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?
Born this way? Selecting for sexual preference
Doctors Offering ‘Gay Gene’ To Same Sex Couples Wanting Gay Children: apparently Dr. William Strider at the Fertility Center of Chicago suggests that homosexual parents should have the option of increasing the chances of their kid being homosexual:
“When straight couples have children, the majority of them want their children to be straight as well. That is why most straight parents have trouble accepting it when their children announce to them that they are gay,” … “So it only makes sense that same-sex couples would want children that carried out their same family values of homosexuality.”
The article is likely reporting wrong on what method would be used: germline manipulation sounds like a unproven and risky approach, while PGD is a proven technique that could presumably select based on X-chromosome sequence. And given the topic it is not implausible that Dr. Strider is being misquoted. But let’s take everything at face value: would it be ethical to select for sexual preference?
Biomedical enhancement and the need for more precise conceptions
Much of the discussion about biomedical enhancements is about arguing whether some biomedical enhancement would, or would not be a good, ethical, or efficient means for enhancing a particular human characteristic. In this blog and in other bioethical literature bioethicists discuss the proposed effects that biomedical enhancements would have, for example, to intelligence and other cognitive capacities, empathy, sunny mood, altruism, sense of justice, or to halting climate change. The list is extensive and endless. The discussion on efficacy, ethics, justice, and human nature is an important part of the whole philosophical debate, as is the discussion about the limits of philosophy, reality, and science fiction. However, an important point that might be in need of emphasis would be to take under inspection the very concepts that are the target of enhancement. What do intelligence, sunny mood, altruism, sense of justice, and the-characteristics-that-prevents-us-halting-climate-change really mean?
If the target characteristics are looked at carefully, it seems that much of the discussion can be described as a form of language bewitchment where conceptions of the human language and conceptions of the empirical science of biology are mixed. Just because the human language includes conceptions such as intelligence, altruism, sunny mood, criminal, and sense of justice, it does not mean that there would be any corresponding concrete physical entities to these conceptions.
The dappled causal world for psychiatric disorders: implications for psychiatric nosology
On Thursday 16th October, Professor Kenneth Kendler delivered his second (and final) Loebel Lecture, entitled ‘The dappled causal world for psychiatric disorders: implications for psychiatric nosology’. You can view it online here or listen here.
Whilst Kendler’s first lecture – summarised by Roger Crisp here – focused on empirical issues, the second lecture was more philosophical. Kendler’s key question in the second lecture could perhaps be formulated as: Given the complex aetiology of mental disorders, how can we best understand and explain how they arise? Continue reading
The Genetic Epidemiology of Psychiatric and Substance Abuse Disorders: Multiple Levels, Interactions and Causal Loops
What causes psychiatric disorders, such as depression or alcohol abuse disorders? It’s obvious that background and upbringing often play a significant role, as do life events, such as losing one’s spouse or one’s job. And we also know now that genetic propensities are important. But how do these different factors inter-relate with one another? For over three decades, these issues have been at the centre of the research of Oxford’s first Loebel Lecturer, Professor Kenneth Kendler.
Professor Kendler is one of the world’s leading, and most highly cited, psychiatric researchers. He uses a range of methods, including family studies, twin and adoption studies, and molecular genetics. He also has a serious interest in the philosophy of psychiatry. His first Loebel Lecture — The Genetic Epidemiology of Psychiatric and Substance Abuse Disorders: Multiple Levels, Interactions and Causal Loops – was presented at the Oxford Martin School on Wednesday 15 October 2014, and is now available on Youtube and as an MP3 audio file. Continue reading
Breaking the mould: genetics and education
Tonight I participated in BBC’s “The Moral Maze”, discussing the recent reactions to a report by Dominic Cummings, an advisor to the education secretary, that mentioned that genetic factors have a big impact on educational outcomes. This ties in with the recent book G is for Genes by Kathryn Asbury (also on the program) and Robert Plomin where they argue that children are not blank slates and that genetic information might enable personalized education. Ah, children, genetics, IQ, schools – the perfect mixture for debate!
Unfortunately for me the panel tore into my transhumanist views rather than ask me about the main topic for the evening, so I ended up debating something different. This is what I would have argued if there had been time:
The Bad Seed: Facts and Values in the Study of Childhood Antisocial Behaviour
Podcast of Uehiro Seminar given by Gwen Adshead
‘The Bad Seed’ was a popular 1954 novel in which a well brought up young girl begins to manifest behaviour characteristic of a criminal psychopath. As the plot develops, the girl’s mother discovers that her own mother was a serial killer who was executed when she was herself a girl.
In this Uehiro Seminar, Gwen Adshead Forensic Psychotherapist at Bluebird House & Broadmoor Hospital explores this idea of the ‘bad seed’ using research into those who exhibit ‘callous and unemotional’ traits when children. In contrast to the theme of the novel, Dr Adshead points out that the causes of behaviour even for individuals who exhibit violent behaviour consistently both as children and adults are mediated by factors other than genetic predisposition. For example, there is a relationship between childhood physical abuse and neglect and delinquency and violence in later life. Dr Adshead argues that a more constructive approach to addressing violence in society might be to explore causes such as parenting rather than focusing disproportionate attention on the children. The lecture and discussion that follows raise fundamental issues to do with our attitude to genetic and other predictors of subsequent violence in adult life, the question of how resources should be allocated to address such problems, and how blame fits within this research framework.
You can listen to the podcast of the seminar here
Paul Troop and Sabrina Stewart
Bold Private John Smith, VC, modified ‘t’ allele of TPH1 SNP rs2108977
By Charles Foster
There’s a significant association of PTSD symptoms with a particular allele, according to a recently published study from UCLA and Duke. Some of the ethical consequences are already being discussed. One consequence might be military. One might be able to detect and filter out PTSD-vulnerable recruits. Perhaps that’s a kindness. It would certainly seem militarily prudent. There might be legitimate qualms about creating a biologically callous warrior-class, but you’re not creating its components – you’re just collecting them together. You might not want to go to their parties, and you might wonder about the mutually brutalizing effect of corralling them in a barracks, but the exercise is really only a scientifically more informed version of the selection that goes on in any event. It’s not very interesting ethically.
But what if a gene for PTSD-resistance could be inserted or artificially switched on? It doesn’t seem fanciful. Should the military be permitted (or perhaps even required) to PTSD-proof their personnel? Continue reading
Is Drug Addiction a Lifestyle Choice?
According to BBC News this week, the brains of some people “may be wired for addiction.” A study has come out in the journal Science that presents evidence of abnormal brain structures that were found in drug addicts and their non-addicted siblings. The lead researcher, Dr Karen Ersche, was quoted by the BBC as saying that the study “shows that drug addiction is not a choice of lifestyle, it is a disorder of the brain and we need to recognize this.”
Has the Ersche et al study in fact shown that drug addiction is not a lifestyle choice? Has it proven that drug addicts should be treated as innocent patients with medical problems rather than being subject to moral censure for their failure to exert self-control, and for their irresponsible and often deeply anti-social behaviour? No! In fact, it is likely that no possible neuroscientific evidence could show such a thing.
Good Grief?
In book 4 of Homer’s Odyssey, Odysseus’s son Telemachos arrives in Sparta to quiz Menelaos on whether Odysseus is still alive and if so where he might be. Menelaos reduces everyone (including himself) to tears by telling everyone how sad he is that Odysseus hasn’t made it home. He then says it’s time for them to pull themselves together and have dinner. His wife Helen, however, also wants to talk about Odysseus, and has a bright idea:
Into the wine of which they were drinking she cast a medicine
of heartsease, free of gall, to make one forget all sorrows,
and whoever had drunk it down once it had been mixed in the wine bowl,
for the day that he drank it would have no tear roll down his face,
not if his mother died and his father died, not if men
murdered a brother or beloved son in his presence
with the bronze, and he with his own eyes saw it. Such were
the subtle medicines Zeus’ daughter had in her possessions,
good things … (4.220-28, trans. Lattimore)
What would it be to ‘forget all sorrows’? And would it be rational voluntarily to take such a drug if it became available? Thinking about these questions raises further issues about the nature of well-being and the value of the emotions, and is particularly appropriate at a time when it is being widely claimed that there may be therapeutic benefits in memory modification or other interventions.
Some people claim that suffering pain is good in itself. It usually turns out, however, that they mean that suffering is good in so far as it enables one to acquire some other good, such as understanding what others are going or have gone through, or certain profound truths about human life. It’s also common for people to suggest that suffering, though it may be bad in itself, is required as a background against which certain good things in life – in particular, of course, pleasure – can stand out. These and other such claims, however, seem especially dubious in the case of someone who has already experienced quite a lot of suffering and can remember it – as will be true of nearly all adult human beings.
Other kinds of suffering, however, are more tricky. Telemachos fears his father may be dead, and one of Helen’s aims is to avoid arousing grief in him. Grief is usually unpleasant, sometimes extremely so. What if some medication could permanently remove any tendency to grief, with no damaging side-effects? It might be thought that if Telemachos were to remain unmoved by the notion of his beloved father’s death, this would somehow undermine the depth of their relationship. But perhaps Helen’s aim is not to remove the cognitive and more positive conative aspects of the experience of grief, but merely the unpleasant feeling. So Telemachus can still think fondly of his father’s patient heart, kindness, bravery, nobility and so on, and of how bad it would be were he to have been killed on his way home from Troy. And perhaps he can still be said to love his father, still being strongly motivated to search for him, spend time with him, and so on.
But even if this is right, it’s not clear that it would be rational to eradicate the capacity for grief in oneself entirely. For indulging in the feeling of grief as a response to fictional events – including many of those depicted in Homer, of course — can be a positively enjoyable experience. Helen might be able to provide a medicine that distinguishes between ‘real’ and ‘fictional’ grief; but it’s hard to imagine that, even in the medium-term future, human beings are going be able to do that.
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