place in academia, I see this book as potentially offering lessons about how institutions “think”, how they issue documents and propose non-solutions to those problems. Expected Miracles, by Joan Cassell, is an older book. It’s still relevant in that it describes the culture of surgery in US hospitals and many of its insights still ring true for the surgeons I know. Habeas Viscus, by Alexander Weheliye, is a slim and dense book that provides a much needed corrective to accounts of biopolitics and bare life that are insufficiently attentive to race.

I’m almost done with Randy Packard’s A History of Global Health. Packard lays out a straightforward account of why, at different points in time, international health and colonial public health largely focused on disease-specific programs, rather than on the social determinants of 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 Clickbait Candidate

By James Williams (@WilliamsJames_)
Note: This is a cross-post with Quillette magazine.

While ‘interrobang’ sounds like a technique Donald Trump might add to the Guantanamo Bay playbook, it in fact refers to a punctuation mark: a disused mashup of interrogation and exclamation that indicates shock, surprise, excitement, or disbelief. It looks like this: ‽ (a rectangle means your font doesn’t support the symbol). In view of how challenging it seems for anyone to articulate the fundamental weirdness of Trump’s proximity to the office of President of the United States, I propose that we resuscitate the interrobang, because our normal orthographic tools clearly are not up to the task.

Yet even more interrobang-able than the prospect of a Trump presidency is the fact that those opposing his candidacy seem to have almost no understanding of the media dynamics that have enabled it to rise and thrive. Trump is perhaps the most straightforward embodiment of the dynamics of the so-called ‘attention economy’—the pervasive, all-out war over our attention in which all of our media have now been conscripted—that the world has yet seen. He is one of the geniuses of our time in the art of attentional manipulation.

If we ever hope to have a societal conversation about the design ethics of the attention economy—especially the ways in which it incentivizes technology design to push certain buttons in our brains that are incompatible with the assumptions of democracy—now would be the time.

Trump’s cynical and dangerous candidacy should be prompting urgent late-night video conferences among leaders in the technology industry.

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: Ethical Technology, Moral Medicine by Emily Goldsher-Diamond

Researchers at MIT have launched Moral Machine, a web project to help gauge human perspectives on “moral decisions made by machine intelligence.” The project comes in the wake of a new Science study regarding the complicated tangle of ethics and driverless cars, where the classic ‘trolley problem’ has been scaled up for new technology. Scientific American, weighing in, writes that real autonomy for new vehicles hinges not on manufacturer issues but on the moral and ethical dilemmas inherent in the new technology. Consumer demand is high and climbing. Mainstream discussions, however, continue to black box the ethical and moral within larger questions about safety systems. The Atlantic traces the driverless car back to the 1920s, where desire was driven by “the promise of improved safety.” Similarly, Volvo’s ongoing Future of Driving survey, while heavy on questions of safety and trust, makes no mention of whether or not driverless vehicles have ethics or ought to be moral. Today’s news, that BMW has secured partnerships with Mobileyes and Intel, ensures that the debates around autonomous vehicles are sure to intensify.

MIT Technology Review has written about Kevin Esvelt’s campaign to regulate gene drives in order to avoid “doomsday” outcomes. Esvelt’s vision for a safe gene drive is distinctly caught up in moral projects. A safe gene drive–one built around transparency and community input–is “a way to rectify what [Esvelt] considers a larger failing of the universe, which is that evolution itself “has no moral compass.”…Gene drives, by giving humankind the ability to fine-tune the battle for survival, could make the world a more just place.”

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.