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Julian Savulescu

First synthetic embryos: the scientific breakthrough raises serious ethical questions

synthetic mouse.
Weizmann Institute of Sciences

Julian Savulescu, University of Oxford; Christopher Gyngell, The University of Melbourne, and Tsutomu Sawai, Hiroshima University

Children, even some who are too young for school, know you can’t make a baby without sperm and an egg. But a team of researchers in Israel have called into question the basics of what we teach children about the birds and the bees, and created a mouse embryo using just stem cells.

It lived for eight days, about half a mouse’s gestation period, inside a bioreactor in the lab.

In 2021 the research team used the same artificial womb to grow natural mouse embryos (fertilised from sperm and eggs), which lived for 11 days. The lab-created womb, or external uterus, was a breakthrough in itself as embryos could not survive in petri dishes.

If you’re picturing a kind of silicone womb, think again. The external uterus is a rotating device filled with glass bottles of nutrients. This movement simulates how blood and nutrients flow to the placenta. The device also replicates the atmospheric pressure of a mouse uterus.

Some of the cells were treated with chemicals, which switched on genetic programmes to develop into placenta or yolk sac. Others developed into organs and other tissues without intervention. While most of the stem cells failed, about 0.5% were very similar to a natural eight-day-old embryo with a beating heart, basic nervous system and a yolk-sac.

These new technologies raise several ethical and legal concerns.

Read More »First synthetic embryos: the scientific breakthrough raises serious ethical questions

Three Observations about Justifying AI

Written by:  Anantharaman Muralidharan, G Owen Schaefer, Julian Savulescu
Cross-posted with the Journal of Medical Ethics blog

Consider the following kind of medical AI. It consists of 2 parts. The first part consists of a core deep machine learning algorithm. These blackbox algorithms may be more accurate than human judgment or interpretable algorithms, but are notoriously opaque in terms of telling us on what basis the decision was made. The second part consists of an algorithm that generates a post-hoc medical justification for the core algorithm. Algorithms like this are already available for visual classification. When the primary algorithm identifies a given bird as a Western Grebe, the secondary algorithm provides a justification for this decision: “because the bird has a long white neck, pointy yellow beak and red eyes”. The justification goes beyond just a description of the provided image or a definition of the bird in question, and is able to provide a justification that links the information provided in the image to the features that distinguish the bird. The justification is also sufficiently fine grained as to account for why the bird in the picture is not a similar bird like the Laysan Albatross. It is not hard to imagine that such an algorithm would soon be available for medical decisions if not already so. Let us call this type of AI “justifying AI” to distinguish it from algorithms which try, to some degree or other, to wear their inner workings on their sleeves.

Possibly, it might turn out that the medical justification given by the justifying AI sounds like pure nonsense. Rich Caruana et al present a  case whereby asthmatics were deemed less at risk of dying by pneumonia. As a result, it prescribed less aggressive treatments for asthmatics who contracted pneumonia. The key mistake the primary algorithm made was that it failed to account for the fact that asthmatics who contracted pneumonia had better outcomes only because they tended to receive more aggressive treatment in the first place. Even though the algorithm was more accurate on average, it was systematically mistaken about one subgroup. When incidents like these occur, one option here is to disregard the primary AI’s recommendation. The rationale here is that we could hope to do better than by relying on the blackbox alone by intervening in cases where the blackbox gives an implausible recommendation/prediction. The aim of having justifying AI is to make it easier to identify when the primary AI is misfiring. After all, we can expect trained physicians to recognise a good medical justification when they see one and likewise recognise bad justifications. The thought here is that the secondary algorithm generating a bad justification is good evidence that the primary AI has misfired.

The worry here is that our existing medical knowledge is notoriously incomplete in places. It is to be expected that there will be cases where the optimal decision vis a vis patient welfare does not have a plausible medical justification at least based on our current medical knowledge. For instance, Lithium is used as a mood stabilizer but the reason why this works is poorly understood. This means that ignoring the blackbox whenever a plausible justification in terms of our current medical knowledge is unavailable will tend to lead to less optimal decisions. Below are three observations that we might make about this type of justifying AI.

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Shaming unvaccinated people has to stop. We’ve turned into an angry mob and it’s getting ugly

Written by Alberto Giubilini and Julian Savulescu. Cross-Posted from The Conversation 
Shutterstock

Julian Savulescu, University of Oxford and Alberto Giubilini, University of Oxford

Unvaccinated mother, 27, dies with coronavirus as her father calls for fines for people who refuse jab.

This is the kind of headline you may have seen over the past year, an example highlighting public shaming of unvaccinated people who die of COVID-19.

One news outlet compiled a list of “notable anti-vaxxers who have died from COVID-19”.

There’s shaming on social media, too. For instance, a whole Reddit channel is devoted to mocking people who die after refusing the vaccine.

COVID-19 vaccinations save lives and reduce the need for hospitalisation. This is all important public health information.

Telling relatable stories and using emotive language about vaccination sends a message: getting vaccinated is good.

But the problem with the examples above is their tone and the way unvaccinated people are singled out. There’s also a murkier reason behind this shaming.

Read More »Shaming unvaccinated people has to stop. We’ve turned into an angry mob and it’s getting ugly

Ethics of Vaccine Passports

Vaccine Passports as a Human Right

The main way to control the pandemic, as we have all painfully found out, has been to restrict the movement of people. This stops people getting infected and infecting others. It is the justified basis for quarantine of people who have been in high risk areas, lockdown, isolation and vaccine passports.

It is the foundational ethical principle of any liberal society like Australia that the State should only restrict liberty if people represent a threat of harm to others, as John Stuart Mill famously articulated. This harm can take two forms. Firstly, it can be direct harm to other people.

Imagine you are about to board a plane (remember that…) Authorities have reason to believe you are carrying a loaded gun. They are entitled to detain you. But they are obliged to investigate whether you have a gun. And if you are not carrying a gun, they are obliged to free you and allow you to board your plane. To continue to detain you without just cause would be false imprisonment.

Having COVID is like carrying a loaded gun that can accidentally go off at any time. But if vaccines remove the bullets from the gun, they are not a risk to other people and should be free.

Vaccine passports are thus a human rights issue under conditions of lockdown like Melbourne and Sydney are experiencing (the situation is different in Europe where lockdowns have been relaxed), if vaccines reduce transmission to other people sufficiently. Vaccination removes the authority and justification to restrict people’s liberty.

It is not discrimination to continue to restrict the liberty of the unvaccinated – it is just like quarantining those who have entered from high risk countries overseas. Their liberty is restricted because they are a threat to others. Discrimination occurs when people are treated differently on morally irrelevant grounds – differential treatment on the basis of differential threat is morally relevant. For example, to enter some countries, travellers must be vaccinated against Yellow Fever and receive a card as a vaccine passport. No card, no travel.

Are COVID Vaccine Passports a Human Right?

Do COVID vaccines fit into this justification for vaccine passports?

Read More »Ethics of Vaccine Passports

Vaccine Nationalism: Striking the balance

Written by Owen Schaefer and Julian Savulescu

This is an updated cross-post of an article published in MediCine

On 2 February 2021, the Director-General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, issues a broadside against COVID-19 vaccine nationalism, calling it “morally indefensible” and “tantamount to medical malpractice at a global scale.” Rich countries representing 16% of the global population have snapped up 60% of the global supply of COVID-19 vaccines. [1] Meanwhile, India, which has only vaccinated 10% of its population, is facing a catastrophic COVID-19 surge.[2] And the COVAX facility – an international effort to get COVID-19 vaccines equitably distributed around the world – currently only projects capacity to offer vaccines amounting to about 3% of participating countries’ populations by mid-year.[3]

COVID-19 vaccine nationalism is not the exception to normal practice. In almost all matters, countries spend the vast majority of budgets on local needs, and only a small fraction of that foreign aid, even when the latter represents much greater need. But the fact that this is normal or expected does not amount to a moral defense.

Here, we explore a question of practical ethics: what is the appropriate extent to which a country can prioritize its own people over those in other countries in the securing of vaccines for COVID-19?

Read More »Vaccine Nationalism: Striking the balance

Press Release: Medical and ethical experts say ‘make general anaesthesia more widely available for dying patients’

General anaesthesia is widely used for surgery and diagnostic interventions, to ensure the patient is completely unconscious during these procedures. However, in a paper published in Anaesthesia (a journal of the Association of Anaesthetists) ethics and anaesthesia experts from the University of Oxford say that general anaesthesia should be more widely available for patients at… Read More »Press Release: Medical and ethical experts say ‘make general anaesthesia more widely available for dying patients’

Cross-Post: The Moral Status of Human-Monkey Chimeras

Written by Julian Savulescu and Julian Koplin 

This article was first published on Pursuit. Read the original article.

The 1968 classic Planet of the Apes tells the story of the Earth after a nuclear war destroys human civilisation. When three astronauts return to our planet after a long space voyage, they discover that humans have lost the power of verbal communication and live much like apes currently do.

Meanwhile, non-human primates have evolved speech and other human-like abilities, and are now running the earth with little regard for human life.

The astronaut George Taylor, played by Charlton Heston, is rendered temporarily mute when he is shot in the throat and captured. In one scene he is brought before the Apes, as he appears more intelligent than other humans.

He regains the power of speech, and his first words are: “Take your stinking paws off me, you damned dirty ape.”

Planet of the Apes may be fiction, but this month the world’s first human-monkey lifeforms were created by Juan Carlos Belmonte at the Salk Institute for Biological Studies in the US, using private funding. Professor Belmonte and his group injected stem cells from the skin of a human foetus into a monkey embryo.

This part-human lifeform is called a chimera.

If implanted into a monkey uterus, the chimera could theoretically develop into a live-born animal that has cells from both a monkey and a human.

While it has been possible to make chimeras for more than 20 years using a different technique that involves fusing the embryos of two animals together, this technique has not been used in humans. It has been used to create novel animals like the geep – a fusion of a sheep and goat embryo.

Professor Belmonte used a different technique– called “blastocyst complementation” – which is more refined. It enables greater control over the number of human cells in the chimera.

But why is this research being done?

Read More »Cross-Post: The Moral Status of Human-Monkey Chimeras

Press Release: Majority of UK public want choice at the end of life – survey

Most people in the UK would like the option of being heavily sedated, having a general anaesthestic or to having euthanasia, if they were dying, according to Oxford research published today in the medical journal PLOS One. Professor Dominic Wilkinson, Professor Julian Savulescu and colleagues from the Oxford Uehiro Centre for Practical Ethics, surveyed more… Read More »Press Release: Majority of UK public want choice at the end of life – survey

Ethics, iBlastoids, and Brain Organoids: Time to Revise Antiquated Laws and Processes

Written by Julian Savulescu
Oxford Uehiro Centre for Practical Ethics and Wellcome Centre for Ethics, University of Oxford
Biomedical Ethics Research Group, Murdoch Children’s Research Institute

Jose Polo and his team at Monash University have successfully reprogrammed human adult cells (fibroblasts – skin cells) to form “iBlastoids”. These are structures which are like early human embryos. Normally when a sperm enters an egg, it produces a new cell, which divides, and these cells divide until a blastocyst is formed in the first week, consisting of 200-300 cells. In normal embryonic development, this would implant in the uterus. However, iBlastoids can’t do this as they lack the normal membrane that surrounds the blastocyst. They cannot by themselves form a fetus or baby.

They will be useful to study early human development and why so many embryos die soon after formation. They can be used to study mutations or the effect of toxins, perhaps developing treatments for infertility. So far, they have only been allowed to develop to the equivalent of a Day 11 Blastocyst. It is not clear whether they can produce the precursors to brain development:

“the developmental potential of iBlastoids as a model for primitive streak formation and gastrulation remains to be determined, and will require an international conversation on the applicability of the 14-day rule to iBlastoids.” (Excerpt from the team’s Nature article)

Read More »Ethics, iBlastoids, and Brain Organoids: Time to Revise Antiquated Laws and Processes

The Ethics of Age-Selective Restrictions for COVID-19 Control

Written by: Bridget Williams1,2, James Cameron3, James Trauer2, Ben Marais4, Romain Ragonnet2, Julian Savulescu1,3

Cross-posted with the Journal of Medical Ethics blog

One of the major controversies of the COVID-19 pandemic has been disagreement about whether age-selective measures should be introduced, with greater focus on preventing infection in older people but tolerance of some transmission amongst younger people. Some have advocated a path of focusing efforts on protecting those most vulnerable and tolerating transmission in younger people. Others have argued for minimising community transmission. This debate involves important empirical uncertainties; including the feasibility of effectively isolating older people and the consequences of allowing infection in a large number of younger people, as well as the feasibility and consequences of alternative measures such as strict border control and quarantine. It also raises ethical considerations, including whether introducing age-selective restrictions is unjust, and whether it is acceptable for a policy to tolerate foreseeable harms.

Here we address these ethical questions and suggest that, although the appropriateness of age-selective approaches requires further consideration of the empirical evidence, ethical concerns should not prevent its consideration as a policy option.

Read More »The Ethics of Age-Selective Restrictions for COVID-19 Control