Imagine a world in which genetic interventions (for hair/eye colour, health, strength, happiness, morality…) were tested, safe, effective and accepted. In this genetic supermarket, who should be allowed to buy – to decide how children should be modified? Parents seem the obvious choice – but on reflection, there seem few reasons to allow this.
Why is it good for people to make their own choices? Firstly, out of liberty: everyone should have the right to do what they want with themselves. Secondly, because people know their own preferences much better than anyone else (one of the reasons that the communist command economies failed). And thirdly because people can experience the consequences of their choices, and become more skilled consumers, driving poor products out of business.
None of these applies to parents choosing their children’s genes. Here they are making the choice for other people, whose preferences they don’t know (because they don’t even exist yet!). And unless parents plan to have ten or twenty children, they have no relevant personal experience to draw on for comparing genetic interventions. And the main effects of these interventions are very long term, making the parents even less suited to making the choice in an informed way. Continue reading
Cultural bias and the evaluation of medical evidence: An update on the AAP
Since my article on the American Academy of Pediatrics’ recent change in policy regarding infant male circumcision was posted back in August of 2012, some interesting developments have come about. Two major critiques of the AAP documents were published in leading international journals, one in the Journal of Medical Ethics, and a second in the AAP’s very own Pediatrics. In the second of these, 38 distinguished pediatricians, pediatric surgeons, urologists, medical ethicists, and heads of hospital boards and children’s health societies throughout Europe and Canada argued that there is: “Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision.”
The AAP took the time to respond to this possibility in a formal reply, also published in Pediatrics earlier this year. Rather than thoughtfully addressing the specific charge of cultural bias, however, the AAP elected to boomerang the criticism, implying that their critics were themselves biased, only against circumcision. To address this interesting allegation, I have updated my original blog post. Interested readers can click here to see my analysis.
Finally, please note that articles from the Journal of Medical Ethics special issue on circumcision are (at long last) beginning to appear online. The print issue will follow shortly. Also be sure to see this recent critique of the AAP in a thoughtful book by JME contributor and medical historian Dr. Robert Darby, entitled: “The Sorcerer’s Apprentice: Why Can’t the US Stop Circumcising Boys?”
The first two weeks of 2013 were marked by a flurry of news articles considering “the new science” of pedophilia. Alan Zarembo’s article for the Los Angeles Times focused on the increasing consensus among researchers that pedophilia is a biological predisposition similar to heterosexuality or homosexuality. Rachel Aviv’s piece for The New Yorker shed light upon the practice of ‘civil commitment’ in the US, a process by which inmates may be kept in jail past their release date if a panel decides that they are at risk of molesting a child (even if there is no evidence that they have in the past). The Guardian’s Jon Henley quoted sources suggesting that perhaps some pedophilic relationships aren’t all that harmful after all. And Rush Limbaugh chimed in comparing the ‘normalization’ of pedophilia to the historical increase in the acceptance of homosexuality, suggesting that recognizing pedophilia as a sexual orientation would be tantamount to condoning child molestation.
So what does it all mean? While most people I talked to in the wake of these stories (I include myself) were fascinated by the novel scientific evidence and the compelling profiles of self-described pedophiles presented in these articles, we all seemed to have a difficult time wrapping our minds around the ethical considerations at play. Why does it matter for our moral appraisal of pedophiles whether pedophilia is innate or acquired? Is it wrong to imprison someone for a terrible crime that they have not yet committed but are at a “high risk” of committing in the future? And if we say that we can’t “blame” pedophiles for their attraction to children because it is not their “fault” – they were “born this way” – is it problematic to condemn individuals for acting upon these (and other harmful) desires if it can be shown that poor impulse control is similarly genetically predisposed? While I don’t get around to fully answering most of these questions in the following post, my aim is to tease out the highly interrelated issues underlying these questions with the goal of working towards a framework by which the moral landscape of pedophilia can be understood. Continue reading
By Brian Earp
Gay genes and gay rights: On the science and politics of sexuality
If homosexuality has a genetic basis, and if gay sex produces no offspring, why hasn’t the culling force of natural selection bred it right out of the species? Neuroscientist Simon LeVay has recently taken to the electronic pages of the Huffington Post to tout his latest book and offer a few hypotheses.
In light of the article’s popularity, Professor LeVay was asked to join a panel of speakers to discuss not only the genetics of sexual preference, but also the social and political implications of such research. Since I had written on this topic on the Practical Ethics blog, I was invited to take part as well.
UPDATED as of 27 May, 2013. See the bottom of the post.
The AAP report on circumcision: Bad science + bad ethics = bad medicine
For the first time in over a decade, the American Academy of Pediatrics (AAP) has revised its policy position on infant male circumcision. They now say that the probabilistic health benefits conferred by the procedure just slightly outweigh the known risks and harms. Not enough to come right out and positively recommend circumcision (as some media outlets are erroneously reporting), but just enough to suggest that whenever it is performed—for cultural or religious reasons, or sheer parental preference, as the case may be—it should be covered by government health insurance.
That turns out to be a very fine line to dance on. But fear not: the AAP policy committee comes equipped with tap shoes tightly-laced, and its self-appointed members have shown themselves to be hoofers of the nimblest kind. Their position statement is full of equivocations, hedging, and uncertainty; and the longer report upon which it is based is replete with non-sequiturs, self-contradiction, and blatant cherry-picking of essential evidence.
“Legitimate rape,” moral consistency, and degrees of sexual harm
Should abortions be allowed in the case of rape? Republican Todd Akin—running for the U.S. Senate from the state of Missouri—thinks not. His reasoning is as follows:
From what I understand from doctors, [pregnancy resulting from rape is] really rare. If it’s a legitimate rape, the female body has ways to try to shut that whole thing down. But let’s assume that maybe that didn’t work or something. I think there should be some punishment. But the punishment ought to be of the rapist, and not attacking the child.
There appears to be no scientific basis for the claim that the trauma of forced intercourse can interrupt ovulation or in any other way prevent a pregnancy; indeed pregnancy is just as likely after rape as after consensual sex, according to the evidence I have seen. This news article sums up the relevant data - though please note that one of my readers [see comments] takes issue with the standard interpretation of the most frequently-cited studies.
Let’s start, for now, then, with a bit of data that is not in question: thousands of pregnancies per year, in the U.S. alone, ensue from cases of reported rape or incest–either through the caveat of Akin’s theory that “maybe [the body's defenses] didn’t work or something” or through the medically orthodox explanation that the body has no such defense. Assuming that falsely reporting rape is relatively rare, as seems to be the case; and acknowledging that many rapes are never reported in the first place, we should be able to agree that pregnancies resulting from rape are a life-changing reality for thousands of women on an annual basis. By “rape” I mean any penetrative act done without clear consent; and here I’m calling attention to the sub-set of such acts that result in conception. I won’t say much about the term “legitimate” — which I find troubling in a hundred ways — simply because other writers have gone to town on it, and I want to say something new.
Now, given everything I’ve just said, what could be going on with Todd Akin’s moral reasoning for him to casually downplay the relevance of rape and incest to the abortion debate while maintaining, as he does, that there should be no exceptions to anti-abortionism even in those cases? Psychologist Brittany Liu uses the notion of “moral coherence” to provide an explanation:
See updated material below – reply to a critic.
Of faith and circumcision: Can the religious beliefs of parents justify the nonconsensual cutting of their child’s genitals?
Circumcising minors on religious grounds amounts to grievous bodily harm according to a German court ruling issued on Tuesday. AFP News reports:
The regional court in Cologne, western Germany, ruled that the “fundamental right of the child to bodily integrity outweighed the fundamental rights of the parents. The religious freedom of the parents and their right to educate their child would not be unacceptably compromised, if they were obliged to wait until the child could himself decide to be circumcised.”
Some Jewish groups are up in arms. They insist that God has “non-negotiably” required that circumcision take place on precisely the eighth day after birth; hence waiting to perform the operation until the child could consent would amount to breaking this keystone covenant with their deity. Using the force of law to delay circumcision, then, is no different from banning it outright, since a delayed circumcision is religiously meaningless.
I don’t find this argument very compelling.
Your politics are determined by your values, your opinions about the facts of the world, and, let’s be honest, just a little bit of tribalism. But the future is approaching, as it often does, and great transformations may be in the cards. Transformations that could dramatically affect the facts of the world. So whatever your values are, there is a chance that you may soon be arguing for the opposite of your usual policies. For instance, what if the future were necessarily…
Communist: one of the easiest ones to conceive of. Here it turns out that as barriers to trade are removed and transaction costs go to zero, the natural state of the economy is one of perpetual crashes. Celebrity and fame feed upon themselves: everyone demands the best, and the definition of the best is shared widely: niche markets don’t exist. Incomes follow such a sharp power law that only a few percent of the population have any wealth at all. Automation means that most people can’t earn enough to sustain themselves: their income drops below the costs of keeping them alive. Hence a large, bloated, over-regulating government becomes a matter of survival.
Ultra-capitalist: as barriers to trade are removed and transaction costs go to zero, the whole market segments into small niches. Everyone can find some buyer for their work, as new demands and new suppliers spring up immediately, connected by new technologies. Technology solves known externalities (like global warming), so there is little need for a centralised controlling authority. Change happens so rapidly that any governmental intervention is counterproductive: by the time the change is implemented, the benefits and costs the government was trying to influence are things of the past. The efficient market, the only thing fast enough to keep up with itself, flows like a river around any blundering governmental efforts, rendering them moot.
You are a public health official responsible for the purchasing of medications for the hospitals within your catchment area in the NHS. Your policies significantly affect which, out of the serpentine lists of heart disease medications, for example, are available to your patients. Today, you must choose between purchasing one of three heart disease medications: Drug A, Drug B, and Drug C. They are pretty similar in efficacy, and all three have been being used for many years. Drug B is slightly less expensive than Drug A and Drug C, but there is emerging evidence that it increases the likelihood that patients will take “bad bets,” i.e. make large gambles when the chance of winning is low (and thus might contribute to large social costs). Drug C costs a tiny bit more than Drug A, but there is some evidence that Drug C may help decrease implicit racial bias. You have been briefed on the research suggesting that implicit racial bias can lead to people making choices that consistently and unintentionally limit the opportunities of certain groups, even when all the involved parties show explicit commitments to social equality. Finally, there is emerging evidence that drug A both helps people abstain from alcohol and dissociates negative emotional content from memories.
Which drug should you purchase?
Let us begin to think about this question through the lens of the idea of the “Nudge,” which has exploded onto the public sphere (and blogosphere) since Thaler and Sunstein’s published their book, “Nudge: improving decisions about health, wealth, and happiness.” (see the blog here). I briefly and incompletely introduce nudges here, in hopes that we may soon move on to discuss the kind of ”nudge drugs” our thought experiment considers.
By Brian Earp
The will is caused, not free
Everyone is talking about free will these days. Sam Harris has a new book out. Eric MacDonald has weighed in on that. Jerry Coyne, Paul Bloom, and some philosopher-types have a debate going on in the Chronicle of Higher Education. And way back in 2009 the Society for Personality and Social Psychology hosted a “showdown” between psychologists Roy Baumeister and John Bargh on the topic: What does the ‘free’ in ‘free will’ really mean? [A video of Bargh's half can be seen here. Baumeister is here.]
The SPSP conference led to a fiery exchange of blog posts between the two principles, and then to a more sedated pair of papers in the society’s newsletter, Dialogue. Baumeister enlisted Kathleen Vohs to co-author his piece, and Bargh (for some reason) enlisted me. Here is what Professor Bargh and I had to say – after this delightful FoxTrot comic by Bill Amend.