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Separation Anxiety – Should Treatment be Imposed for Conjoined Twins?

Separation Anxiety – Should Treatment be Imposed for Conjoined Twins?

by Dominic Wilkinson

@Neonatalethics

On the BBC News website this week, there is a feature on a pair of conjoined twins from Senegal who are currently living in Wales. They have an extremely rare condition – fused at the lower abdomen they have separate brains, hearts and lungs, but shared liver, bladder and digestive system.

The twins travelled to the UK to access medical treatment and surgery for their condition, however, the BBC reports that there is concern that both twins would not survive the surgery. The heart of one twin (Marieme) is weak, and the worry is that if she is separated she will die. Tragically, if the twins remain conjoined there is a fear that Marieme will still die, and her twin Ndeye will also not survive.

What should happen in this case? The twins’ father, Ibrahima, is, according to reports, struggling with the terrible decision that he faces. It isn’t clear at this stage what he will decide.

But what if he refused surgery? What should happen then?Read More »Separation Anxiety – Should Treatment be Imposed for Conjoined Twins?

Press Statement: He Jiankui

The response  to reckless human experimentation has to go way beyond Dr He’s dismissal. This is not merely a failure of compliance, Dr He failed to grasp the ethical principles and concepts he was vigorously espousing.  There will undoubtedly be more guidelines and laws on gene editing but we also need basic education of the… Read More »Press Statement: He Jiankui

A third MRT-baby is on its way

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Written by César Palacios-González

It has been recently reported (link in Spanish) that a 32 year old Greek woman is 27 weeks pregnant with a child who was conceived after a mitochondrial replacement technique (MRT) – in this case Maternal Spindle Transfer (MST). If true this is really big news in terms of reproductive medicine and biotechnology, we are still waiting for data to be published. If successful, this would be just the third birth following a reproductive technique that mixes the DNA of three people (you will probably remember the big media buzz a couple of years ago about ‘three parent babies’). This newest feat was achieved by a group of Spanish and Greek scientists; the clinical trial was carried out in Greece due to the fact that in Spain MRTs are not on the list of authorised reproductive techniques.

Before discussing what I consider to be the main ethical issue with this case, let us talk a bit about mitochondria and MRTs. Every human egg contains thousands upon thousands of mitochondrion. These tiny organelles have the really important task of producing the energy (in the form of ATP) that first the egg, then the developing embryo, and finally the human adult need to adequately function. It is thus not strange that when mitochondria do not work as they should the human body ‘malfunctions’. And it is also not strange that mitochondrial dysfunction more significantly affects the organs that require the most energy, for example the brain and the muscles.

To understand, broadly, what can go wrong with mitochondria, we need to bear in mind two of their characteristics: a) that they have their own DNA, and b) that they are mostly solely maternally transmitted. Regarding the former, inside every nucleated human cell there is nuclear DNA (nDNA) and there is mitochondrial DNA (mtDNA).

 

Read More »A third MRT-baby is on its way

Cross Post: Biased Algorithms: Here’s a More Radical Approach to Creating Fairness

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Written by Dr Tom Douglas

File 20190116 163283 1s61b5v.jpg?ixlib=rb 1.1

Our lives are increasingly affected by algorithms. People may be denied loans, jobs, insurance policies, or even parole on the basis of risk scores that they produce.

Yet algorithms are notoriously prone to biases. For example, algorithms used to assess the risk of criminal recidivism often have higher error rates in minority ethic groups. As ProPublica found, the COMPAS algorithm – widely used to predict re-offending in the US criminal justice system – had a higher false positive rate in black than in white people; black people were more likely to be wrongly predicted to re-offend.

Corrupt code.
Vintage Tone/Shutterstock

Read More »Cross Post: Biased Algorithms: Here’s a More Radical Approach to Creating Fairness

Cross Post: Philosophy Can Make the Previously Unthinkable Thinkable

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Written by Dr Rebecca Brown

In the mid-1990s, Joseph Overton, a researcher at the US think tank the Mackinac Center for Public Policy, proposed the idea of a ‘window’ of socially acceptable policies within any given domain. This came to be known as the Overton window of political possibilities. The job of think tanks, Overton proposed, was not directly to advocate particular policies, but to shift the window of possibilities so that previously unthinkable policy ideas – those shocking to the sensibilities of the time – become mainstream and part of the debate.

Overton’s insight was that there is little point advocating policies that are publicly unacceptable, since (almost) no politician will support them. Efforts are better spent, he argued, in shifting the debate so that such policies seem less radical and become more likely to receive support from sympathetic politicians. For instance, working to increase awareness of climate change might make future proposals to restrict the use of diesel cars more palatable, and ultimately more effective, than directly lobbying for a ban on such vehicles.Read More »Cross Post: Philosophy Can Make the Previously Unthinkable Thinkable

Is Addiction an Expression of One’s Deep Self?

By Doug McConnell

Chandra Sripada (2016) has recently proposed a conative self-expression account of moral responsibility which claims that we are responsible for actions motivated by what we care for and not responsible for actions motivated solely by other desires. He claims that this account gives us the intuitively correct answers when used to assess the responsibility of Harry Frankfurt’s Willing Addict and Unwilling Addict. This might be true; however, I argue that it provides a counterintuitive assessment of real-world cases of addiction because it holds people struggling to recover morally responsible for their relapses.Read More »Is Addiction an Expression of One’s Deep Self?

Reversibility, Colds, and Neurosurgery

By Jonny Pugh

This blog was originally published on the Journal of Medical Ethics Blog

 

Happy new year to readers of the blog!

I always approach the new year with some trepidation. This is not just due to the terrible weather, or even my resolution to take more exercise (unfortunately in the aforementioned terrible weather). Instead, I approach January with a sense of dread because it is always when I seem to come down with the common cold.

In my recent research, I have been interested in the nature and moral significance of reversibility, and the common cold is an interesting case study of this concept. In this blog, I will use this example to very briefly preview a couple of points that I make in a forthcoming open access article about reversibility in the context of psychiatric neurosurgery. You can read the open access paper here.

Read More »Reversibility, Colds, and Neurosurgery

In My Own Blood I Have Written The Things Important To Me

Adrien Locatelli, a French teenager claims to have injected DNA strands encoding verses from the Bible and the Quran in his thighs.

“I did this experiment only for the symbol of peace between religions and science … It’s just symbolic.” he told Motherboard. Sri Kosuri, a UCLA biochemist working on DNA for data storage and quoted in the paper was not amused, tweeting “2018 can’t end soon enough”.

Peak 2018, an inspiring science project, or something else? I will argue for the third option.

Read More »In My Own Blood I Have Written The Things Important To Me

Human In Vitro Gametogenesis and the Same-Sex Marriage Debate

Written by César Palacios-González

It seems that in the not-so-distant future, scientists will be able to create functional human gametes (i.e. eggs and sperm) in a laboratory setting. In other words, they will be able to create human gametes outside of the human body. And just as there is in vitro fertilization (IVF), there will be in vitro gametogenesis (IVG). This means that our already long list of human reproductive acronyms –IVF, PGD, ICSI, PNT, PBT1, PBT2, MST, UTx, CT, etc.–  will get a bit longer. At present, some of the best biology labs from around the world are actively working on how to achieve such goal, and non-human animal models have shown some amazing results.

For starters, scientists have successfully derived in a laboratory setting mouse oocyte-like cells and sperm-like cells from induced pluripotent stem cells and embryonic stem cells. And, most surprisingly, they have been able to create what has been called “cross-sex gametes”. This means that they have been able to create sperm-like cells from female mice, and oocyte-like cells from male mice (I use the terms ‘sperm-like’ and ‘oocyte-like’ because these cells are not identical to naturally occurring gametes). Some of such cross-sex gametes have, in turn, been capable of producing live offspring.Read More »Human In Vitro Gametogenesis and the Same-Sex Marriage Debate

Abortion: a Law Unto Itself

By   Charles Foster

Wrongful life cases (typically where a birth has resulted from a failed sterilisation procedure), used to be big business. The parents would sue the negligent steriliser for the costs of bringing up the unwanted child. There was always something distasteful about parents unwishing their child, and this distaste found legal expression in Macfarlane v Tayside Health Board,1  where the House of Lords said that such claims were unlawful. The ratio of Macfarlane was summarised by the Lord Steyn in Rees v Darlington Memorial Hospital NHS Trust:2Read More »Abortion: a Law Unto Itself