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Bioethics

What Fuels the Fighting: Disagreement over Facts or Values?

In a particularly eye-catching pull quote in the November issue of The Atlantic, journalist and scholar Robert Wright claims, “The world’s gravest conflicts are not over ethical principles or disputed values but over disputed facts.”[1]

The essay, called “Why We Fight – And Can We Stop?” in the print version and “Why Can’t We All Just Get Along? The Uncertain Biological Basis of Morality” in the online version, reviews new research by psychologists Joshua Greene and Paul Bloom on the biological foundations of our moral impulses. Focusing mainly on Greene’s newest book, Moral Tribes: Emotion, Reason, and the Gap Between Us and Them, Wright details Greene’s proposed solution to the rampant group conflict we see both domestically and internationally. Suggesting that we are evolutionarily wired to cooperate or ‘get along’ with members of groups to which we belong, Greene identifies the key cause of fighting as different groups’ “incompatible visions of what a moral society should be.”[2] And his answer is to strive for a ‘metamorality’ – a universally shared moral perspective (he suggests utilitarianism) that would create a global in-group thus facilitating cooperation.

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Can a person in a vegetative state get married?

By Luke Davies

Follow Luke on Twitter.

Recently in Illinois, a woman, Colette Purifoy, has been denied a marriage license because her fiancé, John Morris, who is in a vegetative state, cannot sign the marriage form and consent (Find the story here, here, here, and here). In 2009, just before the surgery during which his anoxic brain injury was inflicted (leaving him in his current, unresponsive condition), Morris proposed to Purifoy for a second time. She said ‘Yes’, also for the second time. The couple has been together for 38 years, but hasn’t been able to marry as a result of financial and family commitments.Read More »Can a person in a vegetative state get married?

Electroceuticals and Mind Control

“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.

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Abortion ‘on grounds of gender’: Like it or not, the DPP was right

There has been a recent storm over the DPP’s decision not to prosecute two doctors in relation to their referral of two women for abortion. The cases were widely represented as cases of abortion on grounds of gender. They came to light in the course of an undercover investigation by the Daily Telegraph of practice in English abortion clinics ( see also here and here).

The DPP has published detailed reasons for his decision. They are well worth reading.

An abortion is only lawful if two medical practitioners are of the opinion, held in good faith, that one of the lawful grounds for abortion is made out. One of the grounds (overwhelmingly the commonest, and the one said to be relevant in both of the cases considered by the DPP), is that ‘the pregnancy has not exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family.’: Abortion Act 1967, s. 1(1)(a).

The Act does not say anywhere that the gender of the fetus is a relevant criterion. But it plainly could be. Take two examples:Read More »Abortion ‘on grounds of gender’: Like it or not, the DPP was right

Announcement: “Brave New Love” in AJOB:Neuroscience – peer commentaries due October 7

Announcement: “Brave New Love” – peer commentaries due October 7 Dear Practical Ethics readers, The paper, “Brave new love: the threat of high-tech ‘conversion’ therapy and the bio-oppression of sexual minorities” by Brian D. Earp, Anders Sandberg, and Julian Savulescu has been accepted for publication in the American Journal of Bioethics: Neuroscience. Proposals for open peer commentaries are… Read More »Announcement: “Brave New Love” in AJOB:Neuroscience – peer commentaries due October 7

Stress Influences Our Moral Behaviour

All of us are stressed, every now and then. Acute stress can have a profound impact on the human body and mind: both physical and psychological stressors affect the autonomic nervous system and the hypothalamic–pituitary–adrenal axis, leading to changes in cardiovascular and neuroendocrine measures. Stress also is shown to affect cognitive functions like memory and attention. Just recently, however, research discovered that acute stress also can influence our moral behaviour.

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Ethical Enhancement

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.

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Let’s Talk About Death: Millennials and Advance Directives

Sarah Riad, College of Nursing and Health Sciences, University of Massachusetts Boston

Melissa Hickey, School of Nursing, Avila University 

Kyle Edwards, Uehiro Centre for Practical Ethics, University of Oxford

As advances in medical technology have greatly increased our ability to extend life, the conversation on end-of-life care ethics has become exceedingly complex. With greater options both to end life early and extend it artificially, advance directives have arisen in an effort to preserve patient autonomy in situations in which he or she becomes incapable of making a medical decision. However, most people—especially young adults—do not think to plan for such moments of incapacity and the potentiality of an untimely death. With a youthful sense of invincibility comes a lack of foresight that prevents us from confronting these issues. The reality is that unexpected events happen. When they do, it is often very difficult to imagine what a person would have wanted and make medical decisions accordingly on his or her behalf. In this post, we suggest both a transition from action-based to value-based advance directives and an interactive website that would make the contemplation of these issues and the construction of a value-based advance directive appealing to and accessible for Millennials, the 20-somethings of today. Read More »Let’s Talk About Death: Millennials and Advance Directives

Safety First? How the Current Drug Approval System Lets Some Patients Down

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.

Like Les Halpin and Jenn McNary, the mother of twins afflicted with a similar rare disease, he has a simple request: earlier access to medicines that might help improve or extend his life.

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.

Read More »Safety First? How the Current Drug Approval System Lets Some Patients Down