By Julian Savulescu. @juliansavulescu
The Australian newspaper ‘The Sunday Age’ reports today that “The Australian Sports Anti-Doping Authority has built a ”non-presence” drug case against 34 Essendon footballers, adopting a strategy similar to the one used to ban Lance Armstrong without a positive test.”
1. What should we think about this latest drugs “scandal” at Essendon, the so called “war on doping” in the Australian Football League (AFL), and in sport in general?
Imagine that you and your partner are having a baby in hospital. Tragically something goes wrong unexpectedly during birth and the baby is born blue. He urgently needs resuscitation if there is to be a chance of preventing permanent severe brain damage. How long would it be reasonable for doctors to wait before starting resuscitation? 15 minutes? 5 minutes? 1 minute?
What would be a reasonable excuse for delaying the commencement of resuscitation? They wanted to get a cup of coffee? The mother wanted to hold the baby first? The mother had catastrophic bleeding and this needed urgent attention?
If it were my baby, I would not want any delay in starting resuscitation. And there would be no justification for delaying resuscitation except some more serious, more urgent problem for another patient, such as the mother.
Yet when people choose homebirth, delay is precisely what they choose. It is simply not possible to start advanced resuscitation in the home within minutes. And their reason is not typically some relevant competing health concern that necessitates delivery at home.
Choosing home birth is choosing delay if some serious problem arises which requires immediate resuscitation.
In recent years, I’ve written a lot on moral enhancement, including moral bioenhancement (e.g., here, here and here), and argued that we should not reject its potential benefits out of hand. One common objection has been to say something along the lines of “sure, this would be good in theory, but the science behind it is so far off that you may as well be talking about the number of angels on a pinhead”.
But recent research suggests our moral behavior is already improving in some respects. In the UK, admissions to hospital due to violent crime fell by 12% . And in the US, a recent survey revealed a decline in violence experienced by children over the past decade, particularly assault and sexual violence. This is also a major theme of Stephen Pinker’s “Better Angels of Our Nature.” Pinker documents the widespread reduction in violence over centuries.
Back in 2010, I blogged about Craig Venter’s creation of the first synthetic organism, Synthia, a bacteria.
Now, in 2014, the next step has been made by a team at John Hopkins University, the use of synthetic biology in yeast, which, whilst still a simple organism, has a similar cell structure to humans (and other more complex organisms): a nuclei, chromosomes and organelles. The engineered yeast has been reproduced to over 100 generations, passing on its new DNA.
The pace is breathtaking. Moore’s law describes a phenomenon in computing, where computer capacity (so far) doubles every two years. Kurzweil uses Moore’s law to predict the ‘singularity’: a state where humans no longer control, or even comprehend, the progress that technology continues to make.
It’s difficult to measure scientific progress in the same way as computer power, but it’s clear that leaps in progress are now measured in years, not decades. Yet still we wait until technology is upon us before we act.
A tragic case was recently reported of a man who died following botched care via the NHS’ telephone helpline. Suffering from blood poisoning, a series of errors, mis-recording and failure to listen meant that he was told simply to take the remedy ‘Gaviscon’. He died shortly afterwards. This was rightly widely reported in the press as a major failing of the health system. Many such catastrophic errors in medicine are reported in the press, and wherever possible safeguards put in place to prevent their re-occurrence.
However, we seem to accept deaths that occur not through medical mistakes but through what I will call moral mistakes. For example, each day 3 people die on the waiting list to receive organ transplants. Many of those could be saved if all those eligible and consenting to give organs did so. But instead, organs are withheld even when those who have opted in to organ donation die, because their families decide against it. Others are withheld because we have failed to introduce an opt out system of consent, meaning that those who simply never got around to signing up are excluded from bringing life to another person.
This is just one example of how mistakes in medical ethics can kill people. There are many more.
Winchester Lectures: Kamm’s Trolleyology and Is There a Morally Relevant Difference Between Killing and Letting Die?
The Winchester Visiting Lecturerships were established in 1995 for the purpose of inviting visiting lecturers in the fields of International Relations, History, Philosophy, Religion, Theology or Law. We are grateful to the committee for this opportunity to bring Professor Frances Kamm to Oxford for this series of two lectures October 21 – 22, 2013.
Over the series, Frances Kamm considered a kaleidoscope of cases in which one innocent person must be killed to prevent 5 innocent people being killed. She argued in some situations, killing one is permissible to prevent 5 other people being killed, yet in other cases it is impermissible to kill one to save 5. Or so go her intuitions. She points to what she finds are morally relevant considerations that distinguish permissible from impermissible killing.
The most straight forward case of impermissible killing, and the one in which she and many others have a clear intuitions, is Transplant.
In Transplant, a doctor contemplates killing one innocent person and harvesting his/her organs to save 5 people with organ failure. This is John Harris’ survival lottery.
But this is a dirty example. Transplant imports many intutions. For example, that doctors should not kill their patients, that those with organ failure are old while the healthy donor is young, that those with organ failure are somehow responsible for their illness, that this will lead to a slippery slope of more widespread killings, that this will induce widespread terror at the prospect of being chosen, etc, etc
A better version of Transplant is Epidemic.
“Electroceuticals”, or therapies utilising electricity, are nothing new and range from the widely accepted defibrillator/ pace makers to the more controversial electric shock therapies like ECT sometimes employed to treat severe depression.
But a recent article in Nature argues that these are just a small, crude sample of what electroceuticals may be able to offer in the future. Universities and pharmaceutical companies are researching a wide range of therapies based around electrical stimulation, promising benefits (in the long term) as diverse as mind-controlled prosthetic limbs to a treatment for anorexia. Transcranial Electric Stimulation (TES) is delivering some promising results in depression and treatment of learning disabilities.
Not only is the research potential there, but it appears that the funding is too. Nature report that GlaxoSmithKline are funding 40 researchers to pursue research in this area, amongst other initiatives to kick start electroceutical development. And earlier this year, the US invested $110 million from 2014’s budget for the “Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative”. At the same time, over in Europe, work has commenced on a 10 year, billion pound ‘Human Brain Project, bringing together 135 institutions to try to map parts of the human brain via computer simulations.
We may be starting out on the track for the “holy grail” of neuroscience: strategic control of single neuronal activity. This is, apparently, one of GSK’s goals.
With that level of control, we could finally reach the realms of science fiction: where the mind and therefore the person is under external control. Freedom might be annihilated.
We would face confronting questions over authenticity and identity. There would be alienation between the pre-existing person and their subsequent brain activity.
Burgess’ A Clockwork Orange is a graphic illustration of a common objection to enhancement, the erosion of freedom. TES at present does not appear to represent a major threat to freedom, but it is one of a family of technologies that could one day be used for effective mind control.
Scientists in America have found a way to reduce crime amongst some high risk groups by 30-40%. It involves a simulation of crime scenes where the victim is a hologram representing the potential criminal in question, followed by discussion with a trained therapist. The experience causes the subject to feel greater empathy and reduces violent crime. We should introduce this therapy now, as a matter of priority.
There is no such therapy, sadly. But there is something which promises the same effects in some groups. Ritalin. A Swedish study found that taking ADHD medication significantly reduced the criminality rate amongst those with ADHD: by 32% in men, and 41% in women. ADHD has itself been associated with an increase in criminality.
Some people will argue that this is a therapy for ADHD, not an enhancement. But ADHD is not a disease like cancer – it is likely a variant of normal functioning involving lower levels of impulse control and attention.
Ritalin, Adderall, Modafenil are all taken by thousands of professionals and students to enhance performance, in a similar way to caffeine. The film Limitless was loosely based on modafenil (in fact, Modafenil doesn’t appear to have such a dangerous side effect profile as is portrayed in the film, though there are as yet no long term studies of normal people). Ongoing research into Alzheimers disease and other impairments will lead to other drugs which enhance normal cognition.
Andrew Culliford, whose story is featured in the Daily Mail, is one of the estimated 7 in 100,000 people living with Motor Neuron disease, a progressive degenerative disease which attacks muscles, leaving those affected eventually unable even to breathe unassisted. For Andrew, a young father who has a severe form of the disease, it means a two to five year life expectancy.
The US introduced a mandatory pre-approval process for pharmaceutical drugs after over 100 people were killed by an untested drug formulation . Today, each drug must go through a series of strictly controlled trials, including Phase 1 tests on healthy volunteers, followed by Phases 2 and 3 which test the drug and dosages on smaller and then larger patient groups. The process is estimated to cost $500 million per drug and to take 8 – 12 years.
The process is designed to ensure the efficacy of drugs has been scientifically demonstrated to a very degree of confidence, and to ensure that patient safety is sufficiently protected. In many ways it has been a triumph of science and regulation.
But it has been a failure for one small group of patients: those with rare, imminently lethal diseases, for whom there are no existing good treatments. Those who will die in less than 8 years. It is these patients who are asking to have access to untested medicines, and to avoid placebo controlled trials, where half the participants are given no drug at all. Les has proposed innovative methods of patient recording data. I have discussed this proposal previously on this blog , and in a joint paper with Les Halpin and clinicians.
On Monday, London will see the world’s first artificial meat burger cooked and tasted, by Professor Mark Post of Maastricht University.
Artificial meat stops cruelty to animals, is better for the environment, could be safer and more efficient, and even healthier. We have a moral obligation to support this kind of research. It gets the ethical two thumbs up.
The development of artificial meat is a triumph for both science and ethics. Current meat production involves inflicting significant suffering on animals. It also causes environmental damage (see the FAO report, Livestock’s Long Shadow) and is hugely inefficient because limited food resources have used to keep a large animal alive. Intensive farming of chickens and pigs is also a breeding ground for the emergence of new strains of flu, causing pandemics that could kill tens of millions. Artificial meat production will almost entirely avoid these issues.
Ethical veganism will become a much more palatable option, as one could avoid eating real meat without sacrificing an integral part of many people’s diet. Indeed, this may be a watershed moment for animal welfare – if artificial meat manages to catch on and take over a large portion of the market, many fewer animals will be cruelly raised and slaughtered through factory farming, a key goal of movements like PETA (who have, incidentally, wholly endorsed and promoted the development of artificial meat).
Of course, such large-scale beneficial effects will only be realized under three conditions: the artificial meat must be safe, cheap and tasty. The safety of Mark Post’s concoction is as yet unknown, but may well be the easiest condition to satisfy. In fact, it could become more safer as meat production could be laboratory controlled and reduce risks of emergent pandemics from flu passing from animals to humans. If he is correct and the meat is identical at the cellular level to actual meat, it should be no less dangerous – though further tests are undoubtedly needed before it could be offered to the public at large. As for cost, previous estimates put Post’s burger at around £250,000, obviously prohibitive for mainstream consumption. Just as the cost of genetic sequencing has fallen precipitously over the years, we can expect artificial meat prices to fall as more efficient means of production are developed. It remains to be seen whether artificial meat can ever be made more efficiently and cheaply than real meat, however. Finally, one of the most important tests of Monday’s event is whether the artificial meat will actually be palatable. It may be that the meat is only suitable simulating ground up meat and mixed with other ingredients to add texture and flavour – but then again, outlets like McDonald’s have made a mint producing widely-enjoyed meat out of an infamous ‘pink sludge’ that is quite disgusting on its own. Indeed, of all potential adopters, the fast-food industry – which relies on efficiency and artificiality much more than aesthetics or ‘all-natural’ ingredients – seems like the most likely outlet for artificial meat.
Perhaps the future of the fast food industry is ethical meat, instead of the unethical meat. Consumers would be hard pressed to tell the difference between an artificial Big Mac and the current one.
Some might object that artificial meat is unnatural. So it should be avoided. True, the meat would be grown in a lab rather than a farm. But what value does naturalness have, on its own? Natural meat often relies on the confinement and slaughter of animals, which many have noted is morally wrong – and in fact, the factory farms where most meat is produced are hardly ‘natural’ environments. In factory farming, they more resemble hideous torture chambers where animals eat their own faeces. Moreover, we are perfectly content to introduce numerous artificial elements into all aspects of our lives – phones replace natural communication, cars replace natural transport, factories replace natural craftsmanship, houses replace natural abodes, and so on. Part of human development is to improve upon the natural state of the world, and artificial meat is just another such development. It is not only inevitable, but should be encouraged and welcomed with open arms.
There is one ethical downside to creating artificial meat. Many animals would not come into existence who would have lived and many farmers might lose their livelihoods. The solution maybe to combine artificial meat production with controls on farming to ensure animals that are brought into existence for farming purposes only have happy, worthwhile lives and are slaughtered in humane ways.
We hope the creation of artificial meat will prompt a thoughtful debate on the ethics of food production and eating.
Doctoral Candidate in Philosophy
University of Oxford
Professor of Practical Ethics