Not the present, but maybe the future?: a look at female sterilization in Uzbekistan

A recent article on the BBC website said that Uzbekistan doctors have been sterilizing female patients without their knowledge as part of a secret government initiative. Doctors were given quotas to sterilize as many as 8 women per month, a practice that is simple to implement because of the abundance of births by Cesarean section. Some doctors have taken the tact of manipulating poor patients into sterilizations, saying that it fewer children will benefit her health, but some cut out the middle man and perform the operation in secret during the cesarean section. The idea behind the program was to decrease infant mortality rates and control the size of the population, as many of the problems of developing countries are severely hampered by very high birth rates. This secret program is clearly a fundamental violation of human rights, and the secrecy surrounding it seems unnecessary, but the rationale behind such a directive raises an interesting question. Is an aggressive population control program a legitimate next step for developing countries? The benefits are clear: with a less explosive birth rate, public services and infrastructural problems become more affordable to fix. In addition, fewer children per family would lead to better overall care, and thus fewer health problems for both the mother and her children. There were human rights violations, but with revisions that prevented the secrecy and obligatory nature of the Uzbekistani doctor, this could be a legitimate way to improve the average quality of life of your country’s citizens.

http://www.bbc.co.uk/news/magazine-17612550

150 Half-Siblings with No Father – A Look at the Limits of Sperm Donation

Cynthia Daily has only one son, but that son has 149 half-siblings.

Ms. Daily, a social worker from Washington, conceived via artificial insemination. Using the identification number on the sperm sample she received and a website called the Donor Sibling Registry, she was able to track down 149 other children who had been conceived from the same sperm donor. “It’s wild when we see them all together — they all look alike,” she says.

The United States does not limit the number of children that may be born from a single donor. The American Society for Reproductive Medicine suggests that one donor be have no more than 25 children per 800,000 people in a given area, but sperm banks are under no obligation to follow this recommendation. Issues of donor restriction are further complicated by the fact that many sperm banks distribute over large areas, often nationwide. Additionally, sperm donors may give to many different banks, often under conditions of anonymity.

There are significant reasons to be concerned about overdonation. Especially in small communities, there is a very real chance that two children of the same donor could meet and enter into a potentially incestuous relationship. Unsuspected incest aside, there is also the risk of propagating otherwise rare genetic defects.

Other countries, including Britain and France, limit the number of children that can be conceived from one donor’s sperm. France even does this while still preserving the donor’s right to anonymity, a potentially thorny issue. There is no good reason that a similar limit could not work in the United States.

Because of the risks involved to the children produced from artificial insemination, the United States should limit the number of children that can be produced from any one donor’s sperm.

Sources:

Mroz, Jaqueline. “One Sperm Donor, 150 Sons and Daughters.” The New York Times

Frith, Lucy. “Gamete Donation and Anonymity.” Oxford Journals

It's what the crowd wants: are current publishing practices unethical?

About a month ago, Stuart Rennie wrote a blog entitled, “Research Ethics as a Sideshow,” which can be found http://globalbioethics.blogspot.com/. In the blog, Rennie reports on a disturbing, growing trend in the realm of research publication. Apparently, it is becoming commonplace for journals to publish ethically questionable studies, as long as they are interesting, and alongside them publish multiple editorials which point out the subtle to glaring violations of ethical conduct that can be found in the studies. He gives the example of a recent tuberculosis treatment study which was published in the International Journal of Tuberculosis and Lung Disease despite not having any method of obtaining informed consent from the participants of the study. It was published alongside two editorials that rejected the reasons for skipping informed consent given by the researchers. Rennie addresses the possibilities of simply not publishing the articles, or retracting them after they have been published. However, he concludes that it is unlikely either will occur.

            How can we allow this to continue? The whole point of ethics codes is to protect people from being exploited and abused in experiments and trials. This practice of publishing unethical goes against the concept entirely. To be fair, each of the studies that was published had already been approved by an ethics review board. However, the multiple steps in the research and publication process should serve as checks and balances for this sort of thing, otherwise there is no point to peer review. To me it seems like a chain reaction is starting, one that should not happen. If publishers become accustomed to accepting unethical trials as long as they add on editorials that say as much, then IRBs may become more willing to approve questionable trials, if for no other reason than the existence of many precedents. We cannot stand by and watch all of our current ethical safeguards fall apart. Journals should not be allowed to publish trials that are obviously ethically unsound, regardless of how “entertaining” they may be.

http://globalbioethics.blogspot.com/

Saving the world, one genome at a time.

    The solution to global warming and environmental issues is not just increased environmental awareness. No, the real solution is genetically engineering children to help the environment.

Wait, what?

    Yes, according to a recently published paper, NYU and Oxford Bioethicists Matthew Liao, Anders Sandberg and Rebecca Roache. The paper proposes human engineering as a potential solution to climate change since existing solutions are ineffective and alternative solutions, such as geoengineering, are incredibly risky.

    In the modern world, most solutions to climate change fall under one of three categories: market solutions, behavioral solutions, or geoengineering. Social solutions involve increasing social awareness of efforts such as recycling and reducing driving. Market solutions rely on regulation and economic factors – such as carbon taxation – to reduce effects on the environment. Geoengineering generally involves much larger solutions ranging from reforestation to space-based mirrors to seeding the ocean to increase carbon absorption. Human engineering would involve biomedical modification of humans to mitigate climate change.

    The paper suggests a few potential benefits for human engineering. The first is to induce meat intolerance in humans. The reason for this is that cows and grazing animals appear to have significant environmental effects, so reducing meat consumption could reduce their numbers and thus reduce these effects. Their second suggestion is simply to make humans smaller. This would reduce the amount of food we consume and also allow for a similar reduction in food consumption and its accompanying environmental benefits. Their last suggestion is to lower birth-rates through cognitive enhancement (genetic, pharmaceutical, and education). While this may not seem to be the most obvious solution, they suggest that such enhancements would increase altruism and empathy, thus making a person more likely to care for the environment. One last proposal is a child-per-family quota based on size rather than on numbers. Such a policy, they argue, would maintain personal freedom by allowing parents to make decisions on how they wanted their children enhanced (Would you like two small children or one basketball player)?

     So, perhaps these are not the most natural solutions to climate change, but they do raise some interesting issues. There are countless arguments for and against enhancement in general, and this proposal probably falls into the bounds of enhancement and genetic engineering for the good of society versus individuals. Additionally, the idea of human engineering may be more realistic than extreme – and potentially extremely dangerous – proposals in geoengineering. So while it may seem absurd now, I think that it is an idea that deserves more thought. Human engineering may seem crazy and unlikely, but perhaps it may turn out to not be so bizarre and unrealistic in the long run.

http://www.bioedge.org/index.php/bioethics/bioethics_article/9986

http://www.smatthewliao.com/wp-content/uploads/2012/02/HEandClimateChange.pdf

Big Brother: Can the fMRI Undermine Privacy?

Researchers at Dartmouth recently conducted a study in which they were able to predict future behavior of the participants based on fMRI scans of the brain. Yes, that’s right; it is now possible to make a pretty good guess as to how disposed an individual is to certain types of behavior.

I will summarize briefly. The researchers showed each subject a series of images while measuring activity in the pleasure center of the participant’s brain. These images — varying from the sexually arousing to the culinarily intriguing — and the degree of increased brain activity associated with each image could accurately predict the behavior of the participant in the future. For example, if a participant showed a particularly acute reaction to a picture of a cake, the researchers hypothesized that the individual would tend to gain weight. After conducting a survey of all participants some months after the experiment (and weighing them before and after), these hypotheses were deemed statistically valid.

So, while this experiment did not attempt to predict thoughts and immediate actions, it did demonstrate the ability to “mind-read” — to accurately gauge an individual’s mental proclivities. Consider what might happen if such fMRI scans became routine in law enforcement: just as we are finger-printed and blood-typed now after a run-in with the police, perhaps in the future we might be brain-scanned for future capacity for criminal behavior.

The problem here is that, while we are guaranteed the right not to self-incriminate, brain-scans don’t lie. If subjected to such a scan, the law could force a person’s psyche into the open — not in any great detail, but enough to be able to judge future behavior. And this is bad; bad for the person in question, and bad for society as a whole. The reason is that, despite the best intentions of the law — protecting the general welfare, for instance — when the law can “steal” information and make significant decisions based on that information (decisions like whether or not to release a minor criminal), that threatens the privacy of everyone. What is to stop the government from extending such a program to try and identify potential criminals before they commit a crime. Sound familiar? 

That’s pretty much the same function as the Thought Police in 1984, and I think that’s where our society — if we were to use brain scans in law enforcement — might end up. If we agree to compromise the individual’s privacy for the sake of general safety, we give up what makes our individual lives worth living; we sacrifice the individual to the aggregate. And while it might not be for the same reasons or have the same manipulative character of the government in 1984, the effects on society would be the same: demoralization and dehumanization, turning the spontaneous and free into the homogenous and mechanical. It’s all well and good to study the brain and learn how it works, but when we can read each other’s minds — and the research cited is a far cry from that — we should be worried.

(1) http://www.popsci.com/technology/article/2012-04/brain-scans-can-reliably-predict-your-future-insatiable-appetites

Extra Lettuce Please, and Hold the Capitalism.

“When you can buy 2000 calories for under $10 at your neighborhood McDonalds, but have trouble getting your hands on an apple, it’s difficult to justify trying to shame anyone into skinniness.” -Dhruv Khullar of the Yale School of Medicine and Harvard Kennedy School. 

           

            Khullar is right. While everyone is responsibility for his or her own health, when people who are willing to eat healthily struggle to do so because of their external environment, it is not the individual who should feel shamed, but the environment.

            Nearly three quarters of Americans are overweight. Statistics about obesity are thrown around left and right, but take a second to appreciate this figure. These figures are off the charts when compared to the rates of fifty years ago, and the trends show no signs of the increase leveling off. So are Americans just getting more undisciplined? It’s unlikely. What’s more likely it that our food chain, from the seed to the grocery shelf store, has been poisoned by the free market. Food companies are to blame: they spend $2 billion dollars a year advertising food that has been stripped of any sort of nutrition, they impose farmers to extract as much of their product as they can, disregarding the consequences of over producing, and they sent their lobbyists to Washington to ensure that their nutrition-depleted food, if you can even call it that, gets to stores shelves at a lower price than fairly  and organically grown real foods. This isn’t news to many. So what’s the solution?

            Let’s get the free market out of the food industry. It’s radical, it’s huge, and with the two so deeply intertwined and so many people making huge profits, it’s much easier said than done, but why not? The US is currently joining the rest of the developing world in creating a universal health care system. The idea behind government run health care is that every human being should have a right to health care. This is a right that countries with national health care systems deem important enough to protect by keeping in public hands and out of hands of profit-driven corporations. I think these countries have the right idea.

            If a country values its citizens’ health enough to ensure access to medical treatment through government run health care, why would it be so bizarre for a country to protect its citizens’ health by ensuring  had access to healthy food by creating government run food companies. That way, governments wouldn’t only play a role in treating disease, but preventing disease. The goal of these companies would be to offer nutritious food untainted by cost-cutting measures associated with private and profit-driven companies. Of course, it’s unlikely a government could meet all the food demands of a population, and so there would still be room for the private sector – so people wouldn’t be deprived of choice, but they would have more healthy choices and less unhealthy ones.

            It’s a big idea, too big to contain within a small blog post, but an idea worth thinking about – Some food for thought.

http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=5796&blogid=140

What Would You Do?

Yesterday, one of my friends mentioned in passing that she and her twin were “test tube” babies—nothing unusual in this day and age (though in vitro fertilization faces harsher restrictions in Europe). As an afterthought, she told me that her mom was once interviewed on CNN. Why? She was one of few women who remained undecided as to what to do with her fertilized eggs that were not implanted. These eggs are normally discarded or, very recently, given to stem cell research. But her mom wasn’t comfortable with either option, opting instead to have them stored in a lab until she is able to make a decision.

The story highlighted the difference between making policy decisions on a macro, impersonal level and making personal decisions on a micro level. Yes, I believe that embryos that comprise of only a few cells might as well be used in stem cell research. But the idea that you can hold something that shares a significant amount of your DNA, and that has the potential to develop into another whole person makes you stop to think. Especially because two of those eggs did eventually develop into two bundles of joy, I found myself surprisingly sympathetic to my friend’s mom’s decision. Even though she is progressive, in favor of abortion and stem cell research, she found it hard to just discard such a tiny part of her, not because she adhered to the conviction that life begins at conception, but because, well, wouldn’t you?

This gut reaction often underlies many objections to bioengineering and medical practices in general. The mother’s support of embryonic stem cell research but reluctance to forfeit her own eggs to the cause may seem irreconcilable, but if we are careful to distinguish macro polices and micro decisions, the issue becomes clearer. Objectively, life is not (yet) legally defined as beginning with conception, and so it is acceptable to donate un-developed fertilized eggs to research. There is no ethical problem with a legal policy that allows such donations. However, there would be something problematic about a legal policy that forced such donations. This is not currently the case, which is why my friend’s mom is free to store the eggs until she is ready to let them go (or make some other decision). This is where subjective gut reactions can come into play—if you, as an individual, are uncomfortable with a certain practice, there is no reason for you to partake in it. For every woman out there who doesn’t want to discard her potential babies, there is probably another who is perfectly happy donating her unused zygotic cells to science. An ethical law in this case is one that ensures that both women are allowed to make their own decision.

More about the IVF controversy:

http://www.cbsnews.com/8301-504763_162-57413777-10391704/fertility-treatment-bans-in-europe-raise-controversy-questions/

http://www.cbsnews.com/8301-504763_162-57357715-10391704/ivf-study-shows-one-or-two-embryos-is-enough/

http://topics.cnn.com/topics/in_vitro_fertilization