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Bioethics

Why public health campaigns should not promote enhancement

by Rebecca Roache

Human
enhancement is a hot topic in bioethics. 
Typically conceived as the use of technology to raise human capacities
above what is merely healthy or normal, it attracts questions such as, Is it
ethical?  Is it desirable?  Is it cheating? and, Should the state
subsidise it?  A common view is that,
whilst therapy—which aims to restore human capacities to what is healthy or
normal, but not to raise them above this level—is desirable; enhancement is at
best unnecessary [1], and at worst unethical [2].  Human enhancement, one might be tempted to
think, is for oddballs only: the average person is content merely to be
healthy.

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Facilitating, Condoning, and Preventing HIV

The Eighteenth International AIDS Conference is currently underway in Vienna, and one of the issues that has been under discussion is how to reduce HIV transmission within the various at-risk groups. One such group is the prison population, among whom HIV transmission occurs due to both illicit sexual activity and intravenous drug abuse. But prison authorities have often resisted putting in place public health measures such as condom or needle distribution that have been shown to be effective, because they regard sexual activity and drug use as prohibited in their prisons, and do not want to to be seen as condoning these activities. Is this concern a reasonable one?

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Performance Enhancement – Athletes are Victims not Delinquents

To describe the obvious power dynamic in modern sports industry from my personal point of view, I’m going to make use of a little metaphor. Therefore you have to imagine sport as a squash game played by several opponents. The competitors, hitting the ball from one corner into the other, represent the different stakeholders in elite-sports. Spectators, coaches, sponsors, national and international associations to mention a few. Of course there’s also one tiny ball incarnating the athlete himself as a kind of focal point, trying to satisfy the different demands. As a ball you’re certainly one of the most important parts of the game. But simultaneously you might be very easy to manoeuvre, because your being spherical, which could imply your lack of personal influence. Merely your ability to leave behind a little black marking on the squash court “wall of fame” is your only chance to colour your sport individually. As an elite sportsperson you’ve almost no opportunity to defend yourself against the prevailing key-players in the system. Otherwise you’re going to risk your career or even your status as a moral competitor. In the following lines, I’ll try to explain my position by disclosing the maladministration and mild coercion top-athletes are confronted with, emphasising four different issues of the “sports-system”.

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Greeks and geeks

At Harvard Medical School someone is screaming, reports the Boston Globe. ‘Death!’, he shrieks, ‘Why after all these years have you not appeared?’ He begs for euthanasia, tormented by his pain. Medical students listen to him.

His lines were written by Sophocles, and the students are listening because they have to: it is part of their curriculum.

The remarkable thing is not that Harvard medical students are being marinated in Sophocles, but that the Globe thought it worth reporting. Most medical students in mainstream western universities will get some ethics teaching. Sophocles is just one tool in the teachers’ toolkit. It’s a very effective one, by all accounts, but no different in kind from the lectures and seminars more conventionally deployed. Ethics teaching aims to teach students some problem-solving strategies, and to help them to recognise, evaluate, criticise, cull or cultivate the values that they themselves bring to the wards. 

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Between Life and Death…

A powerful BBC documentary, “Between Life and Death”, screened this evening on BBC One. The documentary (which can be viewed online for the next week in the UK) examined the life and death decisions made for critically ill patients with severe brain injury. Neuro-intensive care provides a way to interrupt the process of dying for such patients. But it raises difficult questions for medical staff and for families about the wishes of patients, the wishes of family members, and about uncertainty. Should treatment continue at the risk of the patient surviving in a severely impaired state? Or should patients be allowed to die, with the risk that perhaps if treatment had continued they may have recovered?

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Artificial Performance Enhancement in Sports – Are we Overreacting?

by Roman Gaehwiler

Within human history sport consistently has been abused as a platform of political disputes and athletes came to be exploited by governments to benefit the economy. The simple competitor has been transformed into a nationalized single warrior and pushed to represent his country as perfectly as possible. This spirit of the “idealized hero”, whose ability stands for the strength and force of a whole nation persisted until the twenty-first century. Of course not in the same dimensions, but there’s no doubt elite-sportspeople are a kind of mirror for society. In connection with the increasing influence of monetary incentives, a simple comparison of physical strength became an inexorable business. Excessive artificial performance enhancement is just an unavoidable result of that. The paradox obviously is that the audience calls for supernatural performances, but at the same does not approve the athlete to do so by taking performance enhancing substances.Therefore it’s legitimate to ask ourselves: “Are we taking sport too seriously?”

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The Costs of a Right to Demand Treatment

by Bridget Williams

Who has the right to decide when life prolonging treatment
should be withdrawn? Should doctors have the right to refuse to use costly and
scarce resources to continue to treat a permanently unconscious, dying man? Is
there a limit to the medical resources we can reasonably claim for ourselves
and our families when there are others who have the potential to receive much
greater benefits from those same resources?

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Critical Care ethics series – the ethics of maxiple pregnancies

by Dominic Wilkinson Quads, Quins, Sexts, Septs, even Octs! High order multiple pregnancies such as the Suleman octuplets in California generate enormous media attention. However, they also raise some unique ethical questions. In the second of a series of seminars on critical care ethics, the neonatal grand round today looked at ethical questions arising from… Read More »Critical Care ethics series – the ethics of maxiple pregnancies

Foetal pain and the abortion debate: believing what you want to believe

By Janet Radcliffe-Richards

Last Friday’s BBC morning news headlines included a report of two reviews by the Royal College of Obstetricians and Gynaecologists of evidence about foetal pain. The reviews concluded that foetuses under 24 weeks could not feel pain, because “nerve connections in the cortex, the area which processes responses to pain in the brain, does not form properly before 24 weeks”, and that even after that stage “a foetus is naturally sedated and unconscious in the womb”.

The corresponding article on the BBC website added the comment that “anti-abortion campaigners challenged the reports”. There were no details about the form these challenges took or who they came from, but as the reports were reviews of scientific evidence, it sounds as though a challenge to the reports must have been a challenge to the scientific claims. Of course scientific claims are always potentially open to challenge, so if the article had reported that scientists had come forward to challenge the methodology of key studies, for instance, or the way the reviews represented the data, we would just have known there was an ongoing scientific debate on the subject. But the implication of the BBC article was that people who were against abortion were challenging the scientific claims about foetal pain. And if this is true, it is interesting. Why should people with particular moral views (about the wrongness of abortion) or political ambitions (to prevent it) issue challenges to scientific claims? Most of these people are not scientists, and there is no reason to think they have special knowledge of nerve connections in the foetal cortex. So why are the challenging what the scientists say?

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