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How Much Freedom Should We Give Up To Avoid the Spread of Infectious Diseases?

How Much Freedom Should We Give Up To Avoid the Spread of Infectious Diseases?

The first patient to be diagnosed with Ebola outside of West Africa has been reported. He is now in the US, receiving treatment. He arrived from Liberia via Brussels before reporting symptoms, which were initially mis-diagnosed and treated with antibiotics.

If I were in West Africa and I had reason to fear I had been exposed to Ebola, do you know what I would do, if I had the resources? I would not wait to see if symptoms appeared or to be diagnosed, I would fly to the US or Europe, where, if symptoms developed, I would receive the very best health care in the world, including experimental treatments, in front of the world’s media.

If I could afford it, even selling everything, I would get on that plane to freedom, or at least a chance. A better chance to live.

But of course along the way, I would expose others to the risk of infection, and I would risk introducing the infection to areas of the world that are currently Ebola-free. It is unlikely, even so, that it would reach the levels seen in West Africa, as these countries have the resources and infrastructure to implement more effective containment strategies. Nevertheless, there is a chance that some people would die.

So how much freedom should people have? Should our freedom to travel be balanced against the risks it might pose to others?

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Iterated in vitro reproduction and genetic orphans

In an article soon to be published in the Journal of Medical Ethics, Rob Sparrow imagines a procedure via which multiple generations of human embryos might be created in the laboratory. Egg and sperm cells would first be generated from existing or new human pluripotent stem cell lines. The resulting eggs would be fertilised using the sperm to create zygotes and ultimately embryos. Embryonic stem cells would then be harvested from these embryos and used to create new egg and sperm cells, which would in turn be used to fertilise one another to create further embryos. This process could be iterated, in principle indefinitely.

Let’s call this procedure ‘iterated in vitro reproduction’ (Sparrow calls it ‘in vitro eugenics’). Iterated in vitro reproduction is not yet possible, but, citing recent developments in the science of stem cell-derived gametes, Sparrow argues that it may well become so, though he acknowledges are number of significant hurdles to its development. He also discusses a number of possible applications of the technology and calls for an ethical debate on these. The most controversial application would be in the creation of designer children. Consider the following case, which is a variant on one of the scenarios imagined by Sparrow:

Jack and Jill present to a fertility clinic. Jack provides a sperm sample, and fertility doctors harvest a number of eggs from Jill. These eggs are fertilized with Jack’s sperm to create embryos, from which embryonic stem cells are derived. These stem cells are then induced to develop into eggs or sperm which are used to fertilise one another, and so on. The process is iterated numerous times, and at each stage, the embryos are genetically screened via pre-implantation genetic diagnosis. This screening is used to inform a process of selective crossing, so that, over several generations, the population of embryos evolves towards certain genetic dispositions desired by Jack and Jill (a disposition towards longevity, say). This process is aided by adding small amounts of genetic material from stem cell lines derived from other individuals. Eventually, doctors identify an embryo with almost exactly the desired combination of genes, and this embryo is implanted into Jill’s womb and carried to term. A child, Jarvis, is born.

Cases like this raise numerous ethical issues, some of which are discussed by Sparrow and the seven commentators on his paper. However, they also raise an interesting conceptual question: would the users of such a technology be the genetic parents of the resulting offspring? Would Jack and Jill be the genetic parents of Jarvis?

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People and charitable causes are importantly different things

Like Prot – the lovable character played by Kevin Spacey in the underrated movie K-PAX – you’re an intelligent benevolent extraterrestrial who has just been beamed to Earth.  Sadly, unlike Prot, you have no return ticket.  The good news for you is that just moments after hopping off of your beam of light, you found a briefcase stuffed with $3 million.  Being benevolent, and having concern for the inhabitants of Earth, you decide to give nearly all of this money to charity.  Being completely new to the planet, however, you do not yet have any special concern for anyone here – no friends, no loved ones.  Having this equal concern for everyone, you want simply to do the most good possible, and so you decide to give this money to the most cost-effective charities you can find.

Exit science fiction scenario.

One important difference between each of us and this Prot-agonist is that we do have friends and loved ones; we have rich shared histories with them, we care deeply about them, and, crucially, the level of concern we have for them is not on a par with the general concern we have for strangers.  If your fiancé were drowning in a lake to your north, and ten strangers were drowning in a lake to your south, and you could either rescue the one to your north or instead the ten to your south (but not all eleven!), you’d probably head north.  Whether this constitutes morally good behavior on your part is a matter of controversy among contemporary ethical theorists.  But let’s assume the commonsense view that it’s not wrong of you to save your fiancé over the ten others.  This degree of special partial concern is, we’ll suppose, justified.

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A German MP on meth: Enhancement or not?

German MP Michael Hartmann was recently in the news because of his crystal meth use. The media was quick to compare Hartmann to other politicians who use other substances: the past marijuana use of Clinton and Obama, and the recent scandal around the crack addiction of Canadian mayor Rob Ford. The media also stresses that it is hypocritical that Michael Hartmann previously publicly opposed the use of cannabis. The media enforces the image most people have: all substance use is the same and equals addiction, low self-control and bad morals.Read More »A German MP on meth: Enhancement or not?

Bad news for “intelligence-genes”

Intelligence and its heritability has been a popular topic in scientific communities and public discussions for long. Recent findings give new insight to the debate: one of the largest studies on genetic influence to intelligence and other behavioral traits turned up inconclusive findings, as Nature News reports in a recent article “Smart genes” prove elusive.

Existing literature on candidate gene associations is rich in studies that have been unable to replicate and findings have been based on “wishful thinking and shoddy statistics”. According to an editorial in Behavior Genetics,

it now seems likely that many of the published findings of the last decade are wrong or misleading and have not contributed to real advances in knowledge.Read More »Bad news for “intelligence-genes”

Petrov Day

Today, 31 years ago, the human species nearly came to an end. Lieutenant colonel Stanislav Petrov  was the officer on duty in bunker Serpukhov-15 near Moscow, monitoring the Soviet Union early warning satellite network. If notification was received that it had detected approaching missiles the official strategy was launch on warning: an immediate counter-attack against the United States. International relations were on a hair trigger: just days before Korean Air Lines Flight 007 had been shot down by Soviet fighter jets, killing everybody onboard (including a US congressman). Kreml was claiming the jet had been on a spy mission, or even deliberately trying to provoke war.

Shortly after midnight the computers reported a single intercontinental missile heading towards Russia.

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Will Virgin staff really be allowed to take ‘as much holiday as they want’?

This week Richard Branson announced that Virgin would no longer be tracking people’s holidays. The move was apparently inspired by Netflix, who have similarly instigated a “no holiday policy” policy, which permits all salaried staff to ‘take off whenever they want for as long as they want.’ According to Branson, the idea came to him via his daughter, Holly, who sent him the following cheery email about Netflix, sounding suspiciously like a copywriter from Virgin’s media team:

Dad, check this out. It’s something I have been talking about for a while and I believe it would be a very Virgin thing to do to not track people’s holidays. I have a friend whose company has done the same thing and they’ve apparently experienced a marked upward spike in everything – morale, creativity and productivity have all gone through the roof.

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Framing the Ebola epidemic

“CDC estimates Ebola epidemic could be over in Liberia and Sierra Leone by January!”

So ran the headline of exactly no news outlets.  Instead, a typical headline ran the following sort of dire prediction: “Ebola cases could reach 1.4 million within four months, CDC estimates.”  Only a few went with what is arguably the fairest sort of headline: “CDC offers sharply differing forecasts for Ebola epidemic.”  I would suggest that, while on its face the more dire headline is somewhat deceptive and driven by bad journalistic practices, it is all things considered preferable to the alternatives.  Read More »Framing the Ebola epidemic

Trust and Institutions

Last week I attended part of a fascinating conference on Trust, organized by the Blavatnik School of Government in Oxford. In her opening paper, Katherine Hawley raised many interesting questions, including those of whether trustworthiness is a virtue and whether it can be a virtue of institutions.Read More »Trust and Institutions

Not-so-lethal – the ethics and costs of extraordinary fetal intervention

By Dominic Wilkinson (@Neonatal Ethics)

Late last month, a paper in the US journal Obstetrics and Gynecology reported the extraordinary case of Abigail Beutler. Abigail is now 14 months old. She was born without kidneys, a condition sometimes called ‘Potter’s syndrome’. Potter’s syndrome is normally universally fatal in the newborn period, because without kidneys the fetus does not produce urine and has little or no fluid around them. Without any fluid around the fetus, their lungs do not develop.

Abigail is the first baby to ever survive with this condition. Doctors infused artificial fluid into the uterus around her (amnioinfusion) on five occasions during the pregnancy. This seemed to allow her lungs to grow. Although she was born 3 months prematurely, she had only minor breathing problems at birth. She has received kidney dialysis since soon after birth, was discharged home after 19 weeks and is now reportedly being considered for a kidney transplant.Read More »Not-so-lethal – the ethics and costs of extraordinary fetal intervention