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Bioethics

Should you take ecstasy to improve your marriage? Not so fast …

Love drugs and science reporting in the media: Setting the record straight 

By Brian D. Earp, Julian Savulescu, and Anders Sandberg

Love. It makes the world go round. It is the reason we have survived as a species. It is the subject of our art, literature, and music—and it is largely the product of chemical reactions within the brain.

No wonder science is starting to unravel the ways in which we can influence it, and perhaps even control it.

Just as Darwin’s finding that we are descended from apes shocked people in the nineteenth century, so people will be shocked to find that our most lofty social ideal is something we share with our mammalian cousins and which is the subject of scientific scrutiny and even chemistry-book manipulation.

In 2008, two of us (Julian Savulescu and Anders Sandberg) published an article in the journal Neuroethics on the topic of “love drugs” – a term we use to refer to pharmacological interventions based on existing and future bio-technologies that could work to strengthen the bond between romantic partners. All three of us have an article just published in the journal Philosophy & Technology in which we build upon that earlier work. Interested readers will take the time to study those papers in full, but we have a feeling that much of the population will stop at a handful of media reports that have recently summarized our ideas, including at least one article that we think has the potential to mislead. Let us set the record straight.

Read More »Should you take ecstasy to improve your marriage? Not so fast …

A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

By Brian D. Earp 

* Note: this article has been re-posted at various other sites, sometimes with minor edits. This is the original and should be referred to in case of any discrepancies.

 

A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

1. Experimental doubts 

A handful of circumcision advocates have recently begun haranguing the global health community to adopt widespread foreskin-removal as a way to fight AIDS. Their recommendations follow the publication of three [1] randomized controlled trials (RCTs) conducted in Africa between 2005 and 2007.

These studies have generated a lot of media attention. In part this is because they claim to show that circumcision reduces HIV transmission by about 60%, a figure that (interpreted out of context) is ripe for misunderstanding, as we’ll see. Nevertheless, as one editorial [2] concluded: “The proven efficacy of MC [male circumcision] and its high cost-effectiveness in the face of a persistent heterosexual HIV epidemic argues overwhelmingly for its immediate and rapid adoption.”

Well, hold your horses. The “randomized controlled trials” upon which these recommendations are based are not without their flaws. Their data have been harnessed to support public health recommendations on a massive scale whose implementation, it has been argued, may have the opposite of the claimed effect, with fatal consequences. As Gregory Boyle and George Hill explain in their extensive analysis of the RCTs:

Read More »A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

Bad seed is a robbery of the worst kind: prolific sperm donation and screening

New York Times writes about “In Choosing a Sperm Donor, a Roll of the Genetic Dice”: recipients of sperm donation have found out the hard way that there is a risk of genetic disease affecting their children. In at least one case a donor with a clean bill of health and who had, according to the laboratory, been tested for genetic conditions. Unfortunately he turned out to be a carrier for cystic fibrosis like the mother, and the child suffered. Other cases of transmission of genetic conditions to multiple children from a single donor have appeared, suggesting a need to do something. Is there an ethical need for ensuring genetic testing in the case of sperm donation – or is the problem that some donors father many children?

Read More »Bad seed is a robbery of the worst kind: prolific sperm donation and screening

The Kansas Anti-Abortion Bill: An Affront to Autonomy

On Monday, the state of Kansas in the USA passed an anti-abortion bill which includes several morally controversial measures (http://www.huffingtonpost.com/2012/05/04/kansas-abortion-bill_n_1478706.html). One measure receiving a great deal of media attention is the provision to prohibit tax deductions for abortion insurance coverage, thus making a women’s ability to have an abortion far more dependent on her socio-economic status. This is of course an important issue, but I shall address an aspect of the bill which I find even more disagreeable.Read More »The Kansas Anti-Abortion Bill: An Affront to Autonomy

Bold Private John Smith, VC, modified ‘t’ allele of TPH1 SNP rs2108977

By Charles Foster

There’s a significant association of PTSD symptoms with a particular allele, according to a recently published study from UCLA and Duke. Some of the ethical consequences are already being discussed.  One consequence might be military. One might be able to detect and filter out PTSD-vulnerable recruits. Perhaps that’s a kindness. It would certainly seem militarily prudent. There might be legitimate qualms about creating a biologically callous warrior-class, but you’re not creating its components – you’re just collecting them together. You might not want to go to their parties, and you might wonder about the mutually brutalizing effect of corralling them in a barracks, but the exercise is really only a scientifically more informed version of the selection that goes on in any event. It’s not very interesting ethically.
But what if a gene for PTSD-resistance could be inserted or artificially switched on? It doesn’t seem fanciful. Should the military be permitted (or perhaps even required) to PTSD-proof their personnel?Read More »Bold Private John Smith, VC, modified ‘t’ allele of TPH1 SNP rs2108977

When the Law Should Ignore Incest

Worldwide media have been all over a case at the Strasbourg human rights court this week as it dismissed a man’s complaint over convictions for incest with his sister. Faced with a delicate moral question, the court ducked the issue, saying it fell within the ‘margin of appreciation’  (ie the area of discretion that the court leaves to member states in some areas of law). I think the law’s involvement in this case is a problem.

Read More »When the Law Should Ignore Incest

Psychiatric drugs to enhance conformity to religious norms, and conscientious objection

An article in the Israeli newspaper Haaretz reports on the (alleged) frequent use of psychiatric drugs within the Haredi community, at the request of the religious leaders, in order to help members conform with religious norms. Haredi Judaism is the most conservative form of Orthodox Judaism. It is sometimes referred to by outsiders as ultra-Orthodox. Haredim typically live in communities that have limited contact with the outside world. Their lives revolve around Torah study, prayer and family.

In December 2011, the Israel Psychiatric Association held a symposium entitled “The Haredi Community as a Consumer of Mental-Health Services”.  One of the speakers was Professor Omer Bonne, director of the psychiatry department at Hadassah University Hospital. Professor Bonne is claimed to have said that sometimes yeshiva students (yeshiva is a religious school) and married men should be given antidepressants even if they do not suffer from depression, because these drugs also suppress sex drive.

Read More »Psychiatric drugs to enhance conformity to religious norms, and conscientious objection

Nudge Drugs: should the social side-effects of medications weigh into public health?

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.

Read More »Nudge Drugs: should the social side-effects of medications weigh into public health?

How Tony Nicklinson Already Has the Right to Die

According to a BBC report, Tony Nicklinson, 58, from Melksham, Wiltshire, has “locked-in syndrome” after a stroke in 2005 and “is unable to carry out his own suicide.” “He is seeking legal protection for any doctor who helps him end his life.”

In fact, it is not quite correct that Tony Nicklinson “is unable to carry out his own suicide.” He could at present refuse to eat food or drink fluids. Hunger strikers do this for political reasons. He could do it for personal reasons. People should not be force fed against their own autonomous wishes.

Now suppose that Tony did refuse to eat or drink, because he wanted to die because he found a life locked-in to be intolerable. He would die in weeks, perhaps less. Given that he will die, he should be given medical treatment to make his last weeks as comfortable as possible. He should be given sedation and analgesia. He could even be given such doses that render him unconscious.

Such a process already happens, int he UK, in a slightly different way. In the famous case of Tony Bland, law lords authorized the removal of a feeding tube that was keeping Tony Bland, who was permanently unconscious. They, his family and doctors all judged that continued life was not in his interests.

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Moormann

Arbitrary Execution: Why the Law Needs Help from Neuroscience, Psychology and Philosophy

On February 29th, 2012, Robert Henry Moormann was executed in Arizona for murder. Back in 1984, he was in prison for kidnapping and molesting an eight year old girl, when the state gave him three days of compassionate leave. His elderly adoptive mother took a long bus trip to go and meet him. After an argument in a motel room where she was staying, he beat, stabbed and suffocated her, then dismembered her body. He asked a number of local businesses if he could dispose of “spoiled meat and animal guts” in their refuse containers, before disposing of most of her remains in bins and sewers around town. He also asked a prisoner officer to dispose of a box of what he described as “dog bones”. This behaviour raised suspicion. Moormann claimed not to remember the details of the crime, and at the original trial, Moormann’s lawyers mounted a defence of insanity. The jury rejected it. Since 1985, he had been living on death row while his appeals process was gradually exhausted.

In light of the gruesomeness of his crime, it is easy to think that if anyone ever deserved the death penalty, Moormann did. But the contention of Moormann’s defence lawyers that he was intellectually disabled casts a new light on the case.

Read More »Arbitrary Execution: Why the Law Needs Help from Neuroscience, Psychology and Philosophy