Questions to ponder – A Belmont Report

On abdication
On accidents
On alternative medicine
On animal experimentation
On annihilation
On antinatalism
On artificial intelligence
On artificial life
On artificial parts
On assisted reproduction
On body art
On body modification
On body politics
On circumcision
On cities
On clinical trialing
On cloning
On the coming administration
On democracy
On Dia de los Muertos
On disability
On drugs
On extinction
On fear
On gender
On history
On infection
On LGBTQ health
On life-preserving technologies
On love
On the madness of crowds
On mental health
On Michigan
On neuroethics
On others
On overpopulation
On population control
On posthumanity
On prenatal screening
On public health
On the quantified self
On race
On regulation
On the replicability of medical studies
On responsibility
On self
On sex
On solitude
On the Theory of Mind
On vaccination
On virtual reality
On zombies

Abdication

Who are you and what responsibility have you shirked recently?
I contend medical “authority” is an alloy of “trust” and “reliance”: one either must trust a medical practitioners judgment/decisions/actions because they do not (or cannot) know otherwise or must rely on the abilities of the medical practitioner. (One could of course both trust and rely on a medical practice.) Are there any other features that are necessary/sufficient to define medical authority?
What gives rise to “legitimate authority” in the practice of medicine?
Trust and reliance also factor into “power” over other individuals – defined here broadly as the ability to make others do things (they might not otherwise do). And indeed, medical practitioners may wield a great deal of power in their practice. Some decisions really are “life” and “death”. With great powers come, we are cliche-ly told, with great responsibilities. Reflecting on the Hippocratic oath and its various incantations, what are the responsibilities of a physician and how directly do they tie to the power they wield?
Parent and child relationships introduce a bevy of power-imbalances, from the abilities of the adults to the autonomy of the children, and yet few would regard these relationships as “unjust” due to this inequity. How can “unequal” relationships be morally maintained?
When a parent and a child disagree over medical treatment, how ought their differences of opinion be adjudicated? What about when a child’s and a parent’s thoughts around an “irreversible” medical procedure – like euthanasia or gender confirmation surgery – are diametrically/fundamentally opposed?
Who do you hope to be when you “give up the ghost”?
On average, is it better for medical authority to be single-voiced (as in the recent example of Dr. Anthony Fauci) or decentralized?
On average / on-the-whole / in your Ideal World, would healthcare be more centralized or more decentralized? Should this centralization/de-centralization be instantiated by a government or be independent of a geographic sovereignty?
At state and local level, healthcare access and policy drastically change, often “at the behest” of the local inhabitants via their “democratically” “elected” leaders. Many of these policies run counter to more progressive ethical positions (for example, ready access to reproductive technologies, the banning of certain genders from certain activities). These amplifications of local popular will can manifest in stark inequality. How/Can we ensure that local preferences still abide by global principles?
When do you give up your place on the lifeboat? When do we have the responsibility to make others give up theirs?
When is an individual responsible for an institution? When are they not?
When/Will human beings “give up” on this world?
If this were the final conversation you were to ever have, what would you want to talk about?
More broadly, what do you think the final human conversation will be about?

Accidents

Who are you and why are you here?
Diagnosis is a conclusion resulting from an observation of symptoms and a knowledge of human conditions during the practice of the medical arts and sciences. Error can manifest in the enterprise at just about any level – a mistake in observation, an omission of symptoms, an incomplete knowledge of human conditions – and cascade forward, affecting prognosis and treatment. As such an incorrect diagnosis is a singular form of “accidental” medical error. Under what circumstances is an individual practitioner at fault? Can the medical system itself be at fault? Are there times when neither is error and accidents just happen?
Schubert et al. identify four aspects to a framework of identifying liability in medical error: intent (what was a practitioner trying to do), etiology (is there a causal connection between an action and an undesired result?), context (could others of skill in the art have identified/prevented the error readily?), and outcome (does the error result in harm?). Are these four facets sufficient? Is there any feature you would add/eliminate/(de)emphasize?
How do we assign blame?
A surgeon, working 12 hours straight on a difficult and complex open chest heart surgery in the final hour nicks a small vein. After completing the surgery, the patient awakens, spends a few days in recovery, is able to go home. A week after surgery, on the way to their check-in appointment, the patient suffers a cardiac event resulting from the small wound in the nicked vein. Could anything have been done to prevent this or is this “just the way that it goes”?
There has been a trend in modern healthcare systems to shift away from blame and punishment of medical errors in order to facilitate disclosure of said errors. What’s more, self-blame – such as guilt, regret, and remorse – can lead to negative psychological effects on individual practitioner, possibly worsening their abilities. Tigard posits “those who take the blame are in the best position to offer apologies and show that mistakes are being taken seriously, thereby allowing harmed patients and families to move forward in the wake of medical error.” Should medical practitioners take on more active role in their errors (I made a mistake) or a more passive role (mistakes were made)?
Do the “systems” of medicine preferentially/implicitly/necessarily induce accidents in people of color more often than others?
“Medical error” has been identified as the third leading cause of death of the United States with studies putting the annual toll in the hundreds of thousands. Who or what is at fault for these massive casualties? Can the regularity of these deaths (on the order of one every other minute) be said to be accidental or systemic?
Tort law is ultimately intended to promote rectificatory justice, i.e., to pay for harms done. One study found the cost of the medical liability system to be approximately 2.4 percent of total healthcare spending in America (or about $91 billion last year). Is this too much, too little, or just about the right amount of money to be spending on medical errors? (Note, this does not account for the cost of the loss of life due to medical error, merely in the insurance and litigation of such errors.)
“Moral luck” is the contingency of circumstance in moral actions. Consider the scenario in which two doctors are tasked with determining the presence of cancer in their patients, one in the habit of ordering a standard suite of tests intended to diagnosis a wide range of cancers (resulting in larger medical bills, but fewer misdiagnoses) and one who orders narrowly tailored tests based on the observation of symptoms, conditions, and second opinions (resulting in lower medical bills, but an increased possibility of a missed diagnosis). Is one practicing medicine more legitimately than the other? If a patient presents with a difficult case (uncommunicative patient, incomplete medical records, rare cancer), and one fails to diagnose the patient, are they “in error”? Would the patient’s demise in such a case be an accident?
There will come a time when our condition(s) will be diagnosed by both an artificial intelligence and a human medical practitioner. Who ought to make the first diagnosis and who the confirmatory diagnosis?
If a machine-learning algorithm used to aid diagnosis makes an “error” who is at fault?
Fate and Fortune being as they are draw our souls into a world of circumstance and happenstance. Are/Were we meant to be here?
Is it better to come (or go) “on accident” or “on purpose”?

Alternative medicine

What makes medicine “alternative”?
Is “alternative medicine” distinct from “complementary medicine”? Are either or both situated at odds with “traditional”/”Western” medicine?
In their review of 18 trials involving alternative medicines, Bardia et al conclude that “[t]here is paucity of multi-institutional RCTs [randomized controlled trials] evaluating CAM [complementary and alternative medicine] interventions for cancer pain with adequate power, duration, and sham control. Hypnosis, imagery, support groups, acupuncture, and healing touch seem promising, particularly in the short term, but none can be recommended because of a paucity of rigorous trials. Future research should focus on methodologically strong RCTs to determine potential efficacy of these CAM interventions.” To what extent to do you agree with that conclusion given what you know about “alternative” medicines?
I have an aunt who swears by acupuncture. She has had some of the worst pain you can ever imagine in her life, has gone everywhere, consulted every doctor, undergone every treatment, every therapy. She goes to an acupuncturist and the pain is gone and onlywhen she goes to said acupuncturist does this horrible pain get treated to her satisfaction. Should we recommend she keep going?
On placebo. Is it dismissive to attribute a portion of the efficacy of alternative medicine to the placebo effect? Placebo treatments have often proven slightly effective in alleviating certain disorders––to what extent should medical professionals feel comfortable giving them to their patients?
It is estimated that at least one-third of all adults in the United States have used complementary and alternative medicine. It is an industry generating tens to hundreds of billions of dollars in revenue, accounting for likely over one billion trips to “healthcare” providers. This is not the case in other countries. What are we to make of this?
Do you think more or less CAM therapies should be given CPT codes?
If someone told you snake oil really had a curative effective, who would that someone have to be for you to believe them? And why?
Where does something like yoga fall on the Improving Health Spectrum? Do its effects extend beyond those associated with any other form of exercise?
If I gave you a bottle of homeopathic medicine, how many would you feel comfortable taking?
Is there something approaching what we might call the “mind-body-soul” being that medicine should ultimately be treating? We already incorporate quality of life as a factor into most medical decisions, would it really be any different to perhaps take a more “holistic” approach to medical treatment/therapy/devices?
How important is it that we/someone police the boundaries between “medicine” and “not-medicine”? “Science” and “non-science”? Sense and nonsense?

Animal experimentation

Would you personally ever participate in experiments involving animals? To what extent and why?
Do we “own” animals? Can we do to animals anything that we can do to other “property” we own (e.g., a chair, a pencil, a burrito, etc.)?
For many people “pain” and “suffering” mark the bounds of “acceptable research”. Why should these be the bounds and how much of a buffer ought we to keep between them and ourselves?
Are we more (un)comfortable with certain kinds of animal experimentation? Why? Is there something to the notion of “higher” animals? Or is that just something we as ideal versions of said “higher” animals made up? To what extent does/should genetic relatedness play a role in our ethical understanding of a particular animal model?
A strategy of “3 Rs” (reduction, refinement, and replacement) is currently applied for laboratory use of animals. Is there anything about this approach that you would revise?
Roberts et al. note that “it is essential that [our] results are valid and precise. Biased or imprecise results from animal experiments may result in clinical trials of biologically inert or even harmful substances, thus exposing patients to unnecessary risk and wasting scarce research resources.” Do you believe this is an appropriate dimension by which to measure / lens through which to observe the heart of the matter when it comes to animal experimentation?
This weekend a great many dead bird will be eaten around this country (and indeed around the world). Would the world be “better” if it collectively ate less or more of these birds?
Garattini and Grignaschi claim that “There is no magic recipe” to improving our (animal) experiments, “only trial and error.” Are they right?
Ahktar forcefully states that “[t]he unreliability of animal experimentation across a wide range of areas undermines scientific arguments in favor of the practice [and] often significantly harms humans through misleading safety studies, potential abandonment of effective therapeutics, and direction of resources away from more effective testing methods. The resulting evidence suggests that the collective harms and costs to humans from animal experimentation outweigh potential benefits and that resources would be better invested in developing human-based testing methods.” Is she right?
Section 4.5 of the Ethical Principles and Guidelines for Experiments on Animals from the Swiss Academy of Medical Sciences and Swiss Academy of Sciences says that “animal[s] must be able to express [their] sensations” to “where possible avoid painful sensations.” If animals could express their sensations with us, do you think they would be satisfied with our treatment of them? How could we improve interspecies relations?
Myriad forms of vegetarianism seem to be cropping up across the country. Why is that?
To what degree are we responsible for animals?
How can we do better?

Annhilation

Who are you and approximately how long do you think you will be remembered?
How do you know when others are “gone”? How will they know when you are?
Is our current medical determination of death – “brain death” – both a necessary and sufficient description of human death?
Let us consider a few possible routes we may take after death:
1. We are reborn into the exact same body and live the exact same life;
2. We slumber in the grave awaiting the return of a messiah, possibly with violence against good evil;
3. We live, we die, we live again;
4. We join the gods in Valhalla;
5. We disappear into nothingness.
  How would each affect us in life if true?
If oblivion awaits, why mind the fleeting present moment? Why recall the days that disappear as a vapor into the fog of “history”?
One day, the final human being will live and (presumably) perish. Will there be anyone there to watch? What do you think follows?
Testoni et al. (2015) report they analyzed the correlation between Testoni Death Representation Scale and Beck Hopelessness Scale, Suicide Resilience Inventory-25, and Reasons for Living Inventory. The results confirm the hypothesis, showing that the representation of death as total annihilation is positively correlated to hopelessness and negatively correlated to resilience.” Given the professional responsibilities of healthcare workers, do they have a corresponding moral obligation to present (at least to possibly dying patients) “positive” views of death?
We will mostly be nonexistent. Whether it is before we’ve arrived or after we’ve left, what surrounds the “being” of every human is a lot of “nonbeing”. Why do you think that scares (some of) us?
“The mystery no one knows / where does love go when it goes?“
Some hold “selflessness” as a virtue. Transcending the self is intrinsic to many religions. Staring out into the darkness of space can bring about a sense of the numinous. What is it about brushes with self-annihilation that bring about meaningful senses of being?
One day, when we’re long gone, our social media profiles may carry on on servers we’ll never see or agree to. Is this a memorial of us? Can/Should it keep on living without us? (Consider Herman Cain’s Twitter still tweeting long after he took his final breath.)
Of all the times people have predicted the end of the world, who do you think has come the closest? Care to wager when you think the world will end?
Who do you think will be the last person to think of you? (Now’s perhaps your only chance to think of them!)

Antinatalism

Who are you and why were you born?
Zapffe (1933) begins his essay The Last Messiah, “One night in long bygone times, man awoke and saw himself.” Who did he see? And does he (and/or she) look different now than in bygone times?
Zapffe suggests that there are four major ways one “gets through the day”:
1. isolation, “a fully arbitrary dismissal from consciousness of all disturbing and destructing thought and feeling (“One should not think, it is just confusing.”);
2. anchoring, “any culture is a great, rounded system of anchorings, build on foundational firmaments, the basic cultural ideas”;
3. distraction, “[o]ne limits attention to the critical bounds by constantly enthralling it with impression”; and
4. sublimation, “[t]hrough stylistic or artistic gifts can the very pain of living at times be converted into valuable experiences”?
  Ought we engage in more or less of these “survival tactics”?
Is human consciousness the equivalent of the Irish Elk’s antlers, “in all its fantastic splendor pinning its bearer to the ground”?
Given the choice, do you think most “possible” people would opt into existence?
Should we want to have more children born or fewer?
Benatar (1997) posits an inherent asymmetry to the presence of pain in existence (on the whole, not a great thing) and the absence of suffering in non-existence (on the whole, generally a good thing). Is there necessarily harm coming into exist?
Benatar asks, “Who would there be to suffer the end of homo sapiens?”
Will there come a time when human beings capable of and desiring to create “the end of the world” will do so? If so, when do you think that will be? If not, why not?
Emil Cioran begins The Trouble with Being Born, “Three in the morning. I realize this second, then this one, then the next: I draw up the balance sheet for each minute. And why all this? Because I was born. It is a special type of sleeplessness that produces the indictment of birth.” Why might bouts of insomnia cause us to question our birth? Why might we question our existence (or the existence of others) when depressed and not when triumphant?
Cioran goes on, “I know that my birth is fortuitous, a laughable accident, and as soon as I forget myself, I behave as if it were a capital event, indispensable to the progress and equilibrium of the world.” What significance do you place on your own birth? The birth of a family member? A neighbor? Some antipodal stranger?
Rulli (2016) concludes, “The best reason to procreate is in order to experience the parent-child relationship. But adoption offers a viable and worthwhile alternative to procreation for those who want to parent. Adopting an already existing child does not make one complicit in the potential harms of procreation, nor does it add a new person to an overpopulated world.” Must one be pro-adoption (at least in spirit) to be anti-natalist and humanist?
When shall we end?

Artificial intelligence

Unfortunately, “naturally” race enters into the discussion. Whether it is Bay Area nerds coding up healthcare infrastructure or that nurse adding a little something extra about that patient who was being just a bit too snooty for their liking, implicit and explicit biases enter our systems. What is at least one effective way to root some of it out of a system?
Class and economic inequity often enter into this sorts of discussions with the implication that since The Rich are so rich they will have access to the latest and greatest in healthcare and therefore that is what will give them yet another advantage in this life and that is why they will outlive us, The Meek & Mild Discussers of Bioethics. I contend there is scant evidence to suggest that the latest and greatest in most medical enterprises does anything to help those quite literally on the bleeding edge. How will artificial intelligence in medicine help the rich and can we ensure it will also help the not-rich too?
A black box is presented to you. You are told it has exceedingly intelligent insides, which you cannot see. The box says you have a 48% chance of catastrophe. How do you respond?
Can you torture a computer?
Does the rate at which a theoretical artificial intelligence operate warp the ethical calculus we must program into it? Put differently, how ought we human beings program computers to act ethically that operate at thousands to billions to trillions of times faster than any human being or group of human beings ever could hope to if they each lived a hundred lifetimes. Put succinctly, how do we consider ethics at different time scales?
Among the regulatory considerations of a practical implementation of medical artificial intelligence include contextual biases, data import/integrity/privacy/security, explanation of information “learned” from data obtained, exportation of information to “others”, sampling skews, training set biases, trade secrets, and the uncertainty of the American healthcare system (mostly from Minssen et al. 2020). Of these, which do you think poses the greatest practical ethical hurdle and why?
What makes something “artificial”? Is it the same in every case as “man made”? What respect do humans have to things which are artificial that are not human made?
By what mean(s) can a non-artificial intelligence determine an “artificial intelligence”?
In what topsy turvy world could an “artificial intelligence” be held culpable for a crime? Would an A.I.’s “programmers”/”creators” take the responsibility? When/Could such designers be relieved of that responsibility?
When the human race encounters its first honest-to-goodness “alien” lifeform, do you think it will be of an “artificial” or “organic”/”natural” composition?
Do moral actions require conscious creatures?
Is there any way to unhitch the wagon of “artificial intelligence” from advertising or are we destined to see ever more personalized ads that seem targeted at our ever more personalized problems/desires/hopes/plans?
Follow on, is there a “good” pharmaceutical advertisement?
Just between us, now that you’re scanning this far down in the question sheet, how much of this artificial intelligence stuff do you think is just the new “hocus pocus”, the new “snake oil”, the new “set and forget” solution to all your life’s problems? How much of it do you think will end up living up to the hype?
To what degree of granularity should the sewage company be able to tell – via new and improved artificial intelligence-enhanced “surveillance testing” methods – what the neighborhood has been eating?

Artificial life

Who are you and what makes your life “real”?
On May 20, 2010, Science published an article on the Creation of a Bacterial Cell Controlled by a Chemically Synthesized Genome (Gibson et. al 2010) the first known instance of humans creating “new cells […] capable of continuous self-replication”. In comparison to the creation of any other “artificial” thing, was the moral significance of this act any greater? If so, where does lends it such weight? If not, what then is the significance of “life” ceteris paribus?
Much of “life” on this earth is “artificial”. Animals bred only for food, animals domesticated as pets, animals kept at zoos. By what degrees does the imposition of this sort of artificiality on the lives of animals constitute an im/moral act?
Humans, by their very nature (these days) radically alter the nature around them. Leveling forests, damming up rivers, paving of roads, building bridges, heating the atmosphere, the environments humans “need” affect the environments others must live in. What is the bare moral minimum we owe to “preserve” “nature” and who among us meets that minimum?
Is living in a skyscraper an artificial way of life for humans? Is living in an RV? A McMansion?
Should corporations be thought of as “artificial persons”?
Does the creation of life come with a specific set of consequences?
Let’s go back to that artificiality v. im/morality spectrum. Surely, we can all agree that animal experimentation to the extent done now by “modern science” is very artificial. Organisms bred to spec, ravaged by the curiosity of the well-funded, and euthanized for data, models, results cannot be said to have lived any sort of “natural” life. And those lives were lived for the scientific enterprise. Tens of millions of lives created, altered, observed, and ended for another species’ investigations. Is this fair?
Are our lives These Days™ “artificial”? Is this “real” life?

Artificial parts

When the human race encounters its first honest-to-goodness “alien” lifeform, do you think it will be of an “artificial” or “organic”/”natural” composition?
If a prosthetic is harmed, is it a form of property damage or a personal injury? For example, imagine an individual with a prosthetic limb is in a car accident in which the prosthetic is damaged, should compensation for this “loss of limb” be for property restitution or injury coverage?
There will always be medical device malfunctions, defects, imperfections, scenarios unplanned for. What is an appropriate rate of harm for medical devices in general? What about those replacing a limb or a function? What about implanted devices?
In The Tin Man of Oz, we are told that the Wicked Witch of the East enchants Nick Chopper’s axe so that it lops of parts of his body to prevent him from marrying Nimmie. A tinsmith replaces each lost part with tin until he is all tin – a Tin Man! Not content with just this wickedness, The Wicked Witch assembled each of Nick’s severed parts into a whole man, named Chopfyt, who Nimmie has wed. Did Nick marry Nimmie?
Imagine a neural prosthetic has been implanted into your brain that helps to transcode your short-term memories into your long-term memories. This implant that you neither see nor feel sends a pattern of electrical shocks to your hippocampus without you knowing when or how. After a while you notice your memory has improved, recalling more information with greater ease. Has this implant changed “you”? Is this implant now part of “you”? If it were removed…?
An internal alarm for an implanted medical device with an individual manufacturer starts to go off. It is not loud but can be heard within a few feet. It makes a short chirp every 33 minutes. It continues to sound for two years. (A) It requires an invasive procedure which your insurance does not cover and which you cannot afford. (B) The company who manufactured it went out of business a couple years back. (C) As it is not a “life-threatening” malfunction, the company that acquired the company that developed the original device claims no liability and will not cover repair or replacement. What is to be done?
Some forms of deafness – a lack of hearing – can be augmented/treated/aided by cochlear implants. Critics of childhood implantation say members of the deaf community have their own language and culture and that to implant devices in children would diminish an already minority culture. Who should make the decisions involved in these implants and how should they make them?
Would humans who come “to term” within artificial womb-like environments without being birthed through typical – “natural” – means be any “different” from “normal” humans? What would it mean to be “born” from such an environment?
To make the preceding question a little more difficult, when would a human’s life begin within such an “artificial” environment? Would/Should restrictions/regulations of abortion procedures be any different in “natural” and “artificial” cases?
Would you willingly get a prosthetic? What would you make of those who would?

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”?

Body art

Are you who you present yourself to be? Does your body constitute your identity?
Often our culture is thought of as “consumerist”, as it is by Sweetman (1999). With regards to artistic expression(s) of the body, what (if anything) is being “consumed”? Are there risks in commodifying our corporeal identity? For example, “tattooing and piercing [have been] previously ‘classed’, ‘raced’ and gendered practices, associated with specific marginal and subcultural groups [that] have now become so ‘mainstream’ as to almost be considered ‘passé’.” Is this something to guard against?
“Body art” can vary from make-up to plastic surgery, encompassing both the fashionable and the beautiful, the temporary and the permanent. Given these spectra, how should “the body” be viewed by modern audiences?
Is pain a necessary/sufficient condition of art?
Whose, if anybody’s, rights were violated when prisoners (or homeless people or psychiatric patients) are/were used for anatomical displays? What about displays of (unborn) fetuses? What is it that gives us pause in using corpses/cadavers for art?
As van Dijck (2001) and Barilan (2006) relay, in plastinated cadavers, a large quantity of the original organic matter is replaced by a plastic surrogate (about 80% plastic and 20% organic material). That being the case, are we really looking at a “body” when we go to BodyWorlds? What about figures made only of muscles? Only blood vessels? When all that’s left is bones?
To what extent is a “modified” body an “authentic” body?
If we look at a cadaver without a head, are we looking at “someone”? What about a body cut in half? Just a hand or a foot? A torso? What about a full body assembled from multiple individuals?
What should we make of taxidermy?
Much of anatomical science (and art) has its origins in grave robbing. To what extent should this be atoned for?
Should organ donation (after death, i.e., from cadavers) be an opt-out or an opt-in system? Would it be wrong to pay someone during their life for their body or some subset of it (e.g., their organs) after their death?
Washington state recently legalized “recomposition” – “the contained, accelerated conversion of human remains to soil” – as a method of disposing of human bodies. Would you ever wish to have your body converted to fertilizer?
An extraordinarily accurate anatomical atlas (“Pernkopf’s Atlas”) was created by an ardent Nazi who (might have) used victims of the Nazis’ tyranny to arrive at the data. Should we use it? How so? Why?
Can art be separated from its artist? From its medium of expression?
Who are you and can it be expressed (sufficiently) artistically?

Body modification

Body modification includes the deliberate altering of one’s anatomy and/or physical appearance and can include explicit ornamentation (piercings, tattoos, transdermal implants), surgical augmentation (breast implants, circumcision), and physical alteration (foot binding, scarification, branding). Should we endeavor to prevent any of these methods of body modification from being done (commonly)? Why?
One of the most common forms of body modification practiced at scale is the circumcision of babies/children, yet often the alteration of genitals later in life (piercing, removal, “enhancement”, etc.) is met with opprobrium from (polite) society. What accounts for this difference?
Featherstone (1999) notes that “[n]ormally to be a self is to be distinguished from [] other[s]” but that the “body form of conjoin[ed] twins challenges both the distinction between mind and body and body and body.” Ought the medical establishment treat as its mandate the separation of conjoined twins?
In the early 1980s, it was found that administering a constant level of GnRH “desensitizes” an individual’s pituitary, leading to a decrease in secretion of luteinizing hormone and follicle-stimulating hormone. A child can be prevented from going from the gonadarche stage to the somatic growth spurt during puberty, in essence having their puberty “suppressed” and thereby not becoming a gender with which they do not (self-)identify. What should a parent do if their child (has gender dysphoria and) wishes to have their puberty suppressed?
Self-cutting, anorexia, and many other “pathological” forms of body modification seem to manifest during our teenage years. Why do you think that is?
Bridy (2004) relays stories of individuals with “apotemnophilia” – a condition characterized by an intense, long-standing desire for amputation of a (specific) limb. Should an individual be allowed to remove a body part for non-medical reasons? Can we lop off a nose, pluck out an eye, hack off a limb for no clear medical benefit?
Schramme (2007) contends that “the case of extreme body modification is an ultimate test-case for liberal bioethics. It directly confronts two characteristics of a liberal attitude, namely to accept competent decisions even where they seem to be clearly unwise (antipaternalism) and not to impose particular conceptions of the good on other people (neutrality).” How ought the balance between (anti)paternalism and neutrality be struck in the case of body modification?
Schramme presents five possible arguments against voluntary body mutilation (modification): “i) Self-mutilation is never really voluntary, but is caused by pathological beliefs and desires, or is a side-effect of mental disorder; ii) it violates moral duties to oneself; iii) it violates moral duties to others or harms other people; iv) it contravenes nature’s purposes; v) it is unreasonable or irrational.” Do you subscribe to any of these arguments against body modification?
Is our body distinct from our “self”?

Body politics

Who are you and does the government care?
What are the proper roles of a government to the health/wealth of the governed?
“The most vocal contributions to the ethical debates, Takala (2017) says, “tend to be either strongly against or adamantly for the new technologies. This tendency is furthered by the popular media, which prefers headline material.” Does the sensational tend to senses? Does it tend to “make sense”?
“Research is suggesting,” Rich & Evans (2005) suggest “that people are obtaining health information not just from traditional medical sources but from newspapers, magazines, television etc.” Should the government regulate the transmission of medical/health information from these sources?
Politics in just about any context seems to be divisive, eliciting strong emotions and lowered rationales. How can we effectively discuss politics?
Why/Are women’s bodies disproportionally controlled by governments?
What legitimate interest does a government/state have in the health of its population? To whom can you appeal if a State is genuinely bad for your health?
HUD Secretary Julian Castro recently remarked in a debate, “[J]ust because a woman — or let’s also not forget someone in the trans community, a trans female — is poor, doesn’t mean they shouldn’t have the right to exercise that right to choose. And so I absolutely would cover the right to have an abortion.” Should trans females have the right to have an abortion?
Inherent to the practice of government is the (at least veiled) threat of “legitimated” violence – e.g., don’t pay your taxes, get brought to court; run from the police, get tazed by them; hurt someone, get hurt back. How do we ensure that such threats of/violence is indeed legitimate? How do we ensure it is righteous?
What, if anything, should the government do on the following debated topics:
- Compulsory vaccination of children;
- Healthcare in general;
- Homelessness;
- Recreational drug use;
- Right-to-try regulations; and
- Right-to-die legislation?
In the “heartbeat bill” (H.B. 481, “Living Infants Fairness and Equality (LIFE) Act”), the state Georgia amended its Official Code to create “two classes of persons: natural and artificial” in which natural persons are any human being “including an unborn child with a detectable human heartbeat”. Do you believe a heartbeat – “cardiac activity or the steady and repetitive rhythmic contraction of the heart” – a proper measure of the beginning of life? The end? How should a government demarcate?
Was Thích Quảng Đức’s self-immolation of a legitimate use of political influence?
Do we have more bodily liberty now than we have in the past? Will we have more in the future? In what ways? How do you know?
Is our nation on the rise or the decline?

Circumcision

If circumcision did not already exist, would it be necessary for our society to invent it?
Christopher Hitchens once quipped, “Religion forces nice people to do unkind things and also makes intelligent people say stupid things. Handed a small baby for the first time, is it your first reaction to think, ‘Beautiful, almost perfect, now please hand me the sharp stone for its genitalia that I may do the work of the Lord’?” Do you think circumcision is inextricably bound up in religious tradition? Should the practice/procedure be secularized?
Should biomedical procedures only ever be performed to the reasonable biomedical benefit of the patient (or at the very least to the minimal harm of the patient)?
What do you find to be the most convincing reason to alter the genitals of one’s children and/or the children of others?
As Earp points out, “The official position of such influential bodies as the World Health Organization and the United Nations is that any kind of medically unnecessary, non-consensual alteration of the female genitalia – no matter how minor the incision, no matter what type of tissue is or is not removed, no matter how slim the degree of risk, and no matter how sterile the equipment used – is by definition an impermissible “mutilation.”” Why do you think this is the case for procedures on female children and not male children?
Generally, there are four types of ‘female genital alteration’: Type I includes removal of the prepuce or clitoral hood with or without clitorectomy; Type II is the removal of the entire clitoris as well as part or all of the labia minora; Type III, known as infibulation, involves the removal of the labia majora and/or labia minora, possible removal of the clitoris, and stitching together of the vulvar tissue to cover the urethra and introitus, leaving only a small opening for urine, menstrual flow and intercourse; Type IV includes pricking, nicking or incisions of the external genitalia, stretching of the clitoris or labia, cauterization or the introduction of corrosive substances into the vagina. Are any of them acceptable in the sort of society you want to live in? Do you agree with Arora and Jacobs recategorization based on the outcome of the procedure, rather than what is specifically done?
“After a comprehensive review of the scientific evidence,” the American Academy of Pediatrics punted the bioethical conclusion by finding that “the health benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision.” If the benefits are not great enough to recommend for all children, how should we categorize the medical procedure describing the physical alteration of children’s genitals? Enhancement? (Pre-)Treatment? Cosmetic?
Often the medical benefits of (particularly male) circumcision are made, as done ad nauseam by Morris and Cox in their “Current Medical Evidence Supports Male Circumcision”, use studies that fail to disentangle lots of socio/cultural/economic/ethno/religious lines inherent in asking a question such as “is male circumcision medically beneficial?” We note here in passing that most of the benefits of circumcision come hand in hand with Christendom on a map. And so how much do you really “trust” studies and even meta-analyses such as these on the topic of changing the way children’s genitals look/function?
What do you find to be the most convincing reason not to alter the genitals of one’s children and/or the children of others?
In the United States, a general legal and ethical standard when dealing with children is the ‘best interests standard’ wherein “the best interests of a child are determined by judicial and quasi-judicial decisions in individual cases, rather than arising from an established heuristic that would almost always predict the decision prospectively.” Three key Supreme Court cases triangulate the balance interests of a child against parental beliefs and rights: Meyer v. Nebraska (1923); Pierce v. Society of Sisters (1925); and Troxel v. Granville (2000). How do you think the ‘interests’ of children ought to compared against the ‘rights’ of parents?
To what degree ought we as citizens of this nation and/or budding biomedical professionals respect cultural traditions of our centuries-long multicultural experiment? If someone told you they wanted to cut the tip of child’s penis off and have a leader in their community suck the blood off, with his mouth, all because it said somewhere that “circumcis[ing] the flesh of your foreskin […] shall be a token of the covenant betwixt” the gods and their community, what would you think? If that community held that all eight day olds “must needs be circumcised” lest his “soul shall be cut off from his people”, what would you think? If they told you that a ninety-nine year old man cut off a portion of his penis and a portion of the penis of his thirteen year old son that same day, because he heard the gods telling him that such a genital alteration would “make thee exceedingly fruitful” and “indeed” lead to “a child be[ing] born unto him that is an hundred years old”, what would you think? Do you think that is a practice we, ourselves, living the noble lives of the good citizens of the Great Society, ought to adopt as our own and that of [y]our future children?
If we didn’t circumcise children, do you think we would have circumcised adults?

Cities

Who are you and where are you from?
Dye (2008) notes that “urbanization is associated with falling birth and death rates and with the shift in burden of illness from acute childhood infections to chronic, noncommunicable diseases of adults”. With more than half the world’s population already living in urban areas, should we try to convince the other half to move to “the city”? Should there be more or less people(s) living “the city”? More or less people(s) living in the world?
What fears do you have in the exasperation of differences between rich and poor individuals?
“City dwellers”, Dye tells us, “are comparatively wealthy and lead more sedentary lives with easier access to low-cost, low-fiber, high-energy, high-fat food.” To what extent should the nutritional content of a city be regulated by city officials/representatives? What about other health surrogates (such as activity levels, vaccination schedules, etc.)?
Traffic accidents kill over one million children and adults each year, mostly in urban centers. Along with the leveling of environments and the polluting of air, there are hazards to health by mere writ of cities’ existence. How can we mitigate their effects? How can maximize the benefits of the city (to both urban and rural residents)?
Blustein & Fleischman (2004) identify three features – density, diversity, and disparity – affecting the health of urban populations.
1. To what extent does the density of a population determine moral actions?
2. “Is there an obligation to respect the cultural values of individuals even if the traditions and practices that give those values their content are in conflict with the dominant ethical norms” of a city in which the individual exists?
3. Disparate outcomes of health/care correlate to poverty and its consequent lack of access. (“[R]acial and ethnic variations are also independent factors in determining disparate outcomes.”) How can we alleviate these disparities? When will we?
Can a city get too big? Too small? Just right?
Milgram (1970) suggests several “adaptive mechanisms” urban dwellers adopt to deal with the “overload” experienced in cities, including allocating less time to others, disregarding “low-priority inputs” (such as “the drunk sick on the street”), and social burden shifting (e.g., welfare departments, bus drivers no longer offering change, etc.). Given the superficiality, anonymity, and transitory nature of many urban interactions, do cities facilitate “the best of all possible worlds”? Are we our best selves in the city?
When talking about “the city”, one is implicitly talking about “the country”. What is to be said about it, explicitly?
Are cities “natural”?
Are cities necessary for democracy? Does “Western liberalism” require cities?
Many facets of bioethics get brought up in these discussions including clinical ethics (obligations of physicians, rights of patients), research ethics(responsibilities of researchers, protections of subjects), institutional ethics (organizations as moral agents), and public health ethics (populations as the dimension of interest). To this, for cities, we may consider further environmental ethics as issues, such as food safety, water filtration, and “waste” “disposal”, arise with regularity. Are inhabitants of cities in a position to ethically decide how their local environment is altered? What about the world’s? How shall we face our changing climate(s)?
Quo vadis?

Clinical trialing

Do we have a moral duty / ethical obligation / responsibility to participate in scientific research that may benefit others? What obligations do scientists have in turn?
How ought clinical trials to be funded?
Often in our lines of work the objectivity required of the researcher and the considered opinion of the healthcare provider are in conflict within the same person, the same lab, and/or the same institution. How can we ensure a balance is struck between providing optimal care for current and future patients? What does the optimal clinical trial look like?
When are human trials necessary?
The Belmont Report, something of a bible for contemporary clinical trials, arose after hundreds of black men in Tuskegee had their syphilis untreated so that the researchers could track its epidemiology. The Report established three fundamental principles for using human subjects in an area of research: (1) respect for persons by recognizing their autonomy and the necessity of truthfully informed consent; (2) beneficence in which benefits must be maximized and harms minimized; and (3) justice, the reasonable non-exploitation of people in sensitive positions. Does current medical practice enshrine these principles? Are there ways we could do it better? Are there other principles we ought to add?
Can “informed” “consent” ever truly be obtained by a patient in the doctor-patient relationship?
Can the advances being made in data analytics and big/huge-data acquisition and analysis alleviate some of the current burdens to the medical system brought on by trials?
Should all hospitals be teaching/research hospitals? When should a hospital/healthcare center conduct research? When should it not?
Must failure be baked into the cake of clinical trialing?
What are the ethical consequences of non-optimal clinical trialing?
What would it take for you to participate in a clinical trial?

Cloning

If you found out you were a clone of some “original person”, how would that make you feel? What if you found out you were a twin? A quintuplet?
If the technology existed right now, how would you use complete and perfect “cloning”?
Would you ever want your clone to exist? If your clone came into being, how would you deal with it?
Is a clone more like a twin or a child?
If twins are raised in separate wombs are they still twins? What if genetically modify each in different ways? What if we never let them or their mothers/fathers/families/anyone they ever knew interact? If such a twin of yours existed out there, what would you want to say to them? What would you want them to say to you? Who are they to you?
Often fears concerning human cloning (especially those with a more reproductive bent) arise out of the technique’s/technology’s possible undermining of our ( or at least their) sense of self. To this end, three arguments are traditionally given: (1) cloning would undermine our sense of individuality and/or uniqueness; (2) cloning would undermine the value or worth of human beings; and (3) a clone’s freedom and/or autonomy and/or liberty to construct her or his own life is undermined by the presence of an earlier “original”. How do you feel about each of these arguments? Do you agree with Brock on the issues?
Should we resurrect long-dead species? What about the recently extinct?
Should someone be allowed to make their own clone?
Should you be allowed to clone yourself?
What traits are important to define “the self”?
Assume a dystopian future. It is common place (“the norm”) to clone oneself towards the end of life to transfer “the self” that is “you” upon death into a younger clone, and to carry on. This cycle is expected to repeat until the end of time now that world peace has been achieved. Do you keep your “self” going through this cycle?

The coming administration

Do we all agree the next administration will be that of Joseph R. Biden Jr. not donald j. trump?
Do you believe the coming administration will improve healthcare in America, worsen healthcare in America, or keep it about the same?
In what way(s) do you expect the next administration to be different from the current?
In general, Brown (2007) tells us, bioethics has been politicized through three traditional lenses: liberalism, communitarianism, and republicanism. Brown finds “[t]he liberal emphasis on the irreducible plurality of values […] and the communitarian concern with the social dimensions of biotechnology” can be bettered further by the republican tradition “which emphasizes institutional mechanisms” that “enrich but [do] not dominate public deliberation” ensuring public accountability and contestability. Can you imagine other forms of bioethical politicization? Can you imagine a “better” form of politics?
How do we “confront profound moral disagreement” we might have amongst ourselves, such as the ethical status of moral embryos and the positions we take w/r/t them? Put less pointedly, how do approximately 74 million Americans live knowing 80 million Americans disagree (sometimes vehemently! with them and vice versa?
What does a just “public option” look like? How does it function? What does it fix? What comes after it?
How/Shall we revise Obamacare?
Does the upcoming U.S. Supreme Court decision regarding the Affordable Care Act have a moral dimension which ought to be considered along side its legal one(s)?
A recent Executive Order on Lowering Drug Prices by Putting America First¹ (issued on September 13, 2020(, it became “the policy of the United States that the Medicare program should not pay more for costly Part B or Part D prescription drugs or biological products than the most-favored-nation price [… –] the lowest price, after adjusting for volume and differences in national gross domestic product, for a pharmaceutical product that the drug manufacturer sells in a member country of the Organisation for Economic Co-operation and Development (OECD) that has a comparable per-capita gross domestic product.” Should the U.S. Federal Government retain this policy in future administrations?
Will the United States ever have “universal healthcare”?
Will reproductive rights be improved, be diminished, or remain about the same with the Biden administration as compared to the trump administration?
Which U.S. administration has done the most to improve the overall health of Americans?
Will Americans live longer over the next four years than they did previously?
When will this pandemic end? How?
How should/can we remember/honor/carry forward the quarter million dead Americans we have lost thus far and those we’ve still yet to lose?

Please note this comes from the Executive Order found here https://www.whitehouse.gov/presidential-actions/executive-order-lowering-drug-prices-putting-america-first-2/. This differs from one found at a related URL (found here https://www.whitehouse.gov/presidential-actions/executive-order-lowering-drug-prices-putting-america-first/). While substantively the same, the former omits this paragraph in the original justifying the need for the Order:

The need for affordable Medicare Part B drugs is particularly acute now, in the midst of the COVID-19 pandemic, which has led to historic levels of unemployment in the United States, including the loss of 1.2 million jobs among Americans age 65 or older between March and April of 2020. The COVID-19 pandemic has also led to an increase in food prices, straining budgets for many of America’s seniors, particularly those who live on fixed incomes. The economic disruptions caused by the COVID-19 pandemic only increase the burdens placed on America’s seniors and other Medicare Part B beneficiaries.

Democracy

So how about that election, eh?
For social primates such as human beings, there is always a balance to be struck between individual actions and outward effects, especially with regards to other human beings (i.e., our communities). Similarly, the influence of one’s community manifests in one’s acts. Chickens make eggs make chickens make eggs make… This can lead to cycles of health following the tides of the community. (We are, after all, all wearing a mask.) How can a community improve its health?
Can a community (legitimately) opt to decrease its own health?
Can you think of at least one way we could improve democracy in this country?
Can you think of at least one way we could improve democracy in another country?
Can you think of at least one good reason why we should improve democracy in this/another country?
Why/Are we partial to democracy?
Jennings posits that “To give a practice [of medicine] meaning is to locate it in relation to a broader scheme of society, history, and individual experience […] to see how it fits into the various patterns that people use to create order and structure in their lives”. Normalization and familiarization each facilitate integration. Can you think of an example in which a practice of medicine is best understood by the social/historical structures constraining an individual?
Must bioethics strive toward liberalism? Put slightly differently, does “progress” require progressivism?
Solomon and Jennings (2017) contend, “Increasingly, the United States’ cultural narrative has demeaned government as a paternalistic and overbearing “nanny state” or as wasteful and inefficient, and it has construed citizens as mere clients or consumers. This is a phenomenon sometimes described as “civic privatism.” Behind fake news, lack of transparency, and the generation of conflict seemingly for its own sake, there is an increasing cultural denigration of public service and governmental function.” Why/Do you think it is “increasingly” “popular” to disparage the U.S. Government?
On average, do you think families make better medical decisions than individual actors? Conversely, could an individual always determine their course of treatment without reference to their family/community?
Tucker et al. (2019) discuss “the problem of cognitive fixation on prior ideas” as a limiting effect of crowdsourcing. “[P]roviding an example or reference limits the diversity of ideas solicited. This concept is similar to groupthink, which occurs when a group of individuals converges on a single solution.” How can we ensure democratic/community-based solutions mitigate these effects?
Would you be willing to kill/die to defend/spread democracy? Are there circumstances that would compel you? Would you participate in a draft? If called upon by your nation at this moment to serve in the military, would you?
Have the American people elected their next leader of their Executive Branch of government?
Has the internet made democracies around the world better, worse, or left them about the same?
How should we confront profound disagreement?

Dia de los Muertos

How/Should we celebrate the dead?
What rights do you have to claim over your own dead body?
Does the current funeral/body disposal service in America cost too much, too little, or just about the right amount?
How Americans interact with their dead has changed drastically over the course of the past century. Rarely are dead relatives displayed at ones home as a family mourns. More people are opting for cremation and dying in hospitals, meaning that for some families, loved ones go into a hospital only to be seen again as ash. Is this progress in the processes of death?
The dead surround us. Buried into hill sides or vaporized into some carbon wafted in our nose, quite literally what were once about 100 billion other human beings now infuse our environment. Does this require us to treat our environment differently as it grows ever denser with dearly departed?
Will the dead ever walk among us?
Is our modern declaration of “brain death” necessary and/or sufficient to demarcate “the living” and “the dead”?
Hirschkind (2008) notes, “Preachers mine a vast archive of eschatological imagery — the horrors that occur in the grave (ayzeb al-qabr), the terrifying encounter with the angel of death (Azra’il), the exuberant sensuality that awaits the pious in heaven — reworking this stock of highly visual narratives to both astound their audiences and enliven their moral affects.” On average, does the inclusion of “fire and brimstone” rhetoric in discussions of morality and ethics benefit participants? Put differently, are more souls likely to “go to Heaven” if they know they are “held over Hell”?
In what way(s) is a fixation with death beneficial/harmful to a society/culture and/or its neighbors.
Dia de los Muertos refers to a set of Roman Catholic holy days celebrated in Mexico corresponding to All Saints’ Day and All Souls’ Day. Usually the “Day of the Dead” (also, el Día de Animas, el Día de los Finados, and el Día de los Fieles Difuntos) is reserved for All Souls’ Day, with All Saints’ Day being celebrated on its eve. Why/Should we have two days to celebrate our dearly departed: one for the best of us and one for the rest of us?
The history of the United States and Mexico over the development of America has been one of contact, conflict, exchange, and continuous influence. A modern incarnation of this “same old story” is the influx of immigrants from “south of the border” affecting United States healthcare policy. How/Should/Could undocumented immigrants and/or non-citizens of the United States be given healthcare if they lack the means to pay it?
How/Should/Could citizens of the United States be given healthcare as a right?
If you were a ghost, what would you do with your time?
How/Should we fear death?
Do we die the right way these days? Have we in the past? Will we in the future?
How many more Americans will die by this pandemic?

Disability

Who are you and are you enabled to (fully) be your “self”?
Generally, there two models of disability: a “medical model” that stresses the physical limitations inherent to disability, taking as its norm a self-sufficient, non-disabled body and a “social difference model” that defines disability primarily as a social condition resulting from society’s failure to accommodate physical differences of the disabled. Is there one we ought to prioritize over the other? Which and why?
Where should we place the emphasis when thinking about dis/abilities?
Given the ever-increasing capability to prenatally screen unborn children, should conditions that would “disable” a child be looked for (by parents, by physicians)? If found, what, if anything, should be done about such conditions?
In some recent popular culture representations, autism (spectrum disorder) has been portrayed as advantageous, quite possibly “the next stage in human evolution”. How should this be viewed? Is this a misrepresentation of a developmental disorder? A glorification of human variety? Exploitation of the disabled? Awareness building?
According to the Bureau of Labor Statistics, in 2018 “jobless rates for persons with a disability were higher than those for persons without a disability” with “[p]ersons who are neither employed nor unemployed […] with a disability [equal to] about 8 in 10.” Given those facts, should more people with disabilities be encouraged to enter the workforce? How could this be accomplished in practice?
Introduced by Senator Chuck Schumer in the Senate and Representative F. James Sensenbrenner in the House the “Disability Integration Act of 2019” (S. 117 and H.R. 555) is one of 10,071 bills before the 116th Congress. Of the total, 949 bills currently standing before Congress address disability in some way. Do you believe the lives of the disabled will be improved by the federal government in the foreseeable future? Why or why not? What could be done to improve their lives.
Analyzing incidents of people killed by police (from 2013 to 2015), the Ruderman Family Foundation found that “[d]isabled individuals make up a third to half of all people killed by law enforcement officers.” While media coverage often focuses on issues of race in police brutality, this can obscure how disability also factors into police interactions. Why do marginalized groups suffer more at the hands of police? What can be done to prevent such adverse interactions?
Since about the late 1970s, psychologists have identified individuals with “apotemnophilia” – a condition characterized by an intense, long-standing desire for amputation of a (specific) limb. Such individuals can be thought of as challenging stigmas of disability by literally wishing to embody alternative conceptions of “bodily integrity”. They may also be thought of as experiencing a type of body dismorphic disorder in which (physical) self-identity is pathologically warped. Should an individual be allowed to remove a body part for non-medical reasons? Can we lop off a nose, pluck out an eye, hack off a limb for no clear medical benefit?
Is the University of Michigan a sufficiently accessible place for all?
“The last mile” – the distance between an individual’s residence and their transit – can be particularly long for people with disabilities. In what ways can we shorten it?

Drugs

How do drugs differ from other things?
What does responsible drug use and administration require of the user and the administrator? Should such responsibilities be codified in a nation’s laws?
After Congress mandated that the U.S. Food and Drug Administration (the “FDA”) “validate substantial evidence of safety and effectiveness for new drug products based on adequately controlled clinical trials,” Darrow et al states “the average development time for a new drug predictably rose from 2.5 to 8 years.” Assuming these are the two reasonable bounds, towards which of these time points would a healthier society’s drug approval rate skew?
“Three categories of expanded access now exist” Darrow et al tells us. “The most common request is for individual use, a subset of which involves emergency circumstances leading to treatment even before a formal written request has been submitted to the FDA. The second situation relates to requests by intermediate-size patient populations (tens to hundreds) who are eligible to receive a drug early in its development. The final situation is widespread use under a treatment protocol, such as might occur after a successful trial of an experimental agent has been concluded but before it has received FDA approval.” Should these levels of expanded use be met with different ethical and regulatory standards? If so, how should they differ? If not, why should there be uniform standards?
How much would it cost for you to take a random pill?
Volkow et al. notes, “The regular use of marijuana during adolescence [can be] of particular concern, since use by this age group is associated with an increased likelihood of deleterious consequences”. Such consequences include those from short-term use (e.g., impaired short-term memory, impaired motor coordination, altered judgment, paranoia, and psychosis) and long-term use (addiction¹, altered brain development, cognitive impairment, diminished life satisfaction and achievement). With the ever-burgeoning “legalize it” movement pushing for a loosening of federal restrictions on marijuana use, sale, and distribution, what restrictions should remain (particularly with respect to adolescent)? What should accompany them?
Is it better to use more drugs or fewer?
On the subject of using a substance like Adderall to do “better” on an assignment: “Whether the cognitive enhancement is substantially unfair” Greely et al contends, “may depend on its availability, and on the nature of its effects. Does it actually improve learning or does it just temporarily boost exam performance? In the latter case it would prevent a valid measure of the competency of the examinee and would therefore be unfair. But if it were to enhance long-term learning, we may be more willing to accept enhancement. After all, unlike athletic competitions, in many cases cognitive enhancements are not zero-sum games. Cognitive enhancement, unlike enhancement for sports competitions, could lead to substantive improvements in the world.” Do you agree?
What is it that drugs do to us that gets us so curious about them?
“Popular weed killer may be to blame for honey bee deaths, study suggests” a headline from today that were but two words flipped would have made for an excellent discussion.

Extinction

We began this year’s discussions by asking ourselves “to what extent do our brains determine our ethics?” to which myriad answers tended towards “a great deal”. What are we to make of a time when every single one of those brains is gone?
Question 1 asks about a time when our brains are absent. What about spaces in which they are? Must one be moral on Mars?
Question 2 asks about absence in time and space. What if we were to replace it with mere sparsity? That is, what effect does the density of human beings have on those human beings’ (ideal) morality?
Is it better to have more extinctions or fewer? More de-extinctions or fewer?
Do human beings (and/or their ethical equivalents) have an obligation towards species stewardship?
Is there an alternative to extinction?
On the brink of species wide extinction, would you eat another human being to survive?
Would you want to survive a near human extinction?
Human extinction as a result of human action is known as “omnicide.” Could there ever be a time in which a species like ours should commit omnicide?
“By the year 2050,” according to the Pew Research Center (2010), “41% of Americans believe that Jesus Christ definitely (23%) or probably (18%) will have returned to earth. However, a 46%-plurality of the public does not believe Christ will return during the next 40 years. Fully 58% of white evangelical Christians say Christ will return to earth in this period, by far the highest percentage in any religious group.” How ought we to make policy when 2/5ths of the population believes armageddon is just around the corner?
How important is it that human beings prevent extinctions?
Who are you? And, if you will one day be extinct, does it matter?

Fear

What do you fear and why?
Is knowing what other’s fear a matter of privacy? What about other emotions? Will emotional/mental states ever be sufficiently measured by human beings?
Describing fear as a bodily response to a threat, Quirk (2015) describes the flight or flight response as a combination of increased breathing rate, increased blood pressure, increased heart rate, decreased pain sensitivity, etc., i.e., fear as a physiological function. Sometimes altered physiological functions allow performance in extreme conditions. For example, a solider on the battlefield may perform their duty better when scared. Would the U.S. Military be justified in using fear as a motivator for its soldiers? What about removing a solider’s fear? Would we be justified in using fear as a tool of war?
Quirk notes that the brain mechanism of fear learning is conserved across species with the amygdala, a subcortical region located in the medial temporal lobe, crucial as a node in fear circuitry. Why do you think, given nature’s variety, that its response to fear is so largely self similar?
Do you have phobophilia? The love of fear? Do you enjoy scary stories, haunted houses, darkened woods? Why would someone like fear in certain contexts?
Duke et al (1993) end by stating “[b]ecause fear resides within the individual, a manager must project beyond personal opinion about what fear issues are important and develop perspectives similar to those of other stakeholders to properly evaluate the effects of a fear appeal.” How can we develop (empathetic) perspectives for those whose fears we might never understand?
On the eve of the 2018 midterm elections, comedian Chelsea Handler remarked, “I think that fear works on both sides: […] I’m doing more than I’ve ever wanted to do in my entire life because I’m fucking scared shitless.” Is fear a legitimate motivator?
Danis et al (2007) conclude that “[f]ear of retaliation from seeking ethics consultation is common among nurses and social workers, nonetheless this fear is not associated with reduced requests for ethics consultations.” Why does the fear for “doing the right thing” exist?
“Fear,” Fairchild et al. (2018) tell us, “is now commonly used in public health campaigns” going on to examine how fear campaigns against the tobacco industry and HIV/AIDS epidemic began, evolved, and affected those involved. If fear can be used to improve the health of the populace, should the populace live in fear?
Should we be afraid?
“Professor Nobody” says that “Once awareness of the human predicament was achieved, we immediately took off in two directions, splitting ourselves down the middle. One half became dedicated to apologetics, even celebration, of our new toy of consciousness. The other half condemned and occasionally launched direct assaults on this gift.” Do you think that human predicament described – the “[m]adness, chaos, bone-deep mayhem, devastation of innumerable souls–while we scream and perish, History licks a finger and turns the page” of it all – has caused some fundamental shift in human consciousness?
“Fiction, unable to compete with the world for vividness of pain and lasting effects of fear, compensates in its own way. How? By inventing more bizarre means to outrageous ends.” Are their limits to which we should allow our art to induce fear?

Gender

Do there exist inequalities/disparities between genders in current American healthcare? Are such inequalities/disparities unjust?
Should “biological” mothers have a greater say in any given situation due to the unique biological toll/exchange/interactions with their children (e.g., through pregnancy, breastfeeding, etc.) that all other parental units lack? If so, when so? If not, why not?
Did you ever “choose” your gender? What do you think it would be like if you, personally, were suddenly transformed into another gender? You can put this in your mind at least one of two ways: (1) one day you awaken to the all-encompassing feeling that you are not the gender that is currently stamped on your driver’s license or (2) imagine if Who You Are Up In Your Head was transferred into The Body That Is The Person of someone of a different gender than the one to which you currently identify. What’s that like?
West and Zimmerman posit that: “When we view gender as an accomplishment, an achieved property of situated conduct, our attention shifts from matters internal to the individual and focuses on interactional and, ultimately, institutional arenas. In one sense, of course, it is the individuals who “who” gender. But it is a situated doing, carried out in the virtual or real presence of others who are presumed to be oriented to its production. Rather than as a property of individuals, we conceive of gender as an emergent feature of social situations.” Do you agree? In “doing” your gender, how much of what you “do” arises from you exclusively as an individual human being and how much arises from your social environment. That is, when we put “gender” as a biomedical idea on the nature v. nurture scales, how do they tip?
Butler contends: “The authors of gender become entranced by their own fictions whereby the construction compels one’s belief in its necessity and naturalness. The historical possibilities materialized through various corporeal styles are nothing other than those punitively regulated cultural fictions that alternately embodied and disguised under duress.” Do you agree? Is gender closer to a “necessary and natural” part of life or is it more akin to a “punitively regulated cultural fiction”?
Do you believe generally polite, public language should be gender-neutral? If so, what strategies do you employ to do so? If not, why not? What should the gender-neutral plural in American English be?
What should a parent do if their child has gender dysphoria and wishes to have their puberty suppressed?
Is there something worse about preferential abortion of children on the category of sex/gender than there is for such an abortion for another reason? Do the societal (and thus medical) consequences seen in countries in which such population dynamics have been at work for a significant period of time (e.g., China) sway your opinion on the matter?
Is it morally acceptable to preferentially select an embryo for in vitro fertilization for reasons stemming solely from the category of sex/gender?
I believe that eventually the greatest of civilizations will all have people pissing and shitting in approximately the same places. That is, I think gender-neutral bathrooms – those in which persons of any gender can come and do their business – are essentially a hallmark of progress. Is there a biomedical/ethical reason why bathrooms ought to be categorized by gender? Is it merely practical?
It was the indelible Mr. Hitchens who once quipped, “The cure for poverty has a name, in fact: it’s called the empowerment of women. If you give women some control […] and then if you’ll throw in a handful of seeds perhaps and some credit, the floor of everything in that village, not just poverty, but education, health, and optimism will increase. It doesn’t matter; try it in Bangladesh, try it in Bolivia, it works—works all the time.” I can’t help but see the equal empowerment of all people everywhere as a generally good thing towards which we should be striving. As such, news such as which is conveyed by this recent headline, “Women in Iran are pulling off their headscarves – and hoping for a ‘turning point’” as a thing I’m compelled to support. How do you feel?
Spade begins “Resisting Medicine, Re/modeling Gender” by noting: “Everywhere that trans people appear in the law, a heavy reliance on medical evidence to establish gender identity is noticeable. Try to get your birth certificate amended to change your sex designation, and you will be asked to show evidence of the surgical procedures you have undergone to change your sex. Try to change your name to a name typically associated with the “other gender,” and in many places you will be told to resubmit your petition with evidence of the medical procedures you have completed. Try to get your drivers’ license sex designation changed, and again you will be required to present medical evidence.” Should the existence of and due process/equal protections under the law to transgendered individuals be necessarily bound up in the medical examination of, ultimately, the genitals of strangers.
Are the genders in America equal? If not, when will they be?

History

Who are you and how will history remember you?
Medical information is often treated differently than other sorts of information. An emphasis on privacy and integrity goes along with the sensitivity of the information. This can produce fragmentary systems where only certain parties only know certain things. To what extent does this alter the “objectivity” of one’s medical history?
How should we take historical information into account for a present situation?
Desperate times, we are told, often call for desperate measures. In today’s world there is talk of rescinding certain restrictions of established medical privacy law to facilitate the transmission of information during a quickly happening, slowly moving pandemic. How/Can we ensure information gets to where it’s needed and nowhere else?
Is there a line (or set of lines) we can draw in which medical data is strictly the possession of the individual from which it comes and that data which is not? When data is “de-identified”/”anonymized” to what extent can the individual from whom it comes stake any claim?
Nietzsche remarks “There is no set of maxims more important for an historian than … that everything that exists, no matter what its origins, is periodically reinterpreted… in terms of fresh intentions … in the course of which earlier meaning and purposes are necessarily either obscured or lost. … The whole history of custom, [thus] becomes a continuous chain of reinterpretations and rearrangements…” Why/Has medical practitioners’ “duties” (e.g., Hippocratic Oath) remained largely stable through successive reinterpretations? That is, we now allow “cutting for stone”, yet might still find wisdom in that contract to Apollo. Why?
Baker (2002) contends that “If the unexamined life may not be worth living, then, in much the same way, advice by historically uninformed bioethicists may not be worth having.” How much history should be folded into bioethical discussions? Is there ahistorical bioethics? Must actions be justified by moral rules grounded in principles derived from ethical theories that will always be “of their time”?
Is bioethics a recent historical creation? If so, why so? If not, why not?
History, so far as I can tell, is the best evidence we have to the question, “Should we keep going?”
How long should be our history?

Infection

Who are you and how are you holding up on this pandemiciversary?
Communicable, infectious, and “tropical” diseases kill millions each year. Tuberculosis, HIV/AIDS, typhoid, influenza, hepatitis, meningitis, pertussis, malaria, dengue, leishmaniasis, Chagas disease, ebola, and others causes by bacterial, viral, and parasitic infection have ended the lives of billions of the humans who have ever lived. And yet, these infections do not kill equally. According to the WHO, of the top 10 leading causes of death in high-income countries, only one is due to infection. In low-income countries, 6 of the top 10 are from infections. What is it about money that protects populations from infection?
Certainly, we can all agree that we each have a responsibility to avoid (as best we can) infecting others with diseases we might have. To what extent do we have a responsibility to prevent infectious spread between others?
If you could eliminate one infectious disease, which would it be and why?
It is argued by some that vaccines development could be accelerated/improved by conducting controlled human infection studies. That is, if we infect folks with a known virus at a known time and subject them to a known treatment, researchers could potentially get “better” data than what presents (sporadically) in clinical situations. Under what conditions would intentional infections in human studies be acceptable? Could similar arguments be made for the intentional breaking of bones or the development of cancer within human beings to “improve” treatment for those disorders?
Infectious diseases can be and has been used as weapons against others. From small pox blankets to HIV-infect men raping others, the purposeful spreading of contagion can be a means of inflicting a unique form of violence. And at least to my mind, a singularly onerous form. What facet(s) of this violence make it distinct from others?
In war there is violence: violence “justified” by state actors (or their equivalents) for state interventions (or their equivalents). Can/Could/Should infectious disease ever be a legitimate form of violence waged in war? Why or why not?
When does a herd have a right to demand immunity? What just means do we have at our disposal to enforce it? Put more practically, could/should/will the University of Michigan require proof of a Covid-19 vaccination to be a student campus?
Morens & Fauci (2007) suggest “if a novel virus as pathogenic as that of 1918 were to reappear today, a substantial proportion of a potential 1.9 million fatalities (assuming 1918 attack and case-fatality rates in the current US population) could be prevented with aggressive public-health and medical interventions”. Was the United States’ response to the novel coronavirus met with sufficiently aggressive public-health and medical interventions? Is it currently meeting it aggressively enough?
When will SARS-CoV-2 infections end?

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?

Life-preserving technologies

What does it mean to preserve life? Is it different than sustaining life? Maintaining life?
What constitutes a life worth saving? Is its threshold lower, higher, or about the same as a life worth living? Do current medical technologies exist (or could future technologies exist) that would save lives that ought not to be saved? Should we use such technologies? And if so, what limitations/boundaries/restrictions should we employ in their use?
Jahi McMath, a thirteen-year old African-American girl from Oakland, California, went in for a tonsillectomy in December of 2013. Due to complications, she ended up in the intensive care unit. Two days later she was declared “brain dead” (an EEG shows no brain activity, a radionuclide cerebral blood flow study showed no perfusion). Though she is unable to breathe without the use of a ventilator – one she has been on for over four year now – the family claims their daughter is still alive. What are we to make of this? Is the family operating under a delusion? Should we consider alternative definitions of death beyond the mere cessation of brain activity?
In the above example, and in others like it (for example, the “Terri Schiavo case”), do you believe the State has any overriding interest in the quality of life of its citizens that would allow it to go against the wishes of direct family members, perhaps the patient themselves?
An unconscious 70-year-old man with a history of chronic obstructive pulmonary disease, diabetes mellitus, and atrial fibrillation is brought to the emergency department, where he is found to have an elevated blood alcohol level. Across this man’s chest is a tattoo which read “Do Not Resuscitate.” Should the physicians treating him ignore the tattoo and invoke the principle of not choosing an irreversible path when faced with uncertainty? Should they honor the tattoo as an expression of an authentic preference? Would the situation be different if the man had dozens of tattoos or if this was his only one? Tattoos often do not reflect current beliefs or represent past regretful decisions, does that factor in?
Can one regret living? Can one regret being saved?
As medical technologies give us the power to extend/alter/facilitate life into gray areas never before experienced, have we irrevocably changed the human condition?

Love

Who are you and what inspires your love?
If we could create a pharmaceutical that gave rise to that emergent property we call “love” – “a cocktail of ancient neuropeptides and neurotransmitters” – how would we regulate the use of such a drug? What attributes would this form of love lack as compared to its more “natural” counterpart?
If we could “make” someone “love” us – for instance, by mixing into a meal of theirs some of the pharmaceutical in the previous question – would it be ethical to do so? What is the relationship between love and compulsion?
“Underlying human romantic attachment”, Earp et al. (2015) suggests, “is a collection of interlocking brain systems that are hypothesized to have evolved to suit the reproductive needs of our ancestors.” Since contraceptive technologies have helped separate “romantic attachment” and “reproductive needs”, (how) has love changed?
Administration of oxytocin (directly to the brain in voles, through nasal spray in humans) has been observed to increase attachment between pairs. Conversely, oxytocin blockers have been shown to diminish sexual attraction and prevent pair-bonding. Should we research further the neuromodulation of love? What should we do with such information?
Does love preclude/prompt certain actions from/between individuals?
Love takes many forms. What features do “parental love”, “romantic love”, “sexual love”, etc. have in common and what features are type-specific?
Does “love” exist outside of human beings in our universe?
In the not-too-distant past (and some parts of the present), homosexual romantic relationships were considered “wrong”, biologically, socially, morally. Given that same-sex marriage in our country (and others) is legal, how was this “wrong” “righted” and are there other forms of contemporary and/or future love conditions that we ought to make sure we get “right”?
What is “self-love”? Can it be pathological? In what cases? How/Can it be corrected? How is it distinct from self-esteem and general maintenance?
Does love require a self? Does love require others?
Do self-help books, of the variety described in Hazleden (2003), on average help their readers to love themselves more or hinder them in the process?
Is it healthy to love? Is it unhealthy not to? Is there a way to secure love’s benefits for all?
Would the world be better with more love or less? Why isn’t their more/less?
Is it better to love and lose than to never love at all?

The madness of crowds

Who are you and what is the largest in-person gathering you would join at this very moment?
Did we make the “right choice” in November?
What will happen on January 20th?
Across the country at this very moment there are thousands of people who would happily walk into a crowd with explosives strapped to their chest, detonate, and vaporize every nearby citizen. Now such people need merely walk into that same crowd maskless to achieve similar results. Are we ready for the coming age of stochastic viral terrorism?
Does Twitter have the right/responsibility to (de)host world leader’s accounts given their obvious presence on “the world stage”?
Does Zoom have the right/responsibility to (de)host participants discussing the Tiananmen Square Massacre and provide their information to “legitimate” governments of the world?
What is the optimal number of people solving a problem?
Why does it appear that “Fads & Fallacies” must be met with A Continued Need For Vigilance Against Fraud? Why can’t we snuff out fakery for good?
What is the most dangerous conspiracy in our world right now?
Why do people believe weird things?
How/Can one reason with unreasonable people? What are a few strategies for de-indoctrination we can employ to help others?
Is it our moral responsibility to get people out of cults?
Burrell and Gill (2005) write of a series of “cholera riots” that broke out in Liverpool in 1832, where distrusting crowds believed “cholera victims were being removed to the hospital to be killed by doctors in order to use them for anatomical dissection.” One contemporary (writing in The Lancet no less!) said it was a “government hoax got up for the purpose of distracting the attention of the people”. Do you believe the increased civil unrest we have experienced recently is attributable to a similar set of circumstance – distrust, disgust, disguise of a disease – or would this civic strife happen independent of the pandemic?
Some might say peer review represents the rails that keep us on the right track of science. Quality, we are assured, is ensured by the quasi-anonymous review by one’s intellectual colleagues looking over one’s work with keen and careful eyes. As Millard (2011) notes that while some invoke a “quality control” argument in favor of the practice, “others find the practice riddled with incompetence, conflict of interest, interpersonal strife, assorted biases (including pervasive bias toward positive results, along with predictable personal leanings), and occasional intellectual property theft.” How might we improve our peer-review processes? That is, how can we make the best use of our collective time to ensure the integrity of the scientific process/literature/landscape?
Should the COVID-19 vaccine be mandated for the citizens of this nation?

Mental health

What does it mean to be healthy mentally?
From whence arises the stigma(s) of mental health?
Is there something that is meant by “mental health” that has no physical (i.e., anatomical, physiological, biology, chemistry, atoms, quarks, gluons) correlate? Put differently, do all “mental disorders” correspond to some set of “physical disorders”, with no exception?
Must a diagnosis of health have both validity and utility to be used by physician/healthcare provider/healer/psychiatrist?
Five criteria have been generally agreed upon to establish the validity of psychiatric diagnoses: (1) clinical description, (2) laboratory studies, (3) delimitation from other disorders, (4) follow-up studies, and (5) family studies. Are these sufficient?
Kendell and Jablensky note that “Even though the authors of contemporary nomenclatures may be careful to point out that “there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder” (DSM-IV, p. xxii), the mere fact that a diagnostic concept is listed in an official nomenclature and provided with a precise, complex definition tends to encourage this insidious reification.” To what extent can we avoid “pathologizing” disorders with misclassification?
Szasz asserts, somewhat boldly that, “[t]he belief in mental illness, as something other than man’s trouble in getting along with his fellow man, is the proper heir to the belief in demonology and witchcraft. Mental illness exists or is “real” in exactly the same sense in which witches existed or were “real.”” Do you agree with his assertion?
“The term “mental illness””, Szasz says, “is widely used to describe something which is very different than a disease of the brain. Many people today take it for granted that living is an arduous process. Its hardship for modern man, moreover, derives not so much from a struggle for biological survival as from the stresses and strain inherent in the social intercourse of complex human personalities.” Going on further to note that the very “concept of illness, whether bodily or mental, implies deviation from some clearly defined norm.” [Emphasis in original.] Does such “abnormalization” add to our problems?
How ought we be mentally healthy?

Michigan

Who are you and where are you from? (And how far is it from here?)
In her 2019 State of the State, Governor Whitmer stated that, “the vehicle damage from our roads costs the average motorist $562 a year in repairs. We’re paying a road tax that doesn’t even fix the damn roads. That’s money that could go toward childcare, rent, college tuition, or retirement savings.” If each resident of Michigan had an extra $562, where should those funds go to optimize the overall well-being of said residents.
What are the (health) consequences of poor infrastructure?
Are the residents of Michigan generally healthy? Do they suffer from any chronic diseases with greater regularity than other states’ residents? If so, which and where does they stem? If not, why is Michigan such a representative state?
What could be done to make the residents of Michigan generally healthier?
Should there be more Michiganders or fewer? Should there be more Detroiters or fewer? Should there be more Ann Arborites or fewer?
Why doesn’t Flint have clean drinking water?
In recently denying a petition for a writ of certiorari in the case City of Flint et al. v. Shari Guertin, the Supreme Court of the United States has signaled that state and local government officials can be sued for their involvement in the Flint water crisis. How ought the people responsible be held to account?
Foster Friedman and Udow-Phillips (2018) identify four current issues with health/care spending and outcomes in Michigan: (1) Medicaid and the Healthy Michigan Plan; (2) individual market coverage and the health insurance marketplace; (3) opioids; and (4) integration of services. Given the state of our state, how should these issues be prioritized/worked through?
“In June 2018, Governor Snyder signed PA 208 into law, the first step in preparing a work requirement proposal for Michigan. Beginning in 2020, the law would require non-elderly, non-disabled HMP enrollees aged 19-62 to document an average of 80 hours of work per month to maintain eligibility for Medicaid benefits.” Should health/care as such be bound to work? Should there be any consideration for the populations covered by such insurance?
Is Michigan a bubble? As an early adopter of Medicaid managed care and statewide managed care program as early as 1997, Michigan has historically had an uninsured rate less than the national average. “In 2009, 12.2 percent of Michigan residents were uninsured compared with a national average of 15.1 percent. In 2015, 6.1 percent of Michigan residents were uninsured, compared with a national average of 9.4 percent.” The University Hospital generates revenues totaling between 0.1 and 0.2% of America’s overall healthcare spending. What is the Michigan difference?
Will Michigan be red or blue in 2020? (Or will it be some other color entirely?)

Neuroethics

To what extent do our brains determine our ethics? To what should they?
“[I[t has been suggested that a large proportion of inmates on death row may have damaged or injured brains. If careful epidemiologic studies establish that this is the case, how should our views about moral and legal responsibility change, if at all, to accommodate this surprising fact?”
Do we have a right to know when someone is lying?
“If someone knows that he or she is at some risk for, for example, a psychotic episode, should he or she be held legally responsible for actions undertaken while delusional in virtue of not having prevented the episode?”
Is there an ethical distinction to be made between “death” and “brain death”? Would you wish to have one without the other?
“Traditional ethical theory has centered on philosophical notions such as free-will, self-control, personal identity, and intention. These notions can be investigated from the perspective of brain function.” Is this a useful perspective to take on these matters? Why?
Imagine, if you will, that you work at a government weapons lab working on a mind-altering technology, such as a long-term neural prosthetic meant to enhance memory encoding. One day, your advisor asks you to begin looking into its converse, the selective elimination of previously encoded memories. What do you do?
What does it mean to change one’s self?
In some sciences there are facts and theories that yield accurate and worthwhile predictions. For example, knowing how diseases spread gives you both population-level anticipatory power and suggests remedies at the person-level. Some forms of ethics provide the same (e.g., the most good for the most people most of the time at least provides a bearing on the moral compass even if it doesn’t put a pin in the moral map). Does neuroethics – either as a field of science or as a field of ethics – provide comparable accurate and worthwhile predictions?
Do we have free will?
Is there a “ghost in the machine”?
Have the shifts in our biological and ethical perspectives throughout history generally been to the benefit or the detriment of the human experiment?
Is “neuroethics” the right word for what we’re talking about here?
Who are you? And does it matter?

Others

Who are you and why aren’t you any other?
What is it about the existence/presence of “others” that compels us to act differently than we might otherwise?
Why is hard to know what others know? Or to know that they know? Or to know that you know that they know?
On average, are you a “better” person in the presence of “other” people?
Should undocumented immigrants have access to a nation’s healthcare (system) to the same extent as citizens of that country do?
Does one lose rights when incapacitated? What limitations of rights must/should be employed to deal with the “brain damaged” or those in vegetative states?
Is there “someone” in there for other primates? Other mammals? Reptiles? Insects?
How do you know “someone” is in there? How do you know when someone is “not”?
What basic human rights ought to extend to treatment of human bodies? Human minds? Human souls?
In the absence of all other information you might know about a particular person, how ought we treat a human being? What hard and fast limits exist? What etiquette so foundational it requires compulsion? That is, how should we treat others?
Farah (2008) contends, “behavior is particularly unhelpful as a guide to mental status: severely brain-damaged patients who are incapable of intentional communicative behavior, and nonhuman animals whose behavioral repertoires are different from ours and who lack language”. What rights do severely brain-damaged patients have that they might otherwise lack? What rights do/should they have as compared to a nonhuman animal?
How do children go from having virtually no rights but a lot of protections to adults with many rights (and possibly liberties!) but fewer protections?
Thomasma (1997) proposes the following bioethical “rules” for international peace: peaceful dialogue, against xenophobia, respect for cultural pluralism rule of common good, cultural apprehension, respect for persons in context, existential a priori. To what degree do you believe such a list is necessary and sufficient to serve as an ethical foundation for bioethics (as opposed to a more “patient-centric” approach traditionally taken)?
Ought we be “Against culturally sensitive bioethics” as Bracanovic posits?
There is no “us” and “them”, but them, they do not think the same?

Overpopulation

Who are you and do you think the world is overpopulated?
How many people is too many?
When/Will the global population decrease?
Goodwin (2011) states that “[o]verpopulation is a serious threat to future persons’ quality of life.” Taking this as a given, what is our responsibility to “future persons” and their quality of life.
Can a state/government sterilize a subset of its population to prevent overpopulation? Could they sterilize a subset of its population for other reasons? Could/Should they (de)incentivize people’s reproductive efforts?
Why/Did China’s One Child Policy fail?
As Rust (2010) notes, a “stunning 90% of this increase will occur in the developing world”. Thus, when speaking of population control measures, the most “effective” would be applied to developing nations. That being the case, is it “morally acceptable for developed nations to invest in population control mechanisms in developing countries in order to limit their population expansion”?
Should rapidly growing populations be allowed to “hit their limit”? That is, is the solution to overpopulation, allowing the “carrying capacity” of the environment to have its – often rather morbid – say?
The detrimental effects of population are rarely directly tied to the members of the population itself. Instead, there are indirect consequences – sometimes referred to as “negative externalities” – that can harm the population’s environment(s) and thereby harm the population itself. How can we reduce the negative consequences of overpopulation without “culling the herd”?
What is the optimal number of people in a population?
Who is responsible for overpopulation?
Why is it in this ever more crowded earth we (perhaps too often) feel alone?
When the history books are written, will it be said of our time that we had too much, too little, or did we finally achieve a “Goldilocks” generation?

Population Control

Who are you and what is a population you consider yourself a part of?
How many people is too many?
In reference to the above, how/can we say the same for other species? Does overpopulation of a species require a/nother species to “control” it?
What do you estimate the holding population of the human species is?
It is a practical truism that “modernization” and “fertility rates” tend to be inversely proportionate. Do you foresee a time when “civilization” will fail to maintain a higher birth rate than its death rate?
Is what is happening to the Uighurs “genocide”?
If you could eliminate any one species’ population on planet earth to the overall betterment of conscious creatures, would you and which? If not, what makes you hesitant to assume this kind of “control”?
Some argue that the human species itself accounts for a great deal of ugliness and hurt that abounds in the world. Some argue further that for at least that reason, human beings should voluntarily forgo procreation and march off to oblivion. Are human beings really such vile creatures to need such controlling? Could they ever reach such a point?
Who should control our populations?

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 20th century science fiction to describe 20th century 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?

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?

Public Health

Who are you and how do you as an individual keep the public healthy?
The constitutional bedrock rights of “Life, Liberty and the pursuit of Happiness” can be distilled as “right to live”, “right to live (generally) unencumbered”, and “right to live (generally) unencumbered the way you want.” Given this formulation, is “public health” a right of our citizens? Ought it be thought of as a positive or negative right?
Wilson (2016) claims that “[t]oo little state intervention in the cause of improving population health can violate individuals’ rights, just as too much can.” Do you agree? Can you think of a time that state intervention has over/undershot the mark?
What proportion of public funds ought to be spent specifically on public health measures such as those noted by Callahan and Jennings (2002): health promotion and disease prevention; risk reduction; epidemiological and other research; and structural and socioeconomic disparities?
Has the “war on drugs” been an effective public health measure?
How should the obesity crisis be solved?
How should the opioid crisis be solved?
Will the legalization of recreational marijuana improve (public) health outcomes?
Are individuals carrying COVID-19 responsible/culpable for infecting others? What about those with other viral infections (e.g., the common cold, HPV, HIV)? What should be done with to those who knowingly transmit infection/disease?
Noted religious charlatan and actual convicted fraud, Jim Bakker, sells (even at this moment) a “silver solution” intended to “promote natural healing”. During a screening of the hack fraud’s show, a guest claimed that it has been “tested on other strains of the coronavirus and has been able to eliminate it within 12 hours.” This statement prompted a warning letter from the FDA and a cease-and-desist letter from the New York Office of the Attorney General. Should people be allowed to sell snake oil during times of non-emergency? Should Bakker go to jail again?
The singer Brody Dalle points out “I don’t steal the air I breathe”. But if that air is not clean, can it be said that you are free? Who is responsible for our clean air?
In what way(s) should community leaders be held to account for community health disasters? For example, what should be done to state and county officials whose decisions led to the Flint water crisis? In what way(s) should private individuals and/or corporations be held responsible for public health problems? For example, what should happen to the Sackler family given their role in the opioid crisis?
In the 8-1 decision of Buck v. Bell concluding “[t]he principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes”, the U.S. Supreme Court indicated the government did not violate the Fourteenth Amendment when acting “for the protection and health of the state”. Should our government be able to compel vaccination or mandate salpingectomy/vasectomy?
Does climate change represent a legitimate public health crisis?
Ought healthcare be universalized?

The Quantified Self

What is the self being “quantified”? That is who are you? Who/What/Where is “your” “self”? And what in what way(s) can we measure it?
A quantified self is said to have any number of facets – “self-knowledge through numbers”, “life-logging”, “patient-generated health data”, “data as a mirror into our own activities” – all of which require an immense amount of personal data to be collected. Things like your consumption habits, bodily functions, physical activity, medical symptoms, spatial information, physiological statistics, and mental health can all be tracked. Are there any forms of personal data that are particularly revelatory of a “self”?
Are you comfortable with your quantified self existing in places you yourself have little control over?
While life-tracking has been part of the human experience since the beginning – consider, cave painting, journaling, scratching heights into a door frame, etc. – it can now be done with an ever-increasing resolution into the particularities of one’s self: how many calories you (claim to) have eaten; the time you stood up last Tuesday; the last time you saw a friend. Resolution is needed to make use of focus, but is this the new hyperreality we want to prepare ourselves for?
The reality of the wearable situation is much of the data can be a mess and the fidelity of biomedical data is at least questionable. To what extent should physicians act on consumer-grade data?
What would an ideal wearable do?
What would an ideal therable do?
Happenstance and circumstance. It’s an old chestnut at this point that “your ZIP code often says as much or more than your genetic code.” It’s a modern reframing of nature v. nurture. Does a quantifiable self help tease out the effects of those two?
Gamification has been inherent to the quantified self since inception. Humans, as naturally social animals, like to cooperate with, compete against, challenge each other. Making a game out of behaviors makes them fun(ner). But rarely are medical approaches made out to be games, nor are they generally fun. How does this impact the legitimacy of digital health as a tool of healthcare?
I hold that the quantified self is who you see in the mirror of a panopticon. Metaphorically, of course. Thoughts?
Several debates rage:
1. Empowerment v. surveillance and discipline. Patients have gone from minimally informed to active participants in their own health; however, their literal every step can now be tracked. What benefits are worth what risks and what are the worst possible consequences of adverse effects?
2. Improved health v. breakdown of responsibility for public health. Some individuals might see vast improvements to their personal health; however, decollectivizing (public) healthcare can have unintended long-term effects. How should quantified selves be situated within a public health schema?
3. Great (self-)knowledge v. reductionism and non-impartiality. One can now numerically follow the Delphic command to “know thyself”; however, a number of steps and a heartbeat do not a soul make. How do we make biomedical data more revealing of our “selves”?
What does the noble life of the good citizen of the great society look like?

Race

What is race? Does it have a biological meaning we should concern ourselves with?
What do we think about what James Watson thinks about race? And what are we to make of the fact that we have to consider the thoughts of a ninety-year-old white man on the subject?
Kaplan et al. conclude that underrepresented minority faculty members had fewer publications and were less likely to be promoted and retained in academic careers. Why do you think that is?
We can perhaps accept as a given that currently most “races” tend to share similar environments, cultures, rituals, foods, etc. Given a shared set of circumstances/happenstances associated in a biomedically relevant way with “race”, should we study the concept scientifically and investigate potential health consequences?
Could the funding of race-based research be used to justify “racist” beliefs? Could there ever be a legitimate scientific conclusion that could “justify” such racism?
The CDC reports that uterine cancer rates have risen 0.7 parent per year from 1999 to 2015, while deaths from uterine cancer in that same time have risen 1.1 percent per year. What should we make of the fact that black women were twice as likely as other women to be diagnosed with uterine cancer that’s harder to treat and therefore were more likely to die from uterine cancer?
Is the fact that we don’t remember the “noose incidents” described in footnote 4 of Malinowski – “more than 50 to 60 noose-hanging incidents”, incidents that began with “a black student” asking to “sit under a shady tree on campus where the white students usually hung out” only to find “two nooses dangled from the tree” the next day and included “a noose hanging in the Hempstead, Long Island police department”, “across the country […] during fall 2007” – more or less disturbing than the incidents themselves?
Malinowski “proposes that applied bioethics and scientific pragmatism favor recognizing race and ethnicity as a preferred [sic] methodology for population genetics because this approach is most sensitive to personal impact on and
1. self-identification by study subjects,
2. communication with individual members of groups under study,
3. realization of individual consent, recognition and assessment of group impact,
4. the development of group consent in contemporary population genetics, and
5. a means for inclusion for groups historically overlooked in pharmaceutical research and development and subject to health care disparities.”
  Do we agree that these are the things we ought to emphasize in our bioethical approach to race? Are there others?
Civil rights and liberties seem to blossom along contentious racial bounds (at least as it has kinda-sorta in the United States and increasingly elsewhere). Why do you think that is?
Hoberman notes that much of the bioethical literature on race “locate medical racism in the American past or in colonial Africa, while others analyze the medical disorders of fictional characters.” Why is it so hard to talk about the real, true, obvious, and sad facts of racism in the fields of medicine and healthcare?
Analyzing 19,726 patient-visits to an emergency department of “a large, urban-based academic teaching hospital”, Schrader and Lewis found that “African Americans had a significantly longer wait time to a treatment area compared to case-matched Caucasians (10.9min; p<0.001), with much larger differences in wait times noted within certain specific chief complaint categories.” What are we to make of that? That is, how do we fix this situation?
Carrese and Rhodes write that “Historically, the Navajo relationship with dominant society has been marked by conflict. Prominent examples include the military campaign of Kit Carson in 1863, the 300-mile Long Walk and subsequent incarceration of tribal members at the Bosque Redondo in New Mexico from 1864 to 1868, and the livestock reduction program of the 1930s.” Have Americans ever properly atoned for their treatment of Native Americans?
Black lives matter.

Regulation

What is the mandate of our current medical enterprise?
What should the role of the (federal) government be with regards to your personal health?
A classic example of a consequence of the FDA’s slow regulatory process was its delay in allowing beta-blockers to be prescribed in America. In 1965, beta-blockers (specifically, propranolol), were approved for use in the treatment of cardiovascular disease in Europe. The FDA would wait until 1978 to approve the same drugs for the same treatment. To what extent is the FDA culpable in the preventable deaths that occur between 1965-1978? What consequences should there be for regulatory bodies that “fail to do their job”?
What are some differences seen in and between various regulatory environments? For example, how does the United States and European regulatory markets differ? Which do you prefer? Why?
When does the “randomness” necessary for good experimental trials pose sufficient probably harm to a subject as to be dangerous? How should regulatory bodies approach these two necessary but often conflicting factors?
In May 2014 Colorado became the first state to pass “right-to-try laws” – state laws that allow terminally ill patients to try experimental therapies (drugs, devices, biologics, etc.) that have completed Phase 1 testing, but have not been approved by the FDA. As of March 2018, 39 states have enacted such laws. Why do you think there has been such an uptick in this kind of legislation?
Right-to-try laws have been criticized as exploiting the vulnerable and have been heralded as a pinnacle of biomedical liberty. Where do you think the balance lies?
What do you make of the first case of thalidomide embryopathy being a girl born Christmas day of 1956? Are there legitimate omens in this world?
An aside: To what degree are we congenitally predestined? [Re: “Tim’s disability has never prevented him from achieving his goals. His profession as a Genetics Counsellor at McMaster University Medical Centre is close to his heart. Here, he helps families dealing with congenital anomalies and genetic disorders.”]
Why should activities in medical environments be regulated? Who should do such regulated? How should they wield such powers / bear such responsibilities?

The Replicability of Medical Studies

Must (medical) science be replicable?
Pashler and Harris address three (3) general arguments made against the replicability crisis in science:
1. The adoption of a low alpha level (e.g., 5%) puts reasonable bounds on the rate at which errors can enter the published literature, making false-positive effects rare enough to be considered a minor issue;
2. Though direct replication attempts are uncommon, conceptual replication attempts are common—providing an even better test of the validity of a phenomenon; and
3. Errors will eventually be pruned out of the literature if the field would just show a bit of patience.
  Do you believe the mechanisms currently in place are sufficiently self-correcting or should something be done to compensate for possible inadequacy?
As Begley and Ioannidis point out, “The estimates for [scientific[ irreproducibility based on [] empirical observations range from 75% to 90%. These estimates fit remarkably well with estimates of 85% for the proportion of biomedical research that is wasted at-large.” If so much of our time and efforts are wasted, why put any (or much) of our time/effort into these endeavors?
The cost of medical care has ballooned to over $10,000 per person (~3.2 trillion, 16.9% U.S. GDP), the average life expectancy in the United States has declined year-over-year, and medical technologies – rather than decreasing in cost with scale and history – seem to get more expensive by the day (note the 700% increase in an EpiPen over the past decade). All the to ask, is it (at) all worth it?
The rate of positive results in psychological science (as in many biomedical fields) hovers between 90% to 100%, giving the (false) impression that 90% to 100% of the experiments yield such results. Given that most ends in failure, should we publish negative results? Should they get the same space on the page?
Have you noticed that you get invitations to a lot of junk journals? How can we address that scourge?
The Open Science Collaboration, in attempting to replicate the results “100 experimental and correlational studies published in [] psychology journals”, found that “[a] large portion of replications produced weaker evidence for the original findings despite using materials provided by the original authors, review in advance for methodological fidelity, and high statistical power to detect the original effect sizes”. Will there always be the selective bias for “better than average” when publishing that can only be routed out via regression to the mean via replication?
How can we incentivize (and possibly fund) medical/scientific reproduction?
Should taxpayers have to pay to repeat experiments? How many times?

Responsibility

Who are you and to whom are you responsible?
What are your personal responsibilities during these times of COVID-19?
Medical decision-making requires a coordinated effort of a patient, their family, their healthcare provider, their healthcare system, etc. How should we delineate each’s responsibilities? In times of extraordinary burden (e.g., end-of-life-care, pandemics), how/does each’s role change?
“The word “responsibility”,” we are told by Turoldo and Barilan (2008) “appeared for the first time in 1787 in a text attributed to Alexander Hamilton, in reference to the government’s obligation to answer […] questions raised by the parliament.” To whom are the governments of the world responsible? How are they held to account?
When a “leader” of a nation was asked “do you take responsibility?” for a lag in testing for COVID-19 of that nation’s residents, they answered, “No, I don’t take responsibility at all because we were given a set of circumstances – and we were given rules, regulations, specifications – from a different time.” To what extent does historical happenstance and circumstance alleviate/compel the burdens of responsibility? Put differently, how ought we bear “the sins of the father”?
Who is to blame for the empire (of liberty!) erected over the bodies of Native Americans and upon the backs of enslaved blacks? How is past injustice atoned?
Today marks the 26th anniversary of the Rwandan genocide in which over 800,000 Tutsis and those that tried to protect them were murdered, mostly with machetes. Documents reveal, 16 days before the attacks the United States government knew of an imminent “genocide” to be committed but did not intervene. Does the U.S. bear any culpability for failing to act on its intelligence? More broadly, do the more powerful (nations on earth) have a responsibility to help those less powerful?
A general gives an order, a soldier pulls a trigger, a person dies. Who is responsible?
Does culpability exist in the absence of free will? Are the coerced culpable?
Whence comes the responsibility of parent(s) to child(ren)? When does it begin? When/Does it end?
Does our species have a duty to reproduce?
Is the earth humanity’s dominion? Must human beings be stewards of the realms they occupy, of the earth? Do other animals have obligation(s) to their environment?
Are our cities designed responsibly?
Many contracts contain a “force majeure” clause in which both parties are freed from liability/obligation under extraordinary circumstances (e.g., insurrection, epidemic, acts of the gods, etc.). Do you believe that our times have triggered these clauses?
On the eve of the American Civil War, minister Theodore Parker claimed “I do not pretend to understand the moral universe, the arc is a long one, my eye reaches but little ways. I cannot calculate the curve and complete the figure by the experience of sight; I can divine it by conscience. But from what I see I am sure it bends towards justice.” What bends this moral universe? How/Can it be made to bend faster?
When history is written, will it be said our times were just?

Self

Who are you? Who/What/Where is “your” “self”?
Which of the Borges wrote “Borges and I”?
What does it feel like to “be a self”?
Per Blanke and Metzinger (2008), “what are the minimally sufficient conditions for the appearance of a phenomenal self” or put differently, what is the bare minimum necessary for “the fundamental conscious experience of being someone”?
Blanke and Metzinger posit three defining features necessary for the conscious experience of being a self: (1) “a globalized form of identification with [a] body as a whole”; (2) “spatiotemporal self-location” and (3) “a first-person perspective”. Do you agree that these three elements are the minimal requirements for a sense of self?
(In what ways) Can one be wrong about one’s self?
(In what ways) Can one distinguish between self and others?
Caldwell (2010) identifies “five ethical duties owed to the self which enable individuals to deal more productively with themselves, with others, and with the world around them”. Namely,
1. “understand how vulnerable we can be when we are unwilling or unable to address incongruity in our lives”,
2. “acknowledge the underlying internal factors that cause us to deny reality”,
3. “thoughtfully examine our core beliefs and [] reflect upon those beliefs on a regular basis”,
4. “evaluate the stresses that cause us to become vulnerable to self-deception, acknowledge those stress factors, and seek to mitigate the potentially destructive influences of stress in our lives”, and
5. “periodically examine whether our conduct is consistent with the beliefs we proclaim and [] confront incongruities between our beliefs and our behaviors”.
  Do you agree that these circumscribe ethical duties owed to one’s “self”?Do “you” “own” “your” “self”?
Should the individual self be the basis of healthcare?
Are there unethical ways/means by which you can modify your self?
Should there be more or less “selves” in the world? Is there an optimal amount of selfhood for the planet? The universe?

Sex

Who are you and what is one thing you think is ethically relevant to matters of sex?
What is consent? How can be it be given and taken?
Do sexual relationships confer particular responsibilities between individuals? How can breaches of these duties be adjudicated?
Not that I’m trying to tell anyone their business or prescribe policy, but at about what age on average should individuals have sex with one another?
Is there too much, too little, or just about the right amount of pornography in the world?
Should we encourage the use of “sex robots“?
What sorts of technology should be used/advanced/developed for sex? Put differently, what is a proper role of technology in sexual relationships?
What is the strongest possible argument against contraception?
What should be done about those who sexually abuse children?
Can there be a just/ethical/fair/decent form of prostitution?
Why are non-heterosexual relationships (e.g., homosexual relationships, polyamorous pairings, etc.) viewed by some in society with derision/hatred? Put more pointedly, what motivates some to commit hate crimes on the basis of sex, be it of identification, orientation, or association?
Why are power imbalances commonly associated with sexual misconduct and what can be done to mitigate their affects?
Why does there persist sex-based differences in physician compensation and institutional support for junior biomedical researchers?
What is a transgender mouse?
When/Can a child elect to confirm their gender if such a surgery is against the expressed and deeply held beliefs of their parents?
When/Will the sexes be equal?

Solitude

Who are you and how are you maintaining your social distance these days?
Is the individual human being the proper “unit” of (bio)ethics?
Elizabeth Cady Stanton (1892) posits that “[t]he solitude of the king on his throne and the prisoner in his cell differs in character and degree but it is solitude nevertheless.” What is shared between these two in their lonesomeness? Do we share it here today?
Leigh-Hunt et al. (2017) conclude “policy makers and health and local government commissioners should consider social isolation and loneliness as important upstream factors impacting on morbidity and mortality due to their effects on cardiovascular and mental health; their possible influence on behavioural change should also be taken note of.” With the massive upsurge in social isolation due to many state imposed “stay at home” orders, what sort of health consequences do you think will follow therefrom? How should such consequences be mitigated/dealt with?
Are people more or less solitary now than they were a month ago? A year ago? A decade ago? A hundred years ago? A millennium ago? At the dawn of civilization? At the dawn of humankind?
Noting that “[p]eople have biological needs for attachment, affiliation, and sociality, yet they spend time in solitude”, Long and Averill (2003) ask “[h]ow do we account for this apparent need for solitude, and what do we know about the benefits of solitude for which people are searching?”
Are you an introvert or an extrovert and how do you know?
Long and Averill cite studies from 1982 indicating “that adult humans spend approximately 29% of their waking time alone”. With the advent of the “flattened earth” – one interconnected by commerce and communication – do you believe adults are spending more or less of their waking time alone? As a corollary, do you believe adults have more or less “waking time” now than they did in 1982?
As intimated by Callahan (2003), the field of bioethics often tries to find the balance between a patient’s autonomy – an individual’s choice for their self – and the medical enterprises paternalism – decision stemming from the field’s collective expertise. With this tension in mind, Callahan asks “[i]f , for instance, we are interested in a fair allocation of future resources, what kind of a research agenda for what kind of medical progress would most promote it?” And, perhaps more to the point, how would it best be decided?
Are we born alone? Do we die alone? Where does our commune with others begin and end?
Are we any closer than we once were? Are we any farther?
Who are you when you are alone? Is it your “truer” self?

The Theory of Mind

How do you determine the presence of minds in others?
How comfortable are you with the notion that there exist people fully as capable of thoughtful reflection on the world as you (perhaps some even better) and yet come to completely different conclusions? How do you negotiate disagreement with others?
What is it like to be a bat?
If you could be transported instantaneously to a world where other people’s thoughts in your local vicinity were revealed to you but yours were as also revealed to them, would you want to go there? Do you think those who were born into such a world would wish to come to ours where thoughts are kept quietly within skulls?
Can one lie in their sleep?
Why do you think people believe “weird” things? What “weird” things do you believe?
Why do you think so much early/foundational research on the Theory of Mind was spent on “false belief” studies?
For human beings does “life” “end” with the end of “the mind”. Does it begin there as well? Is this the same criteria we ought to apply to those things we believe have minds?
Is there a baseline level of respect owe to the integrity for things which do (not) have minds?
“Think about it,” David Foster Wallace bids us, “there is no experience you have had that you are not the absolute center of. The world as you experience it is there in front of YOU or behind YOU, to the left or right of YOU, on YOUR TV or YOUR monitor. And so on. Other people’s thoughts and feelings have to be communicated to you somehow, but your own are so immediate, urgent, real.” Is this the “default setting, hard-wired into our boards at birth” for all mind-having-beings or is it the conditioned response of a single subset of a single species of primate?
Do we mind-having creatures tend to over-attribute or under-attribute mental states to others? Why/Is it important to understand (the mental states of) others?
Do human beings of today have the same “minds” as human beings of way back when? What about the minds of human beings of the way off when?
When you “change your mind”, what happens?
How often should we change our mind? When/Should we change it more/less?
Will we make it to the next…?

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?

Virtual reality

Who are You™ and who are you virtually?
Is the internet real?
With the app-ification of the world, healthcare has seen more than its fair share of internet-delivered health interventions crop up. From mental health treatment (for anxiety, depression, post traumatic stress, OCD) to addiction mitigation (for tobacco, alcohol, cannabis) to physical health improvement (diet, physical activity, hypertension), hundreds of apps have been developed to cure what ails us. On the whole, are these healthcare apps helpful, harmful, or neutral? Put more pointedly, do they represent “the shape of things to come” in medicine or is this the same old snake oil in new bottles?
Is this discussion a “virtual” discussion? Is it a real one? (Is it “virtually real”?)
Iserson (2018) posits that “use of VR in medical education should increase patient safety and societal confidence in clinicians’ procedural skills, because inexperienced students, residents and practicing physicians, nurse practitioners, and physician assistants will no longer need to use living and newly dead patients or animals as teaching fodder.” Do you agree with the general “gist” of that statement? Would you trust a newly graduated medical student who was taught primarily in “virtual” settings? What benefits are there to a medical education delivered “virtually” as opposed to one given in “reality”?
In what ways can ethics be taught through virtual/extended/augmented reality?
Is the reality of health care extending itself too far? No longer is a patient confined to the bedside for monitoring, often a physician will confirm a prediction first made by an algorithm, surgery is performed by robots: the human element slips away from the human science of medicine. Will these trends in the long run make for “objectively” better medical care?
Has the internet made the world healthier?
Physicians, it would seem, are already performing their work virtually. According to a 2013 study, a physician on average spends approximately 28% of their time directly treating patients, 12% of their time reviewing test results and records, 13% of their time in discussion with colleagues, and 44% of their time on data entry. The alarming figure of 4,000 mouse clicks a day entering and reviewing data was found. Physicians regularly speak of being overworked and interacting with patients less. Yet, more and more of their time is demanded in service of keeping records in lieu of treating patients. What can be done to mitigate physicians from becoming glorified data entrants? (Conversely, and in reference to question 7, what can be done to prevent data models from becoming physicians?)
I understand that “killing” something playing a video game is not the same thing as “killing” something in reality. Yet, is there not some relation between the two? What does a consistent and readily available form of engaging entertainment involving mass violence do to people?
Are you “accurately” represented by your social media presence(s)?
Are “you” being tracked accurately by all those algorithms that find us? Could there exist a meta-bias for the types of algorithms you attract? (For example, do those with gambling problems preferentially face being presented with advertisements for sports betting?) And if so, what sort of “anti bias” training would we have to ensure these algorithms go through?
Can one be addicted to Internet?

Zombies

Would you ever eat a human being?
There is generally something we might call “humanness” – a set of behaviors, mammalian situationality, biological facts, etc. – that approximately every human has. How much of this “humanness” is to be found in “zombies”? What about those in comas? Under sedation?
The boring definition question: what are “zombies”?
When are quarantines ethically justifiable? Does the precision brought to bear by modern day mathematical biology allow us to be more or less ethical? Put somewhat orthogonally: is it better to include too many or too few in a quarantine?
What are one’s rights in a pandemic?
Who are we when we are sick?
Is the patient that comes in for treatment the same as the one who leaves after being treated? What if major organs were replaced? What about faces, hands, brains? How much can a person withstand medical treatment while remaining the same? If/When does that patient become significantly different?
Are you satisfied that a government such as the one that has jurisdiction over you is capable of dealing with something equivalent to a zombie outbreak?
Who do zombies think they are? Does it matter? Does it matter “what it’s like to be a bat”?
Monsters are often those beings which patrol the boundaries between the acceptable and the unacceptable, the normal and the grotesque, the healthy and the sick. Vampires, demons, werewolves, ghosts, they all comment upon some of life-itself’s very borders. What boundaries do zombies patrol that are biomedically relevant?
Right now, in a few labs around the world, the most dangerous viruses/bacteria/organisms are being studied by a few individuals. What sort of screening should there be to make sure the “right” people are studying these issues? If something were to go wrong in one of these labs, do think the people involved are sufficiently prepared?
How much would you have to be paid to let a random person/animal bite you?
What do you do in a zombie outbreak?
Would you want to be as zombie?
Favorite zombie movie?