Practical Ethics

Not better than the alternative: an informal experimentation tragedy

Police are reinvestigating the 2007 death of Yolanda Cox, a woman who collapsed in anaphylactic shock after being injected with an experimental drug by her sister, a GP. The drug was developed by their mother, originally intended to treat diabetes but apparently believed to extend lifespan. After testing on diabetic patients and apparently themselves without any apparent side effects the mother and sister gave it to the woman three times, with tragic consequences the third time. Was it a failure of medical ethics, research ethics - or plain psychological bias?

Shining monkey, sadistic conclusion?

Japanese researchers have genetically modified marmoset monkeys, and demonstrated that the modification can be inherited by their offspring. The modification was the standard green fluorescent protein making the monkey's glow green under UV light, a marker to demonstrate that the modification worked (BBC shows a picture of their feet glowing "an eerie green", while the picture in Nature's News and Views shows the cute monkeys in normal light and the original paper shows both). The long-term aim is to be able to produce transgenic primates that could act as disease models for humans - many conditions do not map well onto mice and rats. But is it acceptable to introduce heritable illness conditions into animals?

Self-control matters - but to what extent can it be taught?

Recently in the news, a report published by the independent think-tank Demos reminds us of the importance of the capacity for self-control (it also mentions empathy, to which most of the following remarks apply) in determining life outcomes. It argues that self-control lessons should be taught at school if children, particularly from deprived backgrounds, are to be given the tools they need to succeed in life – low-self-control has for instance been shown to positively correlate with length of unemployment or criminal behaviour, and negatively with academic achievement. The report echoes renewed interest in the United States in a now famous experiment by Walter Mischel on deferred gratification, dating back to the late 1960s. Mischel tested the capacity of a group of four-year olds to resist the temptation to eat straightaway a marshmallow he had given them. The children who were able to refrain turned out to be better adjusted, more dependable and to do better academically on the whole later in life.

 

The report by Demos makes important points and its proposals deserve to be supported. Nevertheless, even if they are put into practice, we might still feel concerned about how effective we can expect them to be. There is indeed a body of evidence suggesting that the capacity for self-control is to a large extent genetically determined (Wright & Beaver, 2005; Beaver & al., 2009).

 

Contradicting Nature

Rubén Noé Coronado Jiménez is 25 and pregnant with twins. He is unusual in that he is a transsexual man, in the middle of hormone treatments and about to undergo a full operation to change his sex: http://www.guardian.co.uk/world/2009/mar/30/transexual-man-pregnant-twins . The operation has, of course, been postponed while he and his female partner await the birth of their children.

Dr Josep-Luis Ballescà, a gynaecologist at the Clinical Hospital of Barcelona, has said that that the pregnancy is ‘not necessarily ethically acceptable: it is a contradiction.’

It’s hard to know quite what kind of contradiction Dr Ballescà has in mind. But it’s likely that part of what he means is that for a male to give birth goes against nature. And, if we assume that what is unnatural is morally wrong, we can draw the conclusion that Jiménez is acting wrongly. Either he should have had his children while still fully female, or he should have sought other means to have children, such as adoption.

The great C18 Scottish philosopher David Hume said that there is no word ‘more ambiguous and equivocal’ than ‘nature’ (Treatise 3.1.2.7). First, what’s natural can be contrasted with what is supernatural or miraculous. On the face of it, a man’s giving birth to a baby is a miracle, but of course on closer inspection we find that this pregnancy can be explained in purely naturalistic terms. Second, what is typical or usual can be called natural. Certainly what’s going on here is unusual. But why think that what is unusual is bad, regrettable, or wrong? Acts of very great heroism are unusual; but their being unusual if anything makes them more praiseworthy. Third, the natural can be contrasted with the artificial. Again, given the use of reproductive technology in this pregnancy, it could not be described as natural. But it would be hard to take seriously the idea that we should avoid the artificial. Most medical treatment would be forbidden, so it seems unlikely that it is that Dr Ballescà was thinking of.

It is most probable that behind Dr Ballescà’s remark lies a commitment to a kind of teleology: the idea that the world is to be understood in terms of certain purposes or goals, and that each being should seek to achieve the purposes specific to it. This form of naturalism is often tied to theology, and raises the question how we can know the purposes of God. There are certainly passages from the scriptures in various traditions which can be used to criticize Jiménez’s actions; but those passages themselves are open to different interpretations, often informed by other passages of scripture. We are anyway entitled to ask why God might have ascribed to women the role of giving birth. The obvious answer is to continue the species, and there seems no reason why men shouldn’t play the same valuable role.

Designer Babies and Slippery Slopes

Designer babies are in the news again. The LA Fertility Institutes, headed by a 1970s IVF pioneer, have offered the opportunity for potential parents to choose traits such as the eye and hair colour of their children: http://news.bbc.co.uk/1/hi/health/7918296.stm

Unsurprisingly, slippery slope arguments have already begun to appear: http://www.theage.com.au/world/la-delivers-first-designerbaby-clinic-20090302-8meq.html Marcy Darnovsky, director of the Centre for Genetics and Society, has said: ‘The concern is that we'll be creating a society with new sorts of discrimination. Now it’s eye and hair colour. What happens if it’s height and intelligence?’

Slopes can be slippery in different ways, and they can be more or less slippery. The strongest form of slippery slope argument points to a logical implication: if you accept A (which you seem to think is good), then you must accept B (which presumably you think is bad). Pretty clearly, we don’t have an argument of that kind in the present case. There’s no logical inconsistency in  being in favour of parents’ being allowed to select certain traits of their children, while being against discrimination. Nor of course is the existence of selection itself inconsistent with the absence of discrimination.

A more common form of the argument appeals to the lack of a non-arbitrary stopping point. The idea is that you should not accept A because A might conceivably lead to B, and you could find no non-arbitrary place to draw the line between A and B. That doesn’t seem to be Darnovsky’s argument, however, since it wouldn’t be arbitrary to stop selection if it were clearly leading to discrimination, but to permit it up to that point.

The argument here is essentially an appeal to consequences. As stated, however, it is clearly too strong. The concern cannot plausibly that we will be creating a society with new forms of discrimination. Rather, the idea must be that trait-selection may lead to these new forms of discrimination. So we can imagine a world in which people whose parents haven’t selected for certain eye or hair colours are discriminated against, which we can certainly accept would be undesirable.

The main issue here is how likely it is that discrimination on grounds of eye or hair colour will arise. On the face of it, it looks rather unlikely. People’s tastes in eye and hair colour vary a lot, so not everyone would go for (say) blue-eyed and blond children. And these kinds of characteristics anyway do not at present seem to be the basis for any systematic discrimination.

But, the argument suggests, selection for eye and hair colour may lead to selection for height and intelligence, and these may provide the basis for new kinds of discrimination. Again, however, it’s not clear why trait-selection even of these characteristics would lead to new forms of discrimination. There may be discrimination against short people now, in which case trait-selection wouldn’t be creating anything new. And if there isn’t any, then it’s not clear why it should be created merely through there being more tall people around.

Appeals to slippery slopes often rely on the idea that things could get out of control. Once you’re on that slope, you’re just going to keep slipping down and there’s nothing you can do. But that doesn’t seem to be the case with trait-selection. If it does turn out to have consequences we’d prefer to avoid, then we can stop doing it. Fertility clinics do not operate in a legislative vacuum.

So there’s no strong argument here for preventing those few parents who want to choose the eye or hair colour of their children to get on with it. Even if there is a slope, it is not especially slippery -- we can get off at any time.

Is doodling a form of cheating?

The public often complains about the fluctuating and conflicting attitudes of scientists.  So often do things heralded as good for us one week turn out to be deadly the next (consider, for example, this recent report about vitamin pills) that there seems little point in trying to follow the advice of scientists.  

Some recent news stories raise the question of whether the public is inclined to dismiss the conflicting views of ethicists, too.  Ethical concerns about pharmacological cognitive enhancement have regularly been reported in the press (see, for example, here, here, and here); whilst at the same time—as Dominic Wilkinson has noted on this blog—the public has embraced non-pharmacological cognitive enhancement in the form of software designed to improve brain power, and the media currently abounds with docile, non-panicky reports of how instant messaging, texting, taking short naps, taking long naps, listening to The Beatles, and doodling can all enhance cognition in various ways.  So far, there have been no reports of ethical concerns about these activities: nobody is suggesting that students who doodle during lectures are cheating.  It seems that, despite the concerns of some, the public is willing to embrace cognitive enhancement in a variety of forms.

Animal experimentation: morally acceptable, or just the way things always have been?

Following the announcement last week that Oxford University’s controversial Biomedical Sciences building is now complete and will be open for business in mid-2009, the ethical issues surrounding the use of animals for scientific experimentation have been revisited in the media—see, for example, here , here, and here.

The number of animals used per year in scientific experiments worldwide has been estimated at 200 million—well in excess of the population of Brazil and over three times that of the United Kingdom. If we take the importance of an ethical issue to depend in part on how many subjects it affects, then, the ethics of animal experimentation at the very least warrants consideration alongside some of the most important issues in this country today, and arguably exceeds them in importance. So, what is being done to address this issue?

Travelling for Treatment

A BBC report today suggests that “many” UK couples are going overseas to choose the sex of their children. What seems most odd about this is that in some cases they go to places where sex selection is illegal.

What is interesting here is the fascination with what people do when they go overseas or why they go overseas. There are a whole range of stories about Britons going overseas to get things that they cannot get in the UK – or cannot get in the UK as cheaply. The obvious examples are sex selection, assisted suicide or treatments not available on the NHS.

The point of death

The Guardian yesterday reported the death of the man who had been so tragically shot in Antigua, with his wife, three weeks after their wedding. It began like this:

"Ben Mullany, the newlywed who was shot on honeymoon in Antigua in an attack that killed his wife, Catherine, died in hospital in Wales yesterday after his life support machine was switched off.  The 31-year-old trainee physiotherapist, who had suffered a fractured skull and had a bullet lodged in the back of his head, was flown back to Britain while in a coma on Saturday. Tests carried out when his condition stabilised after the 24-hour journey established he was brain dead." 

This is a familiar way of describing such happenings, even among clinical professionals.   Brain death is pronounced, so the life support machine is switched off, and the patient dies.   The clear implication is that brain death is not death.  The machine is still keeping the patient alive, and it is switching off the machine that causes real death. 

Reproductive science: is there something we're missing?

Thirty years after the first test-tube baby, Nature asks various experts for their views on what the next thirty years of reproductive medicine will bring. Some of the more startling predictions are:

• No more infertility, with both children and 100-year-olds able to have children
• Embryos created from stem cells, increasing the ease of embryo research and genetic engineering of children
• … with the resulting greater availability of embryos making it easier to create cloned humans
• Artificial wombs, enabling babies to develop outside the mother’s body
• … which, some worry, could become compulsory as an alternative to abortion, or to avoid premature birth or fetal alcohol syndrome
• ‘Genetic cassettes’ implanted in embryos to counteract the effects of inherited diseases
• Increase in litigation following evidence that IVF babies may later suffer adverse effects from the environment in which they were grown as embryos