Up@dawn 2.0

Friday, November 3, 2017

Interview on suicide and euthanasia

Students occasionally request an interview, to fulfill a class assignment. Here are the questions submitted in a recent one:

1. The demographics and privilege of assisted suicide and euthanasia?
2. What is your opinion on assisted suicide and euthanasia?
3. Does assisted suicide and euthanasia affect the poor and elderly in a negative way?
4. Do you know the difference between the two?
5. Should people be forced to stay alive?
6. Should physicians play a roll?


And my initial responses:

1. Not sure what the question is here. I've not studied "the demographics and privilege of assisted suicide and euthanasia," sounds like something to ask a social scientist. But the word privilege suggests a concern that this is a practice not equally accessible to different socio-economic groups because only the relatively well-off can afford the time and expense of identifying and working with a willing medical practitioner. That would indeed be an ethical concern, an issue of inequity and injustice.

2. I strongly discourage suicide, but euthanasia in the case of someone experiencing severe chronic pain with no prospect of recovery is another matter. People of sound mind should not be denied the opportunity to experience a "good death," under such circumstances.

Albert Camus said the ultimate philosophical question is whether life is worth living, despite its challenges and absurdities. I agree, and I also agree with him that life is worth living... until (as in the aforementioned sort of case) it isn't.

I agree as well with Jennifer Michael Hecht:
“None of us can truly know what we mean to other people, and none of us can know what our future self will experience. History and philosophy ask us to remember these mysteries, to look around at friends, family, humanity, at the surprises life brings — the endless possibilities that living offers — and to persevere. There is love and insight to live for, bright moments to cherish, and even the possibility of happiness, and the chance of helping someone else through his or her own troubles. Know that people, through history and today, understand how much courage it takes to stay. Bear witness to the night side of being human and the bravery it entails, and wait for the sun. If we meditate on the record of human wisdom we may find there reason enough to persist and find our way back to happiness. The first step is to consider the arguments and evidence and choose to stay. After that, anything may happen. First, choose to stay.” 
― Jennifer Michael Hecht, Stay: A History of Suicide and the Philosophies Against It

 3. Depends on the circumstances. But since the poor and elderly are generally more likely to suffer ill health and, under our inadequate health care system are also less likely to have adequate access to health care resources and alternative treatment options, they may be more likely to turn to suicide or euthanasia out of desperation - in that case, they would not experience a "good death."

4. Euthanasia is the voluntary ending of a life (not necessarily one's own) in order to end gratuitous pain and suffering, perhaps to minimize "harm" (as in the Hippocratic Oath's injunction to "do no harm"). Suicide is the taking of one's own life, often impulsively and under duress, and thus arguably not entirely "voluntarily"...  Suicide may be precipitated by an emotional crisis, euthanasia is usually a response to physiological and medical illness. The moral difference between the two must always depend on the specific circumstances and context in which suicide/euthanasia are contemplated or enacted.

5. No. They should be encouraged to appreciate the gift of life, even a life surrounded by pain. But in the end, autonomous individuals possessed of their faculties and in a sound state of mind must be permitted their freedom.

6. Physicians should do whatever they must, to fulfill their Hippocratic Oath and alleviate pain and suffering. If they don't play a role, less qualified people - legislators, for instance - will.







Monday, October 30, 2017

What happens when you identify too much with a patient?

The Rules of the Doctor’s Heart
By SIDDHARTHA MUKHERJEE

Every medical case, to paraphrase the writer Viet Thanh Nguyen, is lived twice: once in the wards and once in memory. Some of what follows is still intensely vivid, as if it were shot in high-def video. Other parts are blurry — in part because I must have subconsciously deleted or altered the memories. I was 33 then and a senior resident at a hospital in Boston. I had been assigned to the Cardiac Care Unit, a quasi I.C.U. where some of the most acutely ill patients were hospitalized.

In mid-September — it had been a moody, rain-drenched month, as I recall — I admitted a 52-year-old man to the unit. I’ll call him by the first letter of his given name, M. As medical interns, we were forewarned by the senior residents not to identify too closely with patients. “A weeping doctor is a useless doctor,” a senior once told me. Or: “You cannot do an eye exam if your own eyes are clouded.” But M.’s case made it particularly hard. He was a doctor and a scientist — an M.D., a Ph.D., like me. He must have been about 15 years ahead of me in his schooling; I could imagine him returning to my class in med school to teach us “Patient-Doctor,” in which students are taught how to deal with real-life patients. He’d trained as a medical resident and then as a fellow in cardiology at another hospital across town. He was now an assistant professor — it seemed like such a victory to have that title — and ran a small laboratory. I knew a student who once worked with him. Six degrees of separation? There was barely one.

Earlier that year, in March or April, M. became short of breath in the middle of his run. (Was his running route the same as mine? Across the Longfellow Bridge at Mass General, looping around the river and then back again by Storrow Drive?) His legs turned cold and blue. He had dizzy spells and lost words in midsentence. He saw a cardiologist — presumably one of his own colleagues — who diagnosed heart failure. A series of scans must have revealed a sluggish heart. In place of the regular, intentional motion — jellyfish pulsing in a tank — there was an eerie wobbliness, just jelly. A biopsy was performed, and the diagnosis was amyloidosis, a mysterious condition in which misfolded proteins begin to be deposited in the organs of the body. Sometimes the proteins come from cancer cells; sometimes from poorly understood sources. The deposits choke the organs: heart, liver, blood vessels, kidneys. “And then, bit by bit by bit, I was all pro-te-in,” he said dryly, paraphrasing the Tin Man in Oz. We laughed.

M. needed a new heart. I’m writing this casually, as if you go to the used-heart salesman on Long Island and pick one up on a three-year lease. Hearts are notoriously hard to find; someone has to die for you to get one. About 3,000 hearts are available in the United States every year. Many come from youngish men and women who’ve had accidents or drowned, leaving them in a peculiar limbo — brain-dead but heart-alive. But there are never enough: At any given moment, about 4,000 patients are waiting for a heart. Many of them will never find one... (continues)

Tuesday, October 24, 2017

Bioethics: the Basics

The text we begin with. NOTE: the new 2d edition (978-0415790314) has just been released.


What is Bioethics?

Is health care just a business like any other, or should health care professionals have a higher standard of ethics? Should we invent a pill that enables people to live for hundreds of years? Have parents the right to use science to design the kind of children they want? Does everyone have an equal right to health care, whatever it costs? 

Monday, October 2, 2017

"Can I Spread the Word About an Unvaccinated Child?"

The Ethicist (nyt)
I’m pregnant with my first child, and concern for my unborn baby has prompted me to ask my friends if their children are vaccinated. One close friend, Y, has two young (vaccinated) children, and lives near another friend, X. Both Y and I have suspected for some time that X chose not to vaccinate her child, and we have been trying to work up the courage to ask her. With the new pregnancy as an excuse, the task fell to me.
It turns out that X has indeed chosen not to vaccinate. When telling me this, she also asked me to keep her answer private. While her choice is not one I would make, I am perhaps even more upset by her request that I conceal the information.
Y and X’s children play together, and we have regular gatherings with many young children present. I feel that parents have a right to know whether they are exposing their children to unvaccinated children, especially with anti-vaxxers on the rise and herd immunity declining. My frustration is compounded by the fact that X’s child attends a public school and as far as I know has no valid grounds (for instance, an immuno-compromised child) for exemption.
I respect the privacy of others; however I don’t like being asked to be complicit in placing others at risk. I feel a responsibility to other parents of young children, especially parents of new babies who are not yet vaccinated. Do I respect X’s request to keep the information secret? Name Withheld
Having children can be scary. Parental love, like all love, makes you vulnerable, because you can be profoundly threatened by harm to someone else. Unlike most other loves, however, parental love also involves overwhelming responsibility. Your young children are enormously dependent on you. In light of these intersecting conditions, it’s not surprising that parents can be panicked by the possibility that they will fail as caretakers. Such panic has been promoted by activists who spread untruths about the dangers of vaccines, especially the vaccine that protects against measles. (The anti-vaccination movement was fueled by a discredited study from 1998 that linked the measles vaccine to autism.) I refer to untruths and not lies, because the anti-vaccination movement is no doubt largely sincere. Sincerity, though, doesn’t make them true.
As you make clear, two benefits come from vaccination. First, a vaccinated child is less likely to suffer serious harm from exposure to the relevant pathogen. Second, if enough children are inoculated, everyone’s risk is reduced by the “herd immunity” you mention. That means that you can help protect all the kids in your community, including those who (because they are immune-compromised or allergic to the vaccine) can’t be vaccinated.
When vaccination rates are high enough, the disease disappears from the population until it’s reintroduced from outside. The level where this happens is called the “herd-immunity threshold”; and it varies depending on the efficacy of the vaccine and the contagiousness of the pathogen. Unfortunately the immunity threshold for measles is very high, around 92 to 94 percent. Fortunately, in most of the United States, we’re at that level. In 2000, the disease had effectively been eliminated here. But there are 10 million cases a year outside the United States, and travelers (especially unvaccinated ones) bring it back. The anti-vaccination movement, meanwhile, appears to have depressed vaccination rates in certain communities, as happened recently in Minnesota. So the virus reappears, and outbreaks can happen.
Given the combination of vulnerability and responsibility I mentioned, one reason parents avoid vaccinations is some version of this thought: “If I decide to vaccinate my child and something bad happens, my child will have suffered at my hands.” But if that’s a sensible thought, so should this one be: “If I decide not to vaccinate my child and something bad happens, my child will have suffered at my hands.” What’s important is whether the likely results of vaccination are better than the alternative. And the answer, once exposure to measles is a possibility, is yes. Even if that weren’t true, there would be a second reason for being vaccinated: If we all did it, we would get herd immunity.
At that point, someone who thought that there were even small risks associated with vaccination might say, “Hey, I’m going to avoid the risks of vaccination for my kids, because the disease is very unlikely to reach them.” But that’s true only because other people are vaccinating. So someone who thinks this way is a free rider, like the person who figures she doesn’t need to pay the bus fare because everybody else does. One of the anti-vaxxers’ offenses is refusing to undertake their fair share of the burdens for something from which they benefit.
And just to be clear about how great those benefits are: In a typical year before the measles vaccine was available in the United States, the virus infected millions, sent tens of thousands to the hospital, gave encephalitis to at least a thousand and killed hundreds. Given that measles is a highly contagious disease that can be fatal and that the risks of vaccination are minuscule, not vaccinating your children is wrong. X has done wrong, too, if she’s lying to her kid’s school — public schools require vaccination unless there’s a recognized medical reason not to or the parents have a sincere religious objection. (Can’t imagine a religious objection? Many Christian Scientists believe that health problems should be dealt with by prayer, not medicine, and so some reject vaccination, even though the founder, Mary Baker Eddy, said that a Christian Scientist should be vaccinated “if the law demand” and then “appeal to gospel to save him from bad physical results.”)
To be sure, the direct risk of infection remains very small, and the main harm done by avoiding vaccination would occur only if more people did it. But it isn’t crazy to worry about the danger of contact with unvaccinated children; parents are entitled to know the status of the kids that their kids play with. Something like 3 percent of vaccinated people can still get measles (though it’s very likely to be less serious than in the unvaccinated). And children aren’t normally vaccinated until they are 1, so older children with infant siblings need to be kept away from the virus, too.
What about respecting X’s request that you keep her answer private? There’s an important norm here, but it doesn’t necessarily apply to information that other people are entitled to know. Besides, you and Y have conferred in your effort to find out the truth; how are you supposed to respond when Y asks you what you learned?
Tell X that she ought to inform Y about the situation and also tell the school the truth. Letting her do it shows that you acknowledge her request not to pass the information on yourself. Give her a few days. If she continues to leave Y in the dark, though, you can tell Y what you’ve learned. As far as the school goes, there may be no easy alternative to informing its officials directly. Why not tell X that you’ll be checking on her? Because that would turn a request to tell the truth into a threat.
But some vigilance is warranted, especially now that anti-vaccination “science” has a proponent in the White House. A recent study found that even a small increase in what’s diplomatically called vaccine hesitancy would have large public-health consequences. Talk about scary.
I volunteer at a used-book store whose proceeds benefit the local public library. Our books are donations and library discards, which we sell at very low prices. Occasionally an old or rare book comes in. We then check the internet to see who else is selling that book and price it at the lower end of what others ask. Recently I came across a book that was priced by another volunteer at a normal low price. However, the book seemed to be an old and rare book that should have been checked. I bought the book at the low price. Do I have an obligation to check the going internet price myself, and if it is high, pay the difference or return the book? Name Withheld
You can tell yourself that you just did what anyone interested in the book would have done. After all, your store is no worse off than if a random customer had bought it. But people who work for charitable businesses have an obligation to look after their interests. If you thought the book was underpriced, you should probably have brought it up with the other staff members and, if you still wanted it, paid the price that was set once its value was known.

Tuesday, September 19, 2017

The Best Health Care System in the World

Friday, July 28, 2017

Dying: A Memoir

Years ago, a palliative care doctor told me that what he knew of a patient’s personality often had little to do with how he or she coped with dying. Generous people could become ungenerous, and brave people could become frightened. Angry people could become gentle, and controlling people could become Zen. Dying, in other words — like combat, like becoming a parent, like any transformative life event — doesn’t always reveal or intensify aspects of our character. It sometimes coaxes out new ones.

For a long time, the writer Cory Taylor took, by her own admission, “a fairly leisurely approach to life.” That changed in 2005, just before her 50th birthday, when doctors removed a mole on the back of her leg. Melanoma, Stage 4. She wrote the novel she’d always meant to write, then another. Then she wrote “Dying: A Memoir.”

The book rings louder in my imagination the more time I spend apart from it, a kind of reverse Doppler effect. “Dying” is bracing and beautiful, possessed of an extraordinary intellectual and moral rigor. Every medical student should read it. Every human should read it. My own copy is so aggressively underlined it looks like a composition notebook.

“Dying” is short, but as dense as dark matter. There is an electrifying matter-of-factness to it, one that normalizes death, which is part of Taylor’s goal. She deplores the “monstrous silence” surrounding the subject of mortality. “If cancer teaches you one thing,” she writes, “it is that we are dying in our droves, all the time. Just go into the oncology department of any major hospital and sit in the packed waiting room...” (nyt, continues)



Cory Taylor, a fine Australian writer, has died within weeks of the rush-publication of her last book, Dying: A Memoir.
Taylor, who had just turned 61, died peacefully on Tuesday in a Queensland hospice with her family at her side... Sydney Morning Herald


Debunking "What the Health"



There’s a sensational new documentary out on Netflix that seems to have a lot of people talking about going vegan.

In the spirit of so many food documentaries and diet books that have come before, What the Health promises us there is one healthy way to eat. And it involves cutting all animal products from our diet.

Meat, fish, poultry, and dairy are fattening us up, giving us cancer and diabetes, and poisoning us with toxins, Kip Andersen, the film’s co-director and star, tells us.

Reflecting on a youth spent inhaling hot dogs and cold cuts, he asks, “Was this like I had essentially been smoking my whole childhood?”

No, Kip, not really... (continues)
==
Q. It seems that many people who are not elite athletes are now hyper-focused on protein consumption. How much protein does the average adult need to consume daily?

A. The recommended intake for a healthy adult is 46 grams of protein a day for women and 56 grams for men. And while protein malnutrition is a problem for millions of people around the globe, for the average adult in developed countries, we are eating far more protein than we actually need.

Most American adults eat about 100 grams of protein per day, or roughly twice the recommended amount. Even on a vegan diet people can easily get 60 to 80 grams of protein throughout the day from foods like beans, legumes, nuts, broccoli and whole grains.

The Hartman Group, a consumer research firm that has been conducting a study of American food culture over the past 25 years and counting, has found that nearly 60 percent of Americans are now actively trying to increase their protein intake. Many are avoiding sugar and simple carbohydrates and turning to protein-rich foods, snacks and supplements. The firm calls protein “the new low-fat” or “the new low-carb,” even “the new everything when it comes to diet and energy.”

“Soccer moms feel they can’t be anywhere without protein,” says Melissa Abbott, the firm’s vice president for culinary insights. “Really it’s that we’ve been eating so many highly processed carbs for so long. Now it’s like you try nuts, or you try an egg again, or fat even” to feel full and help you “get through the day.”

In her research, Ms. Abbott said she always seems to be finding beef jerky in gym bags and purses, and protein bars in laptop bags or glove compartments. Many consumers, she notes, say they are afraid that without enough protein they will “crash,” similar to the fear of crashing, or “bonking,” among those who are elite athletes.

But most of us are getting more than enough protein. And few seem to be aware that there may be long-term risks of consuming too much protein, including a potential increased risk of kidney damage. To learn more, read “Can You Get Too Much Protein?”

Saturday, July 22, 2017

Gene editing, techno-optimists

Gene editing threatens to homogenize society, says Atul Gawande. Aberrant yet valuable characteristics are under threat. Think of George Church's narcolepsy... more »

Biology and its discontents. Techno-optimists come in all stripes — scientists, seekers, grifters, con artists. They share a zeal for augmenting their bodies... more »

aldaily
==
The Gene Machine: How Genetic Technologies Are Changing the Way We Have Kids—and the Kids We Have
by Bonnie Rochman
Scientific American/Farrar, Straus and Giroux, 272 pp., $26.00
DNA Is Not Destiny: The Remarkable, Completely Misunderstood Relationship Between You and Your Genes
by Steven J. Heine
Norton, 344 pp., $26.95
A Crack in Creation: Gene Editing and the Unthinkable Power to Control Evolution
by Jennifer A. Doudna and Samuel H. Sternberg
Houghton Mifflin Harcourt, 281 pp., $28.00Graeme Mitchell/Redux

In recent years, two new genetic technologies have started a scientific and medical revolution. One, relatively well known, is the ability to easily decode the information in our genes. The other, which is only dimly understood by the general public, is our newfound capacity to modify genes at will. These innovations give us the power to predict certain risks to our health, eliminate deadly diseases, and ultimately transform ourselves and the whole of nature. This development raises complex and urgent questions about the kind of society we want and who we really are. A brave new world is just around the corner, and we had better be ready for it or things could go horribly wrong.

The revolution began in benign but spectacular fashion. In June 2000, President Bill Clinton and Prime Minister Tony Blair announced the completion of the first draft of the human genome. According to a White House press statement, this achievement would “lead to new ways to prevent, diagnose, treat, and cure disease.” Many scientists were skeptical, but the public (who footed much of the $3 billion bill) probably found this highly practical justification more acceptable than the mere desire to know, which was in fact a large part of the motivation of many of the scientists involved.

During the 2000s, Clinton’s vision was slowly put into practice, beginning with the development of tests for genetic diseases. As these tests have become widespread, ethical concerns have begun to surface. Bonnie Rochman’s The Gene Machine shows how genetic testing is changing the lives of prospective parents and explores the dilemmas many people now face when deciding whether to have a child who might have a particular disease. Some of these technologies are relatively straightforward, such as the new blood test for Down syndrome or the Dor Yeshorim genetic database for Jews, which enables people to avoid partners with whom they might have a child affected by the lethal Tay-Sachs disease (particularly prevalent in Ashkenazis). But both of these apparently anodyne processes turn out to raise important ethical issues... (nyrb, continues)

Monday, June 26, 2017

The Symptoms of Dying

You and I, one day we’ll die from the same thing. We’ll call it different names: cancer, diabetes, heart failure, stroke.

One organ will fail, then another. Or maybe all at once. We’ll become more similar to each other than to people who continue living with your original diagnosis or mine.

Dying has its own biology and symptoms. It’s a diagnosis in itself. While the weeks and days leading up to death can vary from person to person, the hours before death are similar across the vast majority of human afflictions.

Some symptoms, like the death rattle, air hunger and terminal agitation, appear agonizing, but aren’t usually uncomfortable for the dying person. They are well-treated with medications. With hospice availability increasing worldwide, it is rare to die in pain... (continues)

Tuesday, May 30, 2017

Web MD

“You can’t list your iPhone as your primary-care physician.”

“You can’t list your iPhone as your primary-care physician.”

Monday, May 22, 2017

Siddhartha Mukherjee & Sam Harris on the moral complexity of genetics

In this episode of the Waking Up podcast, Sam Harris speaks with Siddhartha Mukherjee about the human desire to understand and manipulate heredity, the genius of Gregor Mendel, the ethics of altering our genes, the future of genetic medicine, patent issues in genetic research, controversies about race and intelligence, and other topics. Listen here.

Thursday, May 18, 2017

Better dead than "upgraded"?

“[Many people] are happy to follow the advice of their smartphones or to take whatever drug the doctor prescribes, but when they hear of upgraded superhumans, they say: 'I hope, I will be dead before that happens” 

“No clear line separates healing from upgrading. Medicine almost always begins by saving people from falling below the norm, but the same tools and know-how can then be used to surpass the norm.” 

― Yuval Noah HarariHomo Deus: A Brief History of Tomorrow
==
Bill Gates recommenmds Homo Deus, by Yuval Noah Harari. "I recommended Harari’s previous book Sapiens in last summer’s reading list, and this provocative follow-up is just as challenging, readable, and thought-provoking. Homo Deus argues that the principles that have organized society will undergo a huge shift in the 21st century, with major consequences for life as we know it. So far, the things that have shaped society—what we measure ourselves by—have been either religious rules about how to live a good life, or more earthly goals like getting rid of sickness, hunger, and war. What would the world be like if we actually achieved those things? I don’t agree with everything Harari has to say, but he has written a smart look at what may be ahead for humanity."

Read Bill Gates' full review of HOMO DEUS here

Thursday, May 4, 2017

Be healthy and happy, Bioethics class of '17!

Image result for the end is near cartoons
Keep in touch. Let me know how I can help you reach your goals!

Brave New World Final Blog Post: The Beauty and Negativity of Adversity


Pop warner coaches always tell their players that you grow when it is tough. Living the easy life and becoming complacent with our current situation provides little opportunity to mentally or physically grow. Even Arnold Schwarzenegger loved pain, because pain meant growth. However when life becomes too difficult, surviving is the only thing one can be focused on. It is not ideal to be focused on surviving and ignore the pleasure of life.



What is the perfect balance in our lives where it is not overly difficult but neither overly plush? Do we even have control over that balance?

Sometimes in life we are dealt a bad hand. No body can accurately predict when misfortune strikes. You are laid off, get into a car accident, or a flood destroys your home, what happens next? Most people will tell you to pick up the pieces and move on, that the experience will only make you stronger. It is true that these experiences will help you grow as a person, but if you become overburdened with unfortunate events it becomes difficult to not give up. Some might resort to alcohol, drugs, or even suicide. Who is to blame them though,

However, with modern technology and progressive policy it become easier to weather tough times. If you are laid off, there is a safety net to prevent you from starving and losing everything you have. Cars on constantly being improved on to be more safe so that if you get into a car accident you chance of death or serious injury is diminished. Even in cases of serious injury from a car accident, modern medical practices offer a better prognosis of your injuries than in the past.

In first-world countries you have more opportunity thus control over how difficult your life is. Living in a country that is more economically stable gives its inhabits a higher quality of life. Certain diseases are no longer existent and food for the most part is plentiful. Instead of worrying about how difficult life is we may be worry about how easy life is becoming. Will we becomes less motivated if our standard of living becomes too high, or will a higher standard of living provide new opportunities that were not previously achievable?

In Brave New World, life is relatively easy. Commodities are readily accessible, everyone is programmed to be complacent with their life, and if one experiences too much stress a drug called soma is taken to escape reality. Nothing is wrong with enjoying the newest item, accepting your situation for as it is, or consuming alcohol or dope when life becomes stressful. This scenario however was created with lots of influence an oversight. In a naturally progressing society, a life without adversity may not be possible.

Our standard of living 200 years ago does not compare to the standard of living today. Our ancestors may scoff at our problems today, to us however they are of no small matter. If we were to see the problems that future generations face, we may scoff at them. To some degree difficult is relative and here to stay, manifesting in different forms. However, wether we can or can not eliminate difficulty in the future, we should try to embrace adversity now.


If life gives you lemons makes lemonade.









Sorry for the late post Dr. Phil, wrongly assumed that the final blog post would be due on the exam date and not earlier.

Wednesday, May 3, 2017

The Future of Human Nature pt. 2 - The Moral Limits of Eugenics


In the first installation (which can be found here), I attempted to summarize Habermas's  thoughts on "the grown and the made." Habermas's notion here is that, before diving into the Pandora's box that is unlimited biotechnical possibilities, we should first question what we value, and what exactly we mean by "we."

A mere two sections past the previous one I covered, Habermas has stopped trying to convince us to slow our biotechnical roll. At this point, he is assuming that we're going to push the limits, and he's trying to guide us by setting moral boundaries and posing hard-hitting questions.

The section titles "the moral limits of eugenics" is the focus of part two. In the opening paragraph of this section, Habermas states his thesis in no unclear terms:

"Eugenic programming of desirable traits and dispositions, however, gives rise to moral misgivings as soon as it commits the person concerned to a specific life-project or, in any case, puts specific restrictions on his freedom to choose a life of his own." (61)

In essence, Habermas is making the case that it is never, ever morally justifiable to make eugenic modifications that may determine what an individual's life comes to be.
Genetics are an undeniable identifying characteristic that necessarily changes our lives. Whether it be height, skin or eye color, intelligence, or athletic ability- all of these things have a profound effect upon an individual. These (previously) unchangeable characteristics are what Habermas refers to as "natural fate."

He contrasts his idea of nature fate with that of the "socialization fate." The important distinction he makes here is the power of the "second party," or the party that doesn't determine the fate and is instead subject to it. The individual subject to either fate has the opportunity to correct or otherwise change the outcome of the socialization fate; however, the natural fate, as it may be determined by a parent though eugenic enhancement, is entirely inaccessible to the second party. In fact, the second party isn't even "real" in the argument, as the parents would be expected to say "who/what do we want our child to be" instead of "do we possess the moral justification to determine this individual's life?"

Habermas challenges this idea by bringing up the obvious fact: nobody consented to being born! We all are conceived, that is the way of the world- why would it matter if someone other than "fate" rolled the dice? The flaw to this (admittedly not well constructed) argument is that the "creator" is not clarified.
Human being have pondered existence since the existence of pondering. The prospect of pondering the abstract nature of a "creator" is something that all humans (at least in the Western traditions) have in common; this "freedom" wouldn't extend to those individuals "created" or selected by their parents. Instead of the pondering the abstraction of existence, they would be forced to ponder the qualitative nature of determinism (by their parents). This exemplifies the unhealthy relationship detailed above- such a one-way relationship with no compromise or opportunity for recourse is unprecedented and morally unjust.

Word count: 514

Black Man in a White Coat Installment

Jayla Moore
Black Man in a White Coat
First Installment

I’m so glad that I decided to read “Black Man in a White Coat.” Dr. Damon Tweedy does a fantastic job of narrating us through his experiences that lead up to him becoming an African American medical doctor. This book was definitely an eye opener. It’s the first book I ever read that sparingly illustrates the lack of equity in the terms of race and medicine.

In the beginning of the book, Damon expressed to us his insecurity of attending Duke for medical school. Most members of his class had graduated from ivy league colleges and were on the pursuit to graduate for another one. Damon expressed that during his first month of medical school he spent more hours studying than he had his entire senior year of undergraduate school, rechanneling his fear into determination.

Midterms came around. Damon did well on them. He scored within the top half of the class on each single exam up to that point, which proved that all his studying wasn’t in vain. His test scores made him begin to feel comfortable as a first-year medical student at Duke- or at least he seemed that way until he returned from his mid-class break. After his mid-class break, Damon re-entered the classroom and had a seat. His professor came walking in his direction, but Damon thought he was just going to walk right by him because the professor, Dr. Gale, didn’t normally socialize with students. However, the professor stopped right in front of Damon and asked “are you hear to fix the lights?” In this moment, Damon thought maybe he heard him wrong so he asked the professor if he just ask him was he there to fix the lights. With annoyance in his voice, Dr. Gale responded, “You can see how dim it is on over there on that side of the room; I called about it last week.” Damon instantly began to check himself to make sure he didn’t look out of place as a medical student. He then told Dr. Gale that the lights being dim had nothing to do with him. Dr. Gale confusingly asked him why was he in his classroom if that wasn’t the reason. Damon told him that he was in his class. Dr. Gale said, “oh” and then walked away, without saying anything else. This encounter totally turned Damon’s day upside down.

I singled out this section of the book because it hit close to home for me. I have experienced a different but similar encounter. All throughout high school, I took Honor’s English. When my junior year came around, my teacher convinced me to take college freshman English my second semester. High school students can take college courses through a program called dual enrollment. I enrolled in Dyersburg State Community College and took the course. As expected, I made an A in the course. My senior year came around and the first semester I took Honor’s Senior English and made a perfect 100. When my final semester of high school came around, I took college sophomore English at Dyersburg State. This time I didn’t do so well. I made my very first C in school. When the grades got back to my teacher he shared them with my guidance counselor. I remember everything like it was yesterday. My guidance counselor called me into her office and asked me to take a seat. As I sat down she asked me did I have any idea on why she had called me to come into her office. (I literally had no idea)! The look she gave me was very distasteful. She then slammed my transcripts from Dyersburg State Community College down on her desk and told me to look at them. What I saw saddened me a little, but I had already accepted the fact that I wouldn’t have an A or a B in that course. I had already talked to my grandparents about the course. They reassured me that I had already done extremely well as a high school student and one C wouldn’t change the world. They just wanted me to take that grade as a lesson and use that to do better in life. My guidance counselor had a completely different aspect. She was furious about that C. She chewed me out. I remember her saying “this is unacceptable, Jayla. You’ve messed up your collegiate years before even attending college. I’m sure you’ll go to one of those unaccredited HBCU’s and at this point, I’m not sure if you will even graduate from there.” It was at that point that I began to tune her out. I was hurt. My eyes began to fill with tears. My throat felt like it was tightening and it became hard to swallow. I was devastated.
Coming into college, my guidance counselor’s words stuck with me. I graduated high school with a 3.75 GPA and didn’t receive not one scholarship. I entered college acquiring student loans because my family weren’t able to pay for my schooling. Although I did not attend “one of those unaccredited HBCU’s” that she said I’d go to, I still felt like I was a failure. My grades began to show that. I come to school wanted to be a doctor, but deep down I “knew” that would never happen. It wasn’t until I read this book last year, until I gained a completely different view.


The thing that I loved about Dr. Damon Tweedy is that he never let people’s words or actions keep him down. True enough he went through some things that no one would want to experience, but he used that as fuel power to get to his next level. He overcame so much to get to where he is today. This book inspired me to let go of my evil guidance counselor’s words and shift my mindset. Now in four days, I will be graduating from Middle Tennessee State University as Jayla Moore, B.S.!!!! If you’ve ever experienced anything like this, I totally recommend reading this book!

Final Installment

Here is the link to my first *Updated* installment
                http://bioethjpo.blogspot.com/2017/04/final-project-case-against-perfection_3.html

In desperate need for some motivation, (y'all this semester was ROUGH) I looked up inspirational books and ask for the opinion of my peers and found something interesting. I went out and bought it and I haven't finished it yet but I feel better. It's called "YOU are a BADASS: How to stop doubting your greatness and start living an awesome life". Though it wasn't exactly what I was looking for, it's perks were fantastic and it ended up being something better.

Image result for you are a badass

https://www.youtube.com/watch?v=LWQEzsIFZnY

Here is a 45 minute, I know it's lengthy, video of the author basically speaking on the points of this book, how to conquer self doubt. This book is all about living life to the fullest and stop doubting your potential. This was a hard concept at first because self doubt is not something that is taught, in most situations (inserts thinking emoji), but in human nature. Being unsure of something that keeps us sane, it keeps us from making some poor choices and/or hurting ourselves.

This book is about how the author was sick and tired of just making enough money to get by, being unimpressed with her everyday life and knowing she had more potential that what she was exerting. She decides that she wants to change her life and she did. The first part of the book is talking about why we are the way we are, having self doubt. To not give the book away I will tell you only one reason, being our subconscious "Our subconscious mind believes everything because it has no filter, it does not know the difference between what's true and what's not true" (Sincero 22). That our subconscious learned all our information when our frontal lobe wasn't developed so it acts in a sense like a child.

Part two is How to embrace your inner bad ass, part three is How to get over your b.s. already and part four is How to kick ass. By these titles you can get a gist of how the book reads, Jen Sincero is witty and fun to read but really does give insightful information on how to live a new life. I started in the back of the book, starting with How to get over your b.s. already because it was the part I felt like I needed desperately at the moment. It started with "Own your ugly" *inserts shrugging emoji* I fount it hilarious and informative. I recommend you all read this book or find your own inspirational book for the summer and find a new outlook on life.

Tuesday, May 2, 2017

Treatment of Someone with a Mental Illness

     Mental Illness is receiving a lot of attention from researchers now-a-days compared to earlier times. This has led to many developments and discoveries in a more recent time. These discoveries have revolutionized the lives of many suffering from mental illnesses.
     Medication is the most common treatment for someone suffering from a mental illness, but while for many this helps there are some that is does not. Many medications act merely as a placebo for the patient. This is not saying the medication does not work, however, just that most patients are usually unresponsive to the first medication they try. there are some case that the medication was genetically incompatible with patients. One case is a 45 year old named Melissa. She was prescribed Paxil, but due to her genetics, her body broke down the medicine too fast for the medicine to help her. There is also circumstances opposite of this in which people can not breakdown the medicine and the medicine causes them severe side-effects. This is why gene analysis is becoming so important. As we are becoming able to map and view a persons genes, we can more accurately prescribe them medicine. This while still too expensive for the average person may someday be able to turn the view of medicines for mental illnesses as a placebo to a much more efficient, optimal resource.
     This theme of genetics is not only a more effective way of prescribing medicine, but this is allowing for some of the most effective research to be done on mental illnesses. While the genes themselves are not technically the causes of mental illness they shows signs of predispositions to mental illnesses. While these are not bio-markers that can definitively tell if someone is suffering from an illness there can help someone determine how to help them pre-illness possible. Since the rate of occurrence has risen so much over the years maybe doctors could check these makers as a deterrent. Mental illness is not like other diseases in which there is a clear cure. Even with the evolving medicine and other treatment many people still have a hard time living a normal life. If say they were being informed beforehand that certain types of lifestyles could be potentially bad maybe that could help them. This does not mean tell someone that a life without a constant flow of money like an aspiring artist or musician is possible bad for them so the can not do it. However, if they no something is already predisposed to be hard on them they can work harder as to not let it affect them too much. I look at it like high school teachers telling you college will be hard, so when you get to college you know it will be hard and are more prepared. It does not mean you will pass or that you are truly prepared, but it gives you the knowledge that you will have to work if you really want to do it.  
     Mental illness is something that is a hard thing to live with, but there are some silver linings to mental illness in terms of medical breakthroughs. Unlike other illnesses it does not have as high a rate of evolution. Which means scientific discoveries will last longer on treating it unlike other illnesses.


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Anna D. Final Post Assignment -- Part Two

On Osheroff, Medical Ethics, and a Doctor’s Duty

**I apologize for the editing because I've had to post this using my cell phone.


When Raphael Osheroff took shelter at Chestnut Lodge, a psychiatric hospital in central Maryland, he sought relief from his depressive episodes and severe anxiety that put his business dealings in jeopardy. The hospital was known for hosting prominent psychoanalysts of the midcentury era who treated Osheroff along analytic to uncover the root cause of his neurosis. His treatment team anticipated a hospital stay of at least 3 years to work out the cause of unconscious distress. Osheroff’s condition worsened, he became more agitated, he paced constantly, but his medical team refused to give him medication. 
A statement from one of his psychiatric aides expressed worry: “We are concerned about him be when looks like he is depressed, he probably is really depressed and the nursing staff feels like we have to watch him closely.” Osheroff was viewed as suicidal. However, the medical doctors viewed his issued in psychological terms and the ward administrator stated: “He asked to be put on medication but I told him it would interfere with what he came here for! I told him that he needed every neuron to absorb what we are telling him here and that medication would interfere with that. I told him that if his pacing got out of control we would have to wrap him up in a cold wet sheet pack! The social worker told us his agitated behavior was reminiscent of the obnoxious conduct that his father indulged in.”
The ethical dilemma in this instance is self-evident: Osheroff’s doctors wholly believed in their treatment plan, even considered it superior to medication. At what point is the treatment team held responsible for negligence. If Osheroff had committed suicide, could the doctors be held responsible, or could Osheroff’s mental state be blamed for his demise? I believe the medical team should be charged with negligence because medication, a possible treatment option, wasn’t even considered and the patient wasn’t showing improvement with psychoanalysis treatment solely. Osheroff was at the Lodge for seven months until a friend transferred him to another hospital. 
At Sliver Hill in Connecticut, he received antidepressant and antipsychotic medication and the patient showed marked improvement after just three weeks. Osheroff was discharged after a three month and returned to his businesses. The main point of dispute was the patient’s diagnosis; the Lodge psychotherapist argued he was treating personality disorder, specifically narcissism, and a Silver Hill’s clinician cited depression when the insurance was billed. 
When the lawsuit was taken into arbitration, the case was in favor of Osheroff; the patient’s quick recovery after medication and agony during the Lodge stay painted the psychoanalysts’ actions as erroneous, even cruel. The implications of Osheroff v. Chestnut Lodge were powerful: hospitals were now at legal risk if the treatment staff denied medication to vulnerable patients, especially if the medication had efficacious clinical trials. 
When Kramer spoke to Osheroff for his book Ordinarily Well, Osheroff  was seventy- three, and Elavil, a nerve pain medication and antidepressant, had sustained him thus far, and would for the rest of his life. 

Great piece from The Washington Post that further details Osheroff’s stay and treatment at The Chestnut Lodge

My second on Installment II: The Biophilla Hypothesis
The reasoning behind why nature is restorative is fascinating. Simply letting our executive networks take a break can bring us more mental clarity. Also puts much importance on public spaces like parks, and walking & biking trials so those should become a priority for any major city.

My first comment on Installment I: The Biophilla Hypothesis:
Great report. To echo previous comments, I certainly feel time spent outdoors is time well spent. Looking forward to reading the second installment.