Could vaccine requirements for entering pubs be wrong, while closing pubs altogether is OK?
By Tom Douglas
Suppose that, before you could enter a pub, you had to produce a ‘vaccine passport’ showing that you had been vaccinated against the new coronavirus.
Vaccine requirements like this are controversial. In the UK, the government has been keen to deny that it is even considering their use. This is in some ways puzzling, for closing pubs altogether has not been that controversial, and preventing people from entering pubs without exception seems, at first sight, to be a greater imposition on liberty than preventing people from entering pubs without first being vaccinated. As my colleagues Julian Savulescu and Alberto Giubilini recently noted, it seems better, in terms of liberty, to have some choice than none.
This raises the question, could a vaccination requirement for entering pubs be wrong, while closing pubs altogether is not?
Should PREDICTED Smokers Get Transplants?
By Tom Douglas
Jack has smoked a packet a day since he was 22. Now, at 52, he needs a heart and lung transplant.
Should he be refused a transplant to allow a non-smoker with a similar medical need to receive one? More generally: does his history of smoking reduce his claim to scarce medical resources?
If it does, then what should we say about Jill, who has never touched a cigarette, but is predicted to become a smoker in the future? Perhaps Jill is 20 years old and from an ethnic group with very high rates of smoking uptake in their 20s. Or perhaps a machine-learning tool has analysed her past facebook posts and google searches and identified her as a ‘high risk’ for taking up smoking—she has an appetite for risk, an unusual susceptibility to peer pressure, and a large number of smokers among her friends. Should Jill’s predicted smoking count against her, were she to need a transplant? Intuitively, it shouldn’t. But why not?
Should we punish crimes from the distant past?
Former Auschwitz SS officer Oskar Gröning is currently being tried as an accessory to murder for his role as an administrator in the extermination camp, and the trial has stirred up a lot of debate. One strand of the debate addresses the question whether Gröning was complicit in the extermination of prisoners, and whether he was culpable for this complicity. (Roger Crisp wrote a fascinating post on this a couple of weeks back.) But another strand – and the strand that I want to look at here – has addressed the question whether former Nazi war criminals should be tried and punished for deeds in their distant past. Eva Mozes Kor, an Auschwitz survivor and witness in Gröning’s trial has claimed that he shouldn’t be tried, though he should use his knowledge to help fight holocaust denial.
Let’s suppose that Gröning was indeed a culpable accomplice to murder. Should he then be punished? More generally, should serious crimes from decades go be punished? My intuition is that they should, but reflecting on why I have found it is not straightforward to defend this view. Continue reading
Iterated in vitro reproduction and genetic orphans
In an article soon to be published in the Journal of Medical Ethics, Rob Sparrow imagines a procedure via which multiple generations of human embryos might be created in the laboratory. Egg and sperm cells would first be generated from existing or new human pluripotent stem cell lines. The resulting eggs would be fertilised using the sperm to create zygotes and ultimately embryos. Embryonic stem cells would then be harvested from these embryos and used to create new egg and sperm cells, which would in turn be used to fertilise one another to create further embryos. This process could be iterated, in principle indefinitely.
Let’s call this procedure ‘iterated in vitro reproduction’ (Sparrow calls it ‘in vitro eugenics’). Iterated in vitro reproduction is not yet possible, but, citing recent developments in the science of stem cell-derived gametes, Sparrow argues that it may well become so, though he acknowledges are number of significant hurdles to its development. He also discusses a number of possible applications of the technology and calls for an ethical debate on these. The most controversial application would be in the creation of designer children. Consider the following case, which is a variant on one of the scenarios imagined by Sparrow:
Jack and Jill present to a fertility clinic. Jack provides a sperm sample, and fertility doctors harvest a number of eggs from Jill. These eggs are fertilized with Jack’s sperm to create embryos, from which embryonic stem cells are derived. These stem cells are then induced to develop into eggs or sperm which are used to fertilise one another, and so on. The process is iterated numerous times, and at each stage, the embryos are genetically screened via pre-implantation genetic diagnosis. This screening is used to inform a process of selective crossing, so that, over several generations, the population of embryos evolves towards certain genetic dispositions desired by Jack and Jill (a disposition towards longevity, say). This process is aided by adding small amounts of genetic material from stem cell lines derived from other individuals. Eventually, doctors identify an embryo with almost exactly the desired combination of genes, and this embryo is implanted into Jill’s womb and carried to term. A child, Jarvis, is born.
Cases like this raise numerous ethical issues, some of which are discussed by Sparrow and the seven commentators on his paper. However, they also raise an interesting conceptual question: would the users of such a technology be the genetic parents of the resulting offspring? Would Jack and Jill be the genetic parents of Jarvis?
Destroying one ecosystem and constructing another: biodiversity offsetting and particular value
Suppose that the government is proposing a new policy regarding buildings of historical significance. Rather than simply banning the destruction of ‘listed’ buildings, the new policy would allow their destruction, provided that whoever destroys the building agrees to construct, somewhere nearby, a new building of a similar size, in a similar style, exhibiting a similar range of architectural innovations, and of a similar level of beauty. Blenheim Palace could be flattened and built over with a shopping mall and carpark, provided that mall developers agreed to construct a replica of the palace somewhere nearby.
Most would be disturbed by such a policy. Part of the reason that they would be disturbed, I presume, is that it seems to manifest a failure to recognise the true value of historical buildings. Not all of the value of historical buildings consists in their possession of generic properties like ‘being beautiful’, ‘being in the baroque style’ or ‘using space to dramatic effect’. Some of their value is value that they have as particular objects, and that could thus not be realised in any other object. Part of the value of Blenheim Palace derives from it’s being the birthplace of Winston Churchill. This value could not be realised in a replica of the palace built 5 miles down the road.
Of course, no-one is proposing a policy of sort I’ve just outlined. I bring it up because I think reflecting on this kind of case may throw some light on recent discussion regarding biodiversity offsetting (see, for example, here, here and here). Continue reading
Living near a busy road can kill you
Early April saw some unusually smoggy days across much of Western Europe, resulting in widespread media attention to air pollution.
(See, for example, here, here and here.) On one day, air quality in some parts of London was worse than in Beijing. Further attention has been drawn to the issue by a number of recent official reports, including one from the World Health Organisation, which has declared that air pollution is now the world’s biggest single environmental threat to health.
As has been noted, media coverage can give a misleading picture of the health risks of air pollution. Coverage tends to focus on short-term peaks, such as those seen recently in Western Europe, but the health risks of air pollution are primarily related to long term exposure, and show no ’safe threshold’ effect. Elevated baseline levels of pollution are thus more of a problem than occasional peaks.
There’s another important aspect of air pollution that often goes unnoticed; small geographical differences can have a marked effect on exposure to air pollution and thus on risk of adverse health effects. For example, living near a busy road appears to substantially increase air pollution-related mortality. A study published last year in the Lancet (press summary here) investigated the effects of very local differences in air quality on mortality by pooling 22 European cohort studies. The investigators found that an increase in average annual fine particulate (PM2.5) exposure of 5 µg/m3 was associated with a 7% increase in the risk of dying from all natural causes. This is approximately the difference between living on a busy urban road and living in a traffic-free area. The finding was robust in the face of correction for various possible confounding factors. Continue reading
What’s wrong with adopting out an adopted child?
‘Re-homing’ is a term coined to describe the adopting out of adopted children. Reuters today published a long story on the practice, describing several cases in which children adopted from overseas by American parents were then put up for adoption again within the States, in one case only a few days after the initial adoption.
The adoptions described in the Reuters piece are problematic for obvious reasons. It appears that lax oversight arrangements in the US, particularly for intra-state adoptions, have allowed couples to adopt out their children with little or no vetting of the new parents, in some cases into abusive families, and often without much consideration of the child’s interests. But might there also be less obvious considerations in play here? Continue reading
Journal of Medical Ethics special issue on the ethics of stem cell-derived gametes
Recent scientific developments suggest that it may become possible to create viable human gametes from human stem cells. It has been suggested that this will lead to the development of a range of new fertility treatments as well as new strands of research. More speculatively, some have argued that it may
- Allow the radical enhancement of human reproductive capabilities, for example, by allowing same-sex couples or post-menopausal women to have genetically-related offspring
- Provide new means of creating ‘designer babies’, for example, by easing constraints on the number of embryos that can be produced in IVF.
In a feature article forthcoming in the Journal of Medical Ethics, Robert Sparrow discusses the possibility that stem cell technologies might be used to facilitate what he calls ‘in vitro eugenics’; the deliberate and selective breeding of multiple generations of human embryos in vitro. The Editors of the Journal of Medical Ethics now invite submissions for a special issue addressing the ethical questions raised by Sparrow’s paper and by stem cell-derived gametes more generally.
Treating ADHD may reduce criminality
Pharmaceutical treatment of attention deficit-hyperactivity disorder (ADHD) is associated with reduced criminality according to a study published yesterday in the New England Journal of Medicine. The study of over 25,000 Swedish adults with the disorder found that men undergoing pharmaceutical treatments had a 51% chance of committing at least one crime in a 4-year period compared to 63% for those not in treatment. The risk of criminality for women with ADHD was 25% for those taking medication, and 31% for those not in treatment. It’s possible, of course, that the reduction in criminality associated with treatment was due not to the treatment itself, but to other factors, such as desire to improve behaviour, which could have both motivated treatment and reduced criminality. However, even when the investigators adjusted for likely confounders, they found that treatment was associated with significantly reduced criminal offending. Thus, their findings are at least suggestive of a causal relationship between medication and reduced crime.
It will be interesting to see how such a relationship, if it can be further supported, will be viewed by the general public and medical profession. Will it be seen as strengthening or weakening the case for ADHD treatment?
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