Steven Pinker has recently written an op-ed questioning the contribution of bioethics to the safe and efficient regulation of research. This has been widely misinterpreted and criticised, though Alice Dreger has written a recent accurate blog in support of Pinker. Pinker provocatively said that bioethics should get out of the way of research. This has been interpreted to mean that we should give up ethics review of research. Nobody, not me, and not Steven Pinker, thinks we should abandon ethical review of research. He actually says, ” Of course, individuals must be protected from identifiable harm, but we already have ample safeguards for the safety and informed consent of patients and research subjects.” Pinker is objecting to the unnecessary, unproductive obstruction that much bioethics represents to good research and regulation.
I largely agree with him and have said as much myself over the years. I recently wrote a piece for the anniversary issue of the JME arguing as much. I applaud him for trying to generate some self-reflection in the field.
Regular readers of this blog will be familiar with my argument for legalising doping in sport, aiming to focus resources on harm reduction rather than zero tolerance. Key safeguards in this approach are (1) doping carried out under the supervision of a doctor, and (2 ) checks on athletes to ensure they maintain normal physiological ranges of relevant parameters.
Many commentators consider this approach unrealistic. But as the world’s elite riders commence the Tour de France 2015, it appears that they will be riding under something very close to that vision.
In March this year, the Cycling Independent Reform Commission published a report into current doping practices. It concludes that doping is still prevalent, with estimates from those in the sport ranging from 20 – 90% of athletes participating in doping.
However, two mechanisms within anti – doping policy, the Athlete Biological Passport, and the Therapeutic Use Exemption, appear to be functioning effectively as regulators on doping behaviour: enhancing its safety and limiting its impact, without preventing its use outright.
Authors: William Isdale & Julian Savulescu
Last week the Federal Government announced that there would be a review of Australia’s tissue and organ transplantation systems. The impetus for the review appears to be continually disappointing donation rates, despite the adoption of a national reform agenda in 2008.
Since 2008 there has been an increase from 12.1 dpmp (donations per million population) to a peak of 16.9 in 2013 – but the dip last year (to 16.1) indicates that new policies need to be considered if rates are to be substantially increased.
Australia’s donation levels remain considerably below world’s best practice, even after adjusting for rates and types of mortality. At least twenty countries achieve better donation rates than Australia, including comparable countries like Belgium (29.9), USA (25.9), France (25.5) and the UK (20.8).
The review will focus in particular on the role of the national Organ and Tissue Authority, which helps coordinate donation services. However, many of the key policy settings are in the hands of state and territory governments.
It is time to go beyond improving the mechanisms for implementing existing laws, and to consider more fundamental changes to organ procurement in Australia.
By Hannah Maslen, Jonathan Pugh and Julian Savulescu
According to the NHS, the number of hospital admissions across the UK for teenagers with eating disorders has nearly doubled in the last three years. In a previous post, we discussed some ethical issues relating to the use of deep brain stimulation (DBS) to treat anorexia nervosa (AN). Although the trials of this potential treatment are still in very early, investigational stages (and may not necessarily become an approved treatment), the invasive nature of the intervention and the vulnerability of the potential patients are such that anticipatory ethical analysis is warranted. In this post, we show how different possible mechanisms of intervention raise different questions for philosophers to address. The prospect of intervening directly in the brain prompts exploration of the relationships between a patient’s various mental phenomena, autonomy and identity. Continue reading
Hannah Maslen and Julian Savulescu
In a pioneering new procedure, deep brain stimulation is being trialed as a treatment for the eating disorder anorexia nervosa. Neurosurgeons at the John Radcliffe Hospital in Oxford implanted electrodes into the nucleus accumbens of a woman suffering with anorexia to stimulate the part of the brain involved in finding food rewarding. Whilst reports emphasize that this treatment is ‘highly experimental’ and would ‘only be for those who have failed all other treatments for anorexia’, there appeared to be tentative optimism surrounding the potential efficacy of the procedure: the woman who had undergone the surgery was reportedly ‘doing well’ and had shown ‘a response to the treatment’.
It goes without saying that successful treatments for otherwise intractable conditions are a good thing and are to be welcomed. Indeed, a woman who had undergone similar treatment at a hospital in Canada is quoted as saying ‘it has turned my life around. I am now at a healthy weight.’ However, the invasive nature of the procedure and the complexity of the psychological, biological and social dimensions of anorexia should prompt us to carefully consider the ethical issues involved in offering, encouraging and performing such interventions. We here outline relevant considerations pertaining to obtaining valid consent from patients, and underscore the cautious approach that should be taken when directly modifying food-related desires in a complex disorder involving interrelated social, psychological and biological factors. Continue reading
How to Be Free: Objectification and the Noumenal World An Impression of Neil Levy’s First Leverhulme Lecture
When I was a medical student and doctor, there were a few legendary teachers at the Alfred Hospital. The greatest of these was a general physician called Y Lim. He was the Sherlock Holmes of bedside clinicians. He would take groups of medical students to see a patient and diagnose the patient “from the end of the bed”, just by observing carefully the paraphenalia around the patient’s bed, the medication and the movement of the side of their chest.
He was highly sought after as tutorials with Y Lim spelt success in the clinical examinations. I never had him but my friends in the year before did. At the end of their last tutorial, just before the final examinations, they asked him, “Y Lim, how do we do well in the short and long cases? How can we become a doctor?”
Y Lim replied, “Look like a doctor. Talk like a doctor.”
Three Ordinary Agents
Consider the following 3 people (philosophers call them “agents” because they do stuff, like secret agents do stuff secretly). They are all based on real life characters.
by Hannah Maslen, Julian Savulescu and Carin Hunt
A study examining pharmaceutical cognitive enhancement found that participants’ subjective enjoyment of various memory and problem-solving tasks was significantly greater when they had taken modafinil (a drug originally developed for narcolepsy) compared with placebo, but that mood ratings overall were not affected (Muller at al 2013). The authors of the paper therefore concluded that, in addition to the various performance effects, ‘an important finding of this study is that there was a striking increase in task motivation’. Whilst a lot of attention has been paid to the ethical implications of enhancing cognitive performance, much less has been paid to the striking task-motivation finding. We suggest, however, that motivation enhancement might be the more contentious effect, from an ethical point of view. Continue reading
Julian Savulescu discusses the ethics of mitochondrial transfer
Imagine that there was a law which prevented 150 children a year suffering from a life threatening liver or kidney failure from receiving a transplant. This would be unethical. But this is precisely the current state of affairs for around 150 children every year in the UK suffering from mitochondrial disease, or mitochondrial failure.
From an ethical perspective, mitochondrial transfer is most accurately described as a form of transplantation, or “micro-organ” transplantation.
An elegant example of biopsychosocial (BPS) impacts on our health has been reported today.
It has long been reported that chronic stress reduces fertility: it reduces libidos, reduces the likelihood of a pregnancy, and increases the risk of miscarriage.
Scientists from the University of Berkeley have shown that blocking the gene for a hormone – called gonadotropin inhibitory hormone (GnIH) removes the impact of the stress on fertility levels in rats, and restored a normal rate of pregnancy.
If this translates to humans, it could have major impact. According to the University of Berkeley press release:
“Stress is thought to be a major contributor to today’s high levels of infertility: Approximately three-quarters of healthy couples under 30 have trouble conceiving within three months of first trying, while 15 percent are unable to conceive after a year.”
The BPS model explores causal interaction between the biological, psychological, and social factors in illness (usually in the context of understanding mental illness). This might be one of the more simple biopsychosocial interactions. Kenneth Kendler’s fascinating Loebel Lecture series unpicked some complex interactions (video and audio available on the Oxford Loebel Lectures and Research Programme website).
But it raises an interesting ethical question, and one that frequently arises in the enhancement debate. Should we take a biological solution, when an environmental solution is available?