By Frances M. Kamm, Littauer Professor of Philosophy and Public Policy at Harvard’s Kennedy School of Government, Professor of Philosophy in the Harvard University Faculty of Arts and Sciences, and Petrie-Flom Academic Fellow alumna
This book is a collection of Frances M. Kamm‘s articles on bioethics, which have appeared over the last twenty-five years and which have made her among the most influential philosophers in this area. Kamm is known for her intricate, sophisticated, and painstaking philosophical analyses of moral problems generally and of bioethical issues in particular. This volume showcases these articles – revised to eliminate redundancies — as parts of a coherent whole. A substantive introduction identifies important themes than run through the articles. Section headings include Death and Dying; Early Life (on conception and use of embryos, abortion, and childhood); Genetics and Other Enhancements (on cloning and other genetic technologies); Allocating Scarce Resources; and Methodology (on the relation of moral theory and practical ethics).
12:15-2:15pm: “The Science and Ethics of Moral Enhancement”
Can we create a morality pill? Neuroscientists are discovering how hormones and brain chemicals shape aspects of social behavior relevant for morality, including empathy, cooperation, aggression, trust, and altruism. This work opens potential avenues for pharmacological manipulation of ethical values. In this session, speakers will review studies demonstrating how neuromodulators shape moral decisions, evaluate the evidence for and challenges facing the development of moral-enhancing interventions, and discuss the ethical implications of shaping human morality.
Format: 20-minute presentations and 60 minutes of Q & A
Moderator: Barbara Sahakian, University of Cambridge
Julian Savulescu, University of Oxford
Patricia Churchland, Univ of California-San Diego
Molly Crockett, University of Zurich
4:30-6:30pm, “States of Consciousness: Neuroethics in impairments of consciousness, brain-machine interfacing and end of life decisions?”
Recent brain-imaging studies detected covert awareness in a small proportion of patients in vegetative or minimally conscious state. In rare cases patients were even able to answer yes or no questions. Brain stimulation can lead to behavioral improvements of the minimal conscious. What are the ethical and legal implications of these findings for withdrawal of life-sustaining treatment or food and fluid? How reliable is communication via a brain-computer interface especially when it comes to end of life decisions? This panel will discuss a broad range of clinical challenges as well as ethico-legal implications with four renowned experts in the field.
Format: Brief statements of 5 – 8 minutes followed by discussion among the panel and 60 minutes of Q & A
JLB will become the preeminent outlet to publish cutting-edge scholarship wherever law and the biosciences intersect. The journal will take a broad and interdisciplinary view of these areas, publishing articles on topics generally considered part of bioethics or neuroethics, such as the ethical, legal, and social implications of reproductive technologies, genetics, stem cell research, neuroscience, or human biological enhancement. At the same time, JLB will be a home for work that speaks directly to legal issues where the biosciences can be involved, such as food and drug regulation, biosciences patent law, scientific evidence, and criminal responsibility.
In “Company seeks to make sperm banks safer,” a recent article in the Boston Globe, Bill of Health blogger Dov Fox recently weighed in on new companies that propose to screen sperm donor DNA in an effort to reduce the chance that children conceived with donated sperm will have childhood genetic diseases:
Dov Fox, an assistant professor at the University of San Diego School of Law who studies bioethics, said it is unclear whether genomic understanding will evolve to allow testing such as GenePeeks offers to ever be informative for common diseases caused by a blend of genetic and environmental risk factors. And he, like others, worries that one day such technology will be extended to not just avoiding disease, but selecting the babies parents want. GenePeeks will not cross that line, Morriss said.
“‘Some people might say this is in some respects similar to dating websites to the extent you look for traits in somebody you want to have children with,’ said Dov Fox, a law professor at the University of San Diego. But the important question, he said, is whether the accuracy from the genetic testing, albeit imperfect, makes 23andMe’s service more troubling.”
[...] commercial farming of oranges and grapefruit is in dire peril from an insect-borne bacteria that causes a disease known as “citrus greening.” An uncontrollable fungal blight is destroying the banana crop around the world. Coffee rust is knocking out plants in Central and South America. Diseases like rice blast, soybean rust, stem rust in wheat, corn smut in maize, and late blight in potatoes destroy at least 125 million tons each year of the world’s top five foods. The damage done to rice, wheat, and maize alone costs global agriculture $60-billion per year. The effects are especially catastrophic in the developing world, where 1.4 billion people rely on these foods.
There is a way to get rid of such otherwise unstoppable plant diseases, which waste scarce resources, bring about malnutrition and starvation for hundreds of millions, and cost the world economy billions of dollars. Genetically modified organisms.
Specifically, engineering plants to resist the diseases. So why don’t the folks bearing the bad news about GMOs make a connection to the huge problems that could be fixed by genetic engineering? The answer is the bungling mismanagement of a potentially useful breakthrough technology by the GMO industry, alongside market forces that produce GMOs friendly to pesticides rather than hostile to fungi. [....]
Bad management thus turned a technology that should have been greeted as a way out of chemically based farming into a public-relations nightmare.
[In part I, I considered, and rejected, arguments that doping harms the athletes and treats human nature wrongly.]
Spirit of sport
Let us now turn to the third objection: the use of PEDs destroys the spirit of sport. Of course, “spirit of sport” is a rather nebulous concept. Here is what the WADA has to say about it:
The spirit of sport is the celebration of the human spirit, body and mind, and is characterized by the following values: Ethics, fair play and honesty; health; excellence in performance; character and education; fun and joy; teamwork; dedication and commitment; respect for rules and laws; respect for self and other participants; courage; community and solidarity. Doping is fundamentally contrary to the spirit of sport.
Even if one agrees with this not-very-useful definition, it remains a mystery how the WADA deduces that doping (if allowed) is contrary to this spirit so defined.
I think it is better to put the WADA’s statement aside and see if there can be a better use of this concept of the “spirit of sport.” To demystify it, one may ask two questions: what is the purpose/aim of professional sports, and why do we cheer for an athlete. Once we clarify what we mean by the spirit of sport, we can inquire how doping corrupts this spirit.
Sports news has a permanent section now: the doping news. Less than a month ago, Gay and Powell (“the second and the fourth fastest men of all time”) also tested positive for banned substances. What used to be a scandalous piece of news (maybe with its final anti-hero being Lance Armstrong) became more of a curiosity item. The problem of doping became so wide-spread (tainting even curling!) that it is casting doubt on every medal we have ever seen in sports history. The war against doping seems to be a failure and even those who previously fought against doping now start to re-consider their views.
Under the current rules, the ethical problem with doping is obvious: fairness. Those who cheat the system have an unfair advantage. However, the cheating argument is valid only when doping is prohibited. If the use of performance enhancing drugs (PEDs) were allowed, there would be no cheating since every sportsperson would be equally entitled to use them.
Then, why not just allow doping?
Three objections are common:
1. It is dangerous/harmful for the athletes.
2. It treats human nature wrongly.
3. It violates the spirit of sports.
Anthony Stokes, a fifteen year old kid from Decatur County, Georgia, is expected to die in a matter of months, according to his doctors at the Children’s Healthcare of Atlanta. Maybe, they say, he will live for six months. Who knows? Anthony suffers from an enlarged, increasingly less functional heart. His condition is not unusual, and a reasonably effective cure is at hand: a heart transplant. (Learn more about Anthony’s story here.)
However, Anthony has become the latest victim of a dysfunctional U.S. transplantation system, which tempts Americans with a transplant waiting list, but kicks them off if they become too sick or too old. The problem is that there are too few organs to meet demand, and this perennial problem receives far too little attention from Congress. Indeed, the U.S. transplantation list, coordinated by the United Network for Organ Sharing, UNOS, (a private organization that coordinates significant aspects of the U.S. transplant system) is so overcrowded that patients increasingly turn to black markets in India, China, Pakistan, South Africa, and other countries if they hope to survive. (Learn more about that here.) Congressional hearings document Chinese prisoners dying and shortly thereafter Americans receiving organs.
Anthony’s family and some local organizations claim that racism is behind doctors refusing to place the boy on the transplant list. Anthony is African American. They ask, what is the harmin letting him on the list?
Blackjack players who “count cards” keep track of cards that have already been played and use this knowledge to turn the probability of winning in their favor. Though many casinos eject card counters or otherwise make their task more difficult, card counting is perfectly legal. So long as card counters rely on their own memory and computational skills, they have violated no laws and can make sizable profits.
By contrast, if players use a device to count cards, like a smartphone, they have committed a serious crime. For example, several iPhone apps helps players count cards and at least one has a “stealth mode” that lets users surreptitiously enter data and receive feedback. In response, the Nevada Gaming Control Board issued an open letter reminding the public that using such an app when betting at blackjack violates the state’s antidevice statute which provides for up to 6 years imprisonment for a first offense. Somehow using a device to augment our abilities to remember and to calculate turns a perfectly legal activity into an offense with a very serious penalty.
The fact that we do not criminalize natural, unassisted card counting raises interesting questions of criminal and constitutional law: Could we criminalize natural card counting without violating fundamental principles that protect thought privacy? (Email me for a manuscript on that question.) In this recently published paper, however, I focus on a puzzle about technological enhancement. Namely, can we justify criminalizing device-assisted card counting but not unassisted card counting?
The importance of the question extends beyond the world of blackjack and casino gaming because it appears, at least superficially, that antidevice statutes criminalize a kind of technological enhancement. Some ethicists distinguish therapies that seek to return us to normal, healthy functioning from enhancements that promise to give us extraordinary abilities. People are often much more comfortable with therapies (e.g., drugs or devices to treat attention deficit disorder) than with enhancements (e.g., drugs or devices to give us better-than-normal concentration).
As a historical matter, casinos lobbied for antidevices statutes in the 1980s to protect their revenue as computers were becoming more popular and accessible. I focus on a deeper question: Is there any moral justification for permitting an activity, like card counting, when it uses only our natural abilities but severely punishing the activity when it is technologically enhanced? I consider a couple of possible justifications for the differential treatment and suggest that both are lacking.
[Editor's Note: This is Glenn Cohen guest posting on behalf of Kim Mutcherson, what follows below is her post. I will be posting on behalf of several symposium contributors over the next few days.]
On Friday, April 5, a group of almost 30 (mostly legal) scholars gathered at Rutgers Law-Camden to have difficult conversations about abortion and assisted reproduction. The event, sponsored by Rutgers Law and the Law School Initiative of the Center for Reproductive Rights (http://reproductiverights.org/en/our-work/law-school-initiative) sought to initiate discussion about the seeming gulf between those working on issues related to abortion and those working on assisted reproduction and assisted reproductive technology (ART). Friday’s conversation was the first of at least three planned events with the other two to be sponsored at some future point by the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School and the Program for the Study of Reproductive Justice in the Information Society Project at Yale Law School. If the nature of the conversation at this kick-off event is a harbinger of things to come, I am anticipating that top-notch and cutting edge scholarship related to reproductive rights and reproductive justice will emerge from workshop participants.
While it might seem intuitive that scholars of reproduction would talk often, much of the work in this arena exists in silos. Those writing about abortion have plenty of work to do in keeping up with the flurry of state laws seeking to destroy what remains of Roe v. Wade in a post-Planned Parenthood v. Casey world. And those working in the world of assisted reproduction have to keep abreast of emerging science that is always light years ahead of what the law has done or seems capable of doing. As a consequence, opportunities to study the intertwining and divergence between the right to end a pregnancy and a right to create one are sparse.
And so, in the year that we commemorate the 40th anniversary of Roe,we engaged in a respectful, honest, and richly complex dialogue about the appropriate paradigm for understanding the right to abortion and the right to use assisted reproduction—liberty, equality or some new paradigm that we have yet to fully embrace or articulate.
An earlier post discussed the equivocal efficacy of Propecia (finasteride) as a baldness remedy, ending with the provocative assertion that, efficacy aside, “there is little reason for anyone ever to buy or consume Propecia (finasteride), or any doctor ever to prescribe it, since a much cheaper and identical chemical sold under the trade name Proscar (finasteride), is available.” This post continues the discussion, addressing one small component of the rising cost of healthcare—the cost of finasteride. It explores why consumers pay as much as $240 for a bottle of Propecia (finasteride) when a $9 bottle of an equivalent, FDA-approved supply of the identical chemical is readily and legally available at nearby stores.
In the exorbitantly priced landscape of prescription drugs, there is at least one low-cost oasis: Wal*Mart. Though some find reason to criticize the discount store, few would disapprove of the dozens of prescription medications Wal*Mart offers for an unbeatable $4 for a 30-day supply. Cost-sensitive consumers can purchase everything from blood thinners to antidepressants to antibiotics at this price, while a 90-day supply is only $10 (and this price includes shipping to your doorstep). A handful of drugs that cannot be sold at $4 per month sell for a still-modest $9. For the 300 or so drugs on Wal*Mart’s list, this means there is no longer a need for $10 co-pays or snowy treks to the pharmacy in 15 degree weather. That’s right: the Wal*Mart total price is less than most insurance company co-pays. Finally, a major industry player seems to have put effective downward pressure on prescription drug prices. Continue reading →
Questionable baldness remedies have been peddled since the beginning of medicine. According to Pliny (23-79 A.D.), ashes of seahorse could cure baldness. Almost 2000 years later, the British Medical Association warned the public of the increasing “number of preparations put forward for the cure of baldness,” particularly those which “are not applied locally but taken internally.” The purported active ingredient? “[H]aemoglobin.” (see Secret Remedies (1909), page 114).
While the medicinal use of a seahorse or dried blood matter may sound fanciful to modern ears, one has to wonder whether today’s public is any less credulous: Worldwide, consumers have spent over $400 million per year on a modern baldness remedy known by the trade name Propecia (finasteride). Has science finally triumphed over a medical condition that has persisted through millennia? Today’s consumers might rationally believe that its has, given that Propecia is FDA-approved for the treatment of alopecia (baldness). FDA-approved remedies must, according to federal law (21 U.S.C. § 355(d)), prove their efficacy in well-controlled, clinical investigations.
Yet one need only walk through a crowded street to see that, if a baldness cure has truly arrived, a surprising number of people have not availed themselves of it. Is Propecia, then, not effective? Let us take a look at the official data. Continue reading →
Due to the string of December holidays and some traveling by the round-up author, this post belatedly summarizes tweets from the end of 2012 to the beginning days of the new year. The round-up will resume a regular schedule following the conclusion of this week. Read below for this (extended) round-up:
Frank Pasquale (@FrankPasquale)posted an article about China’s growing obesity problem, one that shocks those who remember the Great Famine of 1958-61 and which is still largely minimized by government officials. The total number of obese individuals in China has risen from 25% in 2002 to 38.5% in 2010, according to the World Health Organization. (1/1)
Frank Pasquale (@FrankPasquale) also tweeted this blog post on the possibilities of cyborgs, a potential reality that a recent BBC article notes may not be too distant. Such an invention could potentially result in direct mental control of machines, augmented intelligence, augmented learning, and mood modification, among other benefits, postulates the article author. (1/1)
Frank Pasquale (@FrankPasquale) additionally posted a piece addressing the idea of love between humans and robots. (1/3)
Alex Smith (@AlexSmithMD) announced the release of PREPARE, an online advanced care planning tool meant for individuals to foster communication skills and prepare for decision-making rather than make premature plans. The project in part is meant to help empower individuals rather than have them tied to the medical establishment. (1/4)
Dan Vorhaus (@genomicslawyer) included a blog post on crowd-funding personalized bioscience, particularly summarizing companies aiming to contribute outside the genetics realm. This includes sequencing the gut microbiome and noting biomarker concentrations through the blood. (1/7)
Michelle Meyer (@MichelleNMeyer)posted an article decrying the paternalistic attitudes surrounding the release of genetic information to patients. Not only does this article claim that “People are smarter & more resilient [re #genetic info] than ethic debates give them credit for”, as Meyer references from the article, but it also recognizes that the complexities of the genome do not make it less necessary for doctors to figure out how to discuss it with the public. (1/7)
Michelle Meyer (@MichelleNMeyer)also posted about the Supreme Court’s decision regarding a case on government funding of embryonic stem cell research. SCOTUS declined to hear an appeal to stop the research, which opponents claimed was in violation of the 1996 Dickey-Wicker law. (1/7)
Daniel Goldberg (@prof_goldberg) posted about a recent study on the influence of body weight and gender on courtroom judgments. The Yale Rudd Center for Food Policy and Obesity found that only an obese female was punished when in consideration along with a lean male, an obese male, and a lean female. Goldberg notes in his tweet that the results are “unreal but sadly [unsurprising]“. (1/8)
Alex Smith (@AlexSmithMD) retweeted an article lamenting the continued fall of fellowship trained geriatricians, which noted that the decrease in numbers is surprising considering that a boost from the Affordable Care Act raises a geriatrician’s annual salary by 12 percent through 2015. (1/9)
Arthur Caplan (@ArthurCaplan) shared a link on a sperm donor custody case in Kansas where the sperm provider thought he had absolved any connection to the child that his sperm would create, but is now being called upon to pay child support. While similar cases have not received as much media attention, the concept – being responsible financially as a result of having genetic ties to a child – has come up in cases involving fathers who were deceased yet were called to pay through their estate, and even in a similar sperm donor case in Pennsylvania in 2011. (1/10)
Frank Pasquale(@FrankPasquale) posted an article discussing the recent move by various healthcare centers requiring their health practitioners (doctors and nurses alike) to get a flu vaccine – possibly at the risk of their job. Should this be grounds for termination, or should the healthcare providers have the same choice to abstain from vaccination as does a patient? (1/13)
Note: As mentioned in previous posts, retweeting should not be considered as an endorsement of or agreement with the content of the original tweet.
A special issue published this month by the Journal of Philosophy & Technology features a collection of articles discussing evolution, genetic engineering, and human enhancement. Recent years have seen a rapidly expanding variety of approaches to exploring the normativity of human enhancement, by philosophers, bioethicists, physicians, and biologists. The articles in this special issue largely focus on the question: how can evolution and aetiological teleology inform biological ethics and theories of human enhancement?
For a separate collection of articles discussing the ethics of human enhancement from the perspective of the physician-patient relationship, see this special issue by the American Journal of Bioethics, published approximately a year ago.
Former Penn State football coach Jerry Sandusky was recently sentenced to 30 to 60 years in prison for serial child sex abuse. Sandusky had faced as great as a 400-year potential sentence during trial, but even the 30 year minimum term will likely exceed his natural lifespan all the same: at 68-years-old, Sandusky will probably die in prison long before serving his time. If he lives to the average life expectancy of 75, he will have served only a quarter of his minimum sentence. In light of the vileness and severity of his crimes, Sandusky’s death may leave many victims and observers feeling that death provided an early exit from deserved punishment.
Curiously enough, Sandusky’s former employer patented and licensed a telomerase reporter system capable of monitoring the regulation of telomere maintenance. Telomeres are microcellular regions that protect against gene degradation and promote cell longevity. The maintenance (or lengthening) of telomeres through telomerase therapy is an exciting subfield of life-extension therapy that may radically lengthen human lifespans in future.
The arguments for and against this and other forms of human enhancement technology are fairly well combed-over in popular discourse: it’s unnatural; it’s sinful; it’s unfair; it’s arrogant. On the other hand, this and other subfields of gerontology profess some noble goals: to improve the ratio of “good years” with years of morbidity; to deliver unto humans a “gift” of possibly unlimited life. But what if we inverted the concept of life extension therapy as a “gift,” and could administer it to criminals like Jerry Sandusky, in order to extend their remaining life up to the end of their sentence? Telomerase therapy may be a continual treatment; it could conceivably even be withdrawn to give the old man just enough “life” to watch the clock on his last day. Continue reading →
Forget Lance Armstrong for a second and think about “biomedical moral enhancement”, a proposal recently defended by Ingmar Persson and Julian Savulescu in Unfit for the Future. The Need for Moral Enhancement. In this book Persson and Savulescu claim that neither our current moral software – our morality of common sense as they call it- nor the institutions of liberal democracies are capable of coping with what they label as “ultimate harms”: the perils of terrorism and climate change which might efface human species from Earth.
The reason is that according to Persson and Savulescu we suffer from certain cognitive biases which prompt our moral blindness towards the suffering of those who are not near and dear. Also that we remain hooked to a causal conception of responsibility which gives us the perfect excuse for not blaming ourselves for our tiny – albeit jointly necessary- contributions to the causation of big disasters: from the emission of pollutants to the consumption of red meat. In a nutshell: Evolution did not equip us with the sense of justice and altruism that global poverty and the environmental destruction demand. The solution? Continue reading →
Interesting decision (H/T Wall Street Journal Law Blog ) from the D. Mass ordering the state to pay for a sex change operation for a prisoner. I’ll have more to say on the case soon once I’ve digested, but just wanted to share it for now.