For any (ethical) discussion to be worthwhile, participants actively share both their experiences with the past and their visions of the future. The first year of bioethics discussions begins at the foundations of the medical enterprise (doctors, patients, responsibilities), broadens widely (to families‘ and communities‘ roles in health), and surveys the biomedical landscape (from before birth to after death). In so doing, basic principles of ethical consideration are established by a community (of [possible!] practitioners): how ought individuals dispute ideas with one another?; when judging an act what parameters are pertinent?; what is the point of (bio)medicine? Seeking to strike a balance between evergreen ethical dilemmas, the latest in biomedical technology, and important social issues, the topics of the discussions have us peer into the mists of (bio)medicine’s history and to its future horizons. As roundtable discussions, (hopefully) all involved are at ease and all voices equal. To start, consider where you have been and where you wish to go. Such is the philosophy guiding this series of discussions.
001. First, do no harm. A discussion concerning the basis of care.
002. Organ and body donations. A discussion on the give and take of our very selves. Readings
003. Human experimentation. A discussion testing the limits of testing ourselves.
004. Big data, little privacy. A discussion on the shape of things to come.
005. Universal healthcare. A discussion on the (inevitable?) end of medicine.
006. Family in medicine. A discussion on love, blood, and responsibility.
007. Death. A discussion on our ends.
008. Abortion. A discussion “going there” respectfully.
009. Assisted reproduction. A discussion for the bravest in the new world.
010. Prenatal screening. A discussion on early look and tough decisions.
011. Genetic manipulation. A discussion on changing our codes.
012. LGBTQ health. A discussion including inclusion and finding ourselves.
013. Vaccination. A discussion on public health and individual choice.
014. Regulation. A discussion about the maze and the pathway.
015. Posthumanity. A discussion on our end.
Readings: The Hippocratic oath; The nocebo effect of informed consent; The doctor-patient relationship in different cultures; The survival lottery; The case for allowing kidney sales; Organ donation and retrieval: whose body is it anyway?; The Belmont report; The patient and the public good; Scientific research is a moral duty; We’re trying to help out ticket people, not exploit them; Ethical issues in big data health research; Confidentiality in medicine: a decrepit concept; On telling patients the truth; Bubbles under the wallpaper; Uncertainty and welfare economics of medical care; Barack Obama’s speech to Joint Session of Congress, September 2009; The abnormal child; Life past reason; Treatment decisions regarding infants, children and adolescents; Abortion and health care ethics; Abortion and infanticide; A defense of abortion; The ethics of uterus transplantation; Assisted reproduction in same sex couples; Multiple gestation and damaged babies; Prenatal diagnosis and selective abortion; Genetics and reproductive risk; Sex selection and preimplantation genetic diagnosis; Questions about some uses of genetic engineering; The moral significance of the therapy-enhancement distinction in human genetics; Should we undertake genetic research on intelligence?; Growing pains: problems with puberty suppression in treating gender dysphoria; The duty to warn and clinical ethics: legal and ethical aspects of confidentiality and HIV/AIDS; Obergefell v. Hodges decision; Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children; The moral case for the routing vaccination of children in developed and developing counties; Ethics and infectious disease; Thalidomide retrospective: what did we learn?; Improving medical device regulation: the United States and Europe in perspective; Ethics, regulation, and comparative effectiveness research; In defense of posthuman dignity; Stem cells, biotechnology, and human rights: implications for a posthuman future; A cyborg manifesto
Questions to ponder
- On assisted reproduction
- Is infertility a disease? Should it be treated as such? Should it be covered by insurance? Should it be included in universal healthcare programs (that is, should its diagnosis, treatment, and prevention be funded via tax payer money)?
- What role should the age of potential parents play in weighing decisions of assisted reproduction? Should those past their “reproductive primes” get lesser priority, greater or the same as their younger counterparts?
- Does in vitro fertilization cause a negative externality to society in suppressing the impetus adopt children? Put differently, what is the correlation between adoption and assisted reproduction and does it come with any moral obligations?
- During in vitro fertilization, many embryos will be fertilized but only a few will be implanted. May we test on the non-implanted embryos? Who should bear the cost of sustaining frozen embryos?
- Assisted reproduction is increasingly used by same-sex couples to have children. In some cases of lesbian couples, one mother is the biological mother (providing the fertilized embryo) and one is the birth mother (carrying the baby to term). Should one of these mothers enjoy a preference under the law (such as is currently the case for mothers v. fathers in custody cases)?
- Often babies conceived through assisted reproductive means have co-morbidities, that is, they will often have lower birth weights, are susceptible to birth abnormalities/defects, and are at a significantly higher risk of having future health problems. To what degree should such future costs be factored into the initial decision-making process of going through with assisted reproduction?
- What does it mean to “play god”?
- On prenatal screening
- Can one ethically/morally prefer to have one sex/gender of child as opposed another?
- The elimination of disease/disability is often given as a justification for prenatal genetic diagnoses. Moreover, this argument is used in favor of some selective abortions, such that if a fetus is exhibiting signs or genes that show it would have a disability later in life, that genetic alteration or selective abortion might be called upon. Is the argument-from-disability a philosophically sound argument for the implementation of prenatal genetic screening? Is its extension to use of genetic manipulation, genetic elimination, justifiable?
- If you could have known what sort of biological situation you were getting yourself into (please consider your past, current, and perceived future life) and you yourself could have changed it to one you might consider more desirable (being a man/woman, lacking a certain ailment, etc.), would you choose to make use of such information? Would you want to be aware of such information at all?
- What is the distinction, ethically speaking, between medical and non-medical choices?
- Were we to develop pre-prenatal screening techniques, such that we could choose what type of child we could/would have before conceiving of that child, what reservations in regards to prenatal screening would be alleviated? What new reservations would be added?
- How does the relative inequity of the availability of means in prenatal screening affect our ethical considerations? Put conversely, what if everyone had the means of controlling the birth of human beings they bring into this world?
- Do parents have a right (and/or a responsibility) to do all they can to ensure their child(ren) have the best possible lives, even if that means selecting from their best possible children?
- Is nature a just arbiter?
- On LGBTQ health
- To what extent is a person’s gendered/sexual information morally/ethically relevant to decisions made by and with regards to that person? To what extent ought this information be relevant in our lives? What principles would you call upon to justify your “ought” belief.
- Confidentiality is often taken as a bedrock principle of medical fields. “It is founded” as Safken & Frewer (2007) note “on two main principles: first, there is the physician-patient relationship; only a patient who fully relies upon the physicians’ confidentiality will reveal personal and intimate details about his state of health. The second is keeping the patient’s secrets, which is essential for public confidence in the medical profession and an efficient health care system.” However, from time to time there arise situations that might compel a physician to warn a third party. What are some examples of situations in which a physician might have an obligation to warn some third party about a patient (e.g., about or because of an illness that might infect them, etc.)?
- Is it ever okay for a medical professional to disclose a patient’s gendered/sexual information to a third party? What if it is against the expressed wishes of the patient? (Put plainly, is it okay for a doctor to “out” someone for their LGBTQ activity/identity?)
- What are a few medical/societal conditions that uniquely affect LGBTQ communities? How might one go about positively influencing such conditions so as to bend the moral arc of history in a preferred direction?
- Why did it take so long for America to legalize gay marriage?
- What are current environments out there like for LGBTQ communities? What has gotten better, what has gotten worse with time? Why do you think that is? Is there anything we can do to, again, bend that moral arc?
- Should marriage be a federal institution?
- To what extent should we suppress the puberty of children? Can a parent make that decision without the input of the child? How much weight should we give to the child’s preference/wishes in making such a decision? What about other medical decisions? Is there something unique to gender-altering procedures that are different than other medical procedures?
- What’s next? We know our country hasn’t yet mastered “liberty and justice for all.” What further liberties ought we to extend to one another / recognize for one another?
- On vaccination
- Do we have a right to tell others how to live? If so, under what circumstances do we have such a right?
- To what extent can/should a special organization (e.g., a trade union, a corporation, a school, a government) have a say in the health of its members? When can an organization force a member to subscribe to its health “mandates”? Are there certain medical decisions in which third parties have a legitimate stake in?
- What is the “public good”? Is it distinct from the “common good”? Should the public and/or common good influence medical treatments, healthcare, and/or public policy? How so?
- Are there times when the public and/or common good outweigh individual liberties? If so, under what circumstances? What does this greater public/common good look like and why is its presence more desirable than that of individual liberty?
- Do we have a right to tell others how to raise their children? If so, under what circumstances do we have such a right?
- Under what circumstances can a third party overrule parents’ (medical) decisions?
- If vaccines caused autism, should we still give them to children?
- To what extent should we tolerate pseudoscience? To what extent should we tolerate quackery? Alternative medicine? Complementary medicine? Holistic medicine? How should we police the boundaries of our biomedical landscape?
- How should a government handle the medical concerns of its governed?
- Should all people be vaccinated?
- To what extent should we respect the religious beliefs of others in the course of their medical treatment?
- How much should vaccines cost?
- On posthumanity
- What is human? What is a human being? Can a human exist independently (at least in principle) of their biological body?
- Is there an ethical distinction between treatment and enhancement that we should be aware of and respect as legitimate? Could people, for example, be justified in genetically modify themselves simply because they felt like it or because it was a Tuesday?
- Would you personally wish to be post/transhuman? Can youever be post/transhuman?
- Do you believe, as does futurist Ray Kurzweil, that the singularity is near? What implications does the nearness or farness of human-level artificial intelligence have on our moral decision making?
- If only one half of the population could be effectively treated/enhanced by a technique/technology, can we justify its broad use? Must a technology be as egalitarian as possible to be as morally upright as possible?
- I have some sense of what a “crime against humanity” might be, but what might a “crime against posthumanity” look like? Would the crime be “more” or “less” severe?
- Can a robot have rights? Could those rights ever become equivalent to human rights? Are they greater, less than, about equal to, or incomparable to animal rights?
- Should human beings seize control of their own genetic dispositions, evolutionary progressions, and biological status? Or ought some of these things be left to “nature”?
- Do we really need to develop a philosophy of cyborgs?
- Haraway refers to a cyborg as “a hybrid of machine and organism, a creature of social reality […] lived social relations, our most important political construction, a world-changing fiction.” She goes on to state that “taking responsibility for the social relations of science and technology means refusing an anti-science metaphysics, a demonology of technology, and so means embracing the skillful task of reconstructing the boundaries of daily life, in partial connection with others, in communication with all of our parts.” What do you make of her use of a construct from 20thcentury science fiction to describe 20thcentury women and (how) does it apply now to our own age?
- Take two individuals, A and B. Swap half of their organs after ensuring immunocompatibility. Have the identities of A and B changed?
- How do you think the human species will end?