Quiz Feb.16

The Case Against Perfection, ch2-Bionic Athletes

1. As athletic enhancement increases, what fades?

2. Does Sandel think the main problem with enhancement is that it undermines effort and erodes human agency?

3. What do genetically altered athletes corrupt?

4. Sandel thinks Lasik surgery to correct normal vision would be an acceptable enhancement for a golfer under what condition?

5. Does Sandel allege an ethical problem with mega-calorie diets?

6. What is "far-fetched" about the view that the rules of a game are arbitrary?

==
DQ:
1. A devil's advocate might say, of the complaint that an enhanced performance is less impressive, that if it's so easy to hit 70+ home runs on steroids then more than just two should have been able to do it. The implication is that, enhanced or not, elite athletic accomplishment is entertaining and exceptional. What do you think?

2. Do you agree that we should be a more humble and less "promethean" species, more appreciative of the gift of life and less willful, less confident in our ability to "remake nature, including human nature"?

3. "Striving is not the point of sports; excellence is." (28) Agree? Were McGwire's and Bonds's achievements less excellent than Ruth's and Maris's?

4. Is it clear to you where we should draw the line between "natural gifts" and artificial enhancements? Isn't medical science an expression of culture, itself in turn a natural evolutionary adaptation on the part of our species? Aren't nature and culture on the same continuum? Or does this attitude extend a blank check for any and every humanly engendered aleration as equally "natural"?

5. Do transfusions, hormone injecctions (EPOs), altitude training, and genetic modifications all share the same ethical status, if their effect on performance is the same? 33

6. What threatens "the integrity of [a] game"?
==

	Oxford Academic (@OUPAcademic)
2/12/16, 6:40 PM As life expectancy increases, so should our understanding of the issues surrounding #aging - especially in #medicine bit.ly/1T5ignD

	Rose Eveleth (@roseveleth)
2/14/16, 7:46 AM Male biology students consistently underestimate female peers, study finds washington.edu/news/2016/02/1…

• Some Christians believe God rewards the faithful. So why did I get Stage 4 cancer? nyt
Death goes in and out of fashion. The topic lingers behind euphemisms for a few years, and then someone calls it forth again: Elisabeth Kübler-Ross with her disciplined “On Death and Dying” in 1969; Susan Sontag with her angry but profound “Illness as Metaphor” in 1978 and the empathetic follow-up “AIDS and Its Metaphors,” in 1988; Derek Humphry, implausibly, with his suicide handbook “Final Exit” in 1991; Sherwin Nuland with his magisterial “How We Die” in 1993; more recently, Joan Didion with her agonizingly precise “The Year of Magical Thinking” in 2005; and Atul Gawande with his humane “Being Mortal” in 2014. Each of these books argues, one way or another, for a continuum between life and its conclusion. The gloss of youthful vitality can persuade us that life is for the living, but life is also for the dying, and repudiating that ultimate punctuation escalates our anxiety and deprives us of final dignity. Time and again, we must clarify our individual and collective beliefs about how the last chapter changes the rest of the narrative. “Or not to be” is not in fact a question. (continues at Andrew Solomon, The Good Death...)

	Longreads (@Longreads)
2/15/16, 5:48 PM Triplets, a legal battle, and murky ethics in the surrogacy industry: lgrd.co/1Wo7MyR @Slate#longreads pic.twitter.com/NzsaGJBZAD

	bioethics.net (@bioethics_net)
2/15/16, 5:24 PM #Bioethics: If U.S. continues to ignore CRISPR regulation we wont be ready for the futureow.ly/Ymq58 pic.twitter.com/yJlpaOhqTz

==
The late David Carr on Black Mirror, MicroSoft's HoloLens, and our dwindling experience of "actual unencumbered reality."

Micah Hester's colloquium talk at Vandy presented several ambiguous cases of "brain death" and "biological death," including that of Jahi McMath...

Breaking Up With My Meds By DIANA SPECHLERThe drugs I take for anxiety, depression and insomnia have helped, but I’ve decided to quit.

THE NEW OLD AGE Continued Questions on Benzodiazepine Use in Older Patients By PAULA SPAN A new reports that among 65- to 80-year-old Americans, close to 9 percent use drugs like Valium, Xanax, Ativan and Klonopin.

==

‘The Patient Will See You Now,’ by Eric Topol, reviewed by Sandeep Jauhar, nyt bk rev 2.13.15. 

Despite awesome increases in computational power, I think it is premature to conclude that doctors’ judgments — not to mention their healing touch — can be rendered by computers. In an illustrative vignette, Topol writes about a plane flight he was on in which a passenger lost consciousness soon after takeoff. In the air, Topol performed a smartphone examination of the patient, including checking an electrocardiogram, measuring blood pressure and doing a cardiac ultrasound. The patient was fine, but despite this investigative tour de force, Topol curiously concludes that the passenger did not require a doctor on the plane to make the diagnosis. “All that was needed were the tools to collect the data,” he says. This, I believe, is wishful thinking.
==
Another old Sandel post:
Walk on air

...today’s always a gift, and that’s why we call it the present. Dare we open it? (No peeking? How about peak experiencing?)

Gift is Michael Sandel’s keyword in today’s Bioethics chapter, too, as his Case Against Perfection continues in chapter two. He’s an anti-doping anti-perfectionist (with the world’s most popular course on justice), worried that we’ll design ourselves right out of the possibility of accomplishing our own goals and, ultimately, achieving meaningful lives.

“Bionic Athletes,” enhanced by various means (not restricted to pharmaceuticals), have looked the gifthorse of natural (some will say “god-given”) athleticism in the mouth (he says). They’ve corrupted their respective sports and compromised our capacity to appreciate their gifts and their games.

So what? Games are only, well, games. Arbitrary, unimportant, meaningless. Right?

Maybe. Maybe not. But that’s not the central argument here. Let me just say, though, that I’ve experienced at least a few glorious afternoons in the bleachers that felt anything but “meaningless” – they felt like what James Carse calls “infinte games,” played for their own sake and experienced as ends in themselves. Never mind, though, for now.

Sandel’s clear insinuation is  that we’re in danger of killing the biggest game of all, the game of life. If we make winning by all means the only thing, we’ll be robbing life of intrinsic interest, meaning, joy. Joie de vivre is the greatest gift; the dopers and cheaters and transhumanist dreamers may yet prove to be our greatest killjoys.

The deeper danger of enhancement and genetic engineering is that they represent a kind of hyper-agency, a Promethean aspiration to remake nature, including human nature, to serve our purposes and satisfy our desires.

At stake, Sandel says, is “an appreciation of the gifted character of human powers and achievements.” Such appreciation reflects a “religious sensibility” that is grateful but humble, and not so presumptuous as to try and replicate those powers. Hmmm.

Do nature’s gifts require and reward such self-abnegating gratitude? Does the “religion of humanity”?

There follows an interesting comparison, interesting at least to baseball fans, of Pete Rose and Joe DiMaggio.

Then, a surprising and at least overstated (probably false) claim: “striving is not the point of sports; excellence is.” I think Sandel really does not want to say that, does not mean what his words may convey. He wants to block the kind of ambitious striving that lusts after (say) seven medals at the Tour de France, or 73 suspiciously -amped Home Runs, or a shortcut to the marathon finish line. But surely he does not oppose striving against one’s own previous limitations to overcome internal resistance and achieve more than we knew we could.

Don’t some admirable athletes (and humans in general) possess a gift for striving?

I do think Sandel’s right to point out that “success” in baseball must continue to mean a 70% (or so) failure rate, in order to sustain our interest. I also agree that Judge Scalia is full of peanuts when he calls all rules “arbitrary.”

Sandel did an interesting Philosophy Bites interview worth hearing. His Harvard lectures on justice are wildly popular. He was also described in a recent profile as a “rock star.”

Richard Powers’ Generosity: An Enhancement (Part Two: “Walk on Air”) also raises crucial questions about the genetic gift of a sweet and happy disposition, and how well- or ill-advised we and our heirs might be to experiment with re-gifting happiness via biogenetic interventions and therapies. There are “big winners in genetics’ happiness roulette” (the biggest are hyperthymic, “every day bathed in renewable elation”) and relative losers. It’s not fair. Can we level the playing field? Can “peak experience” be packaged and sold?

A few highlights from today’s Generosity:

People want to live longer and better. When they can do both, they will. Ethics is just going to have to catch up.

…we might still become the authors of our own lives.

One glance at the only available planetary future made having children at best
benighted and at worst depraved. Nulliparity— human build-down— was a moral imperative… she was already a member of the Voluntary Human Extinction Movement.

Resolved: the human race would have been better off if the agricultural revolution had never happened. Resolved: the government should cap the salaries of professional athletes… Resolved: the human race will not survive its own ingenuity. Resolved: the cure for our chronic despair is just around the corner… Tonia Schiff can make the most cataclysmic debate almost as entertaining as reality itself.

Candace helps students understand that feeling good about themselves is more important than being “perfect…”

It took the species millions of years to climb down out of the trees, and only ten years more to jump into the fishbowl.

“If I knew a drug that produced sustained, intense, level, loving well-being without any trace of stupor or edge, I’d take it myself.” She cocked her head and twisted her lips. “You’d have to. Everyone else would already be on it.”

You have cause — so have we all — of joy.

Does generous [heart, joie, expansion, big feeling] include all those who are by nature genuine, generative, anyone pregnant with connections, keen to make more kin?

     Or is generosity a question of having the right blood, the innate germ of the genteel gentry?

Enough philosophy; she has sworn off it. Philosophy never consoled anyone.

I’d spent my whole life coming here, and now I was home. Everyone alive deserves to feel that way once.

Only once?

And so we’re off to BNA. Happy flight, kids. Walk on air.

Quiz Feb.11

The Case Against Perfection - The Ethics of Enhancement

Happy Darwin Day (Feb12)...

1. "We do not view what we did as very different from what many straight couples do..." What did they do?

2. How much did Genetic Savings & Clone plan to charge for cloned canines?

3. According to what objection is genetic engineering objectionable because "designer children" are not fully free? OR, Why does Sandel not find this objection persuasive?


Also worth a look: Sandel's Adam Smith Lecture; What Money Can't Buy; The Public Philosopher; Conversation with A.C. Grayling

4. What questions do we need to confront, to grapple with the ethics of enhancement?

5. (T/F) Sandel says it may soon be possible to take a drug that prevents horrific events from being deeply registered in memory.

6. What does Sandel mean by a" hormonal arms race" with respect to height?

BONUS: Michael Sandel served on what high-profile council, OR teaches a hugely popular MOOC course at Harvard on what subject?

DQ:
1. Do the deaf couple defend their reproductive choice as primarily a matter of sexual freedom, rather than of the rights of the hearing-impaired? Is the issue of their sexuality relevant?

2. Is it unconscionable to spend a small fortune to create a custom-made pet?

3. If you knew your happiness, athleticism, height, or some other distinctive personal trait had been selected for you by your parents, would you consider yourself any less free than if you had simply inherited those qualities in the "genetic lottery"?

4. How would you characterize "the moral status of nature" and the proper stance of humans towards the "given world"? Must we respect it, and its independence from human purposes and interests, as a repository of value in itself? To what extent are we obliged to preserve its "wild" quality? To what extent has that become a moot point?

5. If you could take a drug that would selectively and reliably suppress your memory of specific events, would you?

6. Do you want to live in a society where parents feel compelled to spend a fortune to make perfectly healthy kids taller/smarter/happier/etc.? (Or feel inadequate because they don't have a fortune to spend?) Are we headed in that direction?

7. Is an eight-cell embryo growing in a petri dish morally equivalent to a fully developed human being? (21) Why or why not?

ALSO OF INTEREST:

	Atul Gawande (@Atul_Gawande)
2/10/15, 10:39 PM .@clairebrooks My wife totally disagrees w me on #WhatMattersMost. "If I look happy, keep me going. It doesn't matter if my memory is gone."

	Mother Jones (@MotherJones)
2/11/15, 5:09 AM Vaccines Are One of Our Best Weapons Against Global Warming bit.ly/1IRRKej

	Slate (@Slate)
2/11/15, 5:17 AM You Should Be Able to Know Whether Your Kids Are Surrounded by Unvaccinated Classmatesslate.me/1AURXJt

	The Daily Beast (@thedailybeast)
2/10/15, 7:56 PM No, the HPV vaccine will not drive teens to have wild, promiscuous sex. thebea.st/1DYVS5T

Seeking a 'Beautiful Death' nyt -

Virgie Divinigracia had the kind of death last month that most Americans say they want: at home, relieved of physical and mental pain, surrounded by those she loved, “a beautiful death” as those present described it. Alas, this is true for too few Americans. Most still die in costly medical facilities tethered to machines, often unable to communicate, in a futile attempt to prolong their lives...

Options regarding end-of-life care should be discussed well before an emergency — or for those with dementia, during the early stages of mental decline. “The absolute worst time to contemplate decisions about medical care is when one is critically ill and in the hospital,” Dr. Volandes writes.

The kinds of questions doctors should be asking:
■ What gives your life meaning and joy?
■ What are your biggest fears and concerns?
■ What are you looking forward to?
■ What goals are most important to you now?
■ What trade-offs or sacrifices are you willing to make to achieve those goals?

Whoever is chosen as health care agent must understand the patient’s priorities and agree to honor them, regardless of what that person might want for himself. A strong backbone is needed to assure that the agent will advocate the patient’s wishes even if doctors or family members disagree.

Dr. Angelo E. Volandes, the author of an enlightening new book, “The Conversation,” said that although Americans received some of the best health care money could buy, “they also experience some of the worst deaths in the developed world,” mainly because people failed to articulate what they wished for at the end of life, and doctors failed “to recognize that fixing specific problems may not fix the whole patient.” (continues)

==

What Would Jesus Do About Measles? nyt - MEASLES is back. Last year, about 650 cases were reported in the United States — the largest outbreak in almost 20 years. This year, more than a hundred have already been reported.Parents have chosen not to vaccinate their children because they can; 19 states have philosophical exemptions to vaccination, and 47 have religious exemptions. The other reason is that parents are not scared of the disease. But I’m scared. I lived through the 1991 Philadelphia measles epidemic... (continues)

==

Also of possible interest, this old post from 2013 on Sandel & related matters:

Enhanced, but… improved?
We’re on in Bioethics to Michael Sandel’s The Case Against Perfection: Ethics in the Age of Genetic Engineering (“The Ethics of Enhancement”) and Richard Powers’ Generosity: An Enhancement.

“Enhancement” is the inescapable issue here. Enhanced for what, to what end, with what rationale?

In Enough: Staying Human in an Engineered Age, Bill McKibben imagines several responses. Perhaps the road to enhancement will take us to Enchantment too, and answers (at last!) to the philosophers’ perennial questions.

• Where did the universe come from? 
• Why is there something rather than nothing? 
• What is the meaning of conscious existence? 

“Not to be impolite, but for this we trade our humanity? Sure, these questions are important, especially the last one. But they’re not all-important.” Are we happy? might just be a better one.

What’s ultimately problematic about enhancing ourselves and our progeny, aside from legitimate worries about equity, democratic opportunity, and enhancement for all? Sandel is concerned for our freedom and dignity, for the “moral status of nature” and the “given world.” He’s worried about the prospective sacrifice of our humanity for something less intrinsically meaningful and more divisive.

Powers is concerned for the fragility of happiness, and seems eager to impress upon us all a consciousness of ourselves, at this specific moment of natural history, as the collaborative authors of a future to whose inhabitants we owe the greatest generosity (which we can pay only in the coin of responsibility in the present).

Sandel begins with the case of the deaf lesbian couple who wanted a child “like themselves” (i.e., hearing impaired) and so arranged it, with a strategy “not very different from what straight couples do when they have children.”

Well, that could be the problem. Emerson long ago scolded parents who insist on reproducing “another you,” when “one’s enough” already. The problem’s in the will to design, rather than accept the genetic lottery’s default. “None of us chooses our own genetic inheritance,” nor should any of us have to accept the choices of parental engineers

And yet, “Viagra for the brain” sounds irresistibly alluring to some of us. “Memory suppression” too.

But as a parent who’s already spent a small fortune to educate the next generation, I’m definitely not interested in “hormonal arms’ races,” height extension, gender selection, or anything else in any Gattaca scenario. “They used to say that a child conceived in love…has a greater chance of happiness. They don’t say that anymore.” Well call me old-fashioned, I still do. [More… It’s Time to Question Bio-engineering… Powers@dawn/DS]

As for our playfully self-conscious novel, with its Camus epigraph, Sisyphean theme, and protagonist called “Stone”: the early stage-setting of Generosity comes with a foreboding warning (but also a reminder that we’re involved here with a story, a work of the imagination still subject to human choice and will): “Here… is one plot no one will ever bother writing down: A happy girl passes through the world’s wretchedness and stays happy.” Happy, generous, and present.

But do remember: this is fiction. So far.

Super

Lorenzo Mauldin of the New York Jets is carted off the field after suffering a concussion in a game on Sept. 13.Rich Schultz/Getty Images

His body wrecked at 36, Antwaan Randle Elregrets ever playing in the National Football League. After he died of an overdose of pain medication at 27, Tyler Sash was found to have chronic traumatic encephalopathy, the degenerative brain disease believed to be caused by repeated blows to the head. Concussion diagnoses have increased by about a third since the league let independent medical officials assess players. And it seems that with each N.F.L. veteran’s death, another diagnosis of C.T.E. is revealed.

How can fans enjoy watching a game that helps ruin players’ lives?

READ THE DISCUSSION »

Quiz Feb4

Research

Today in Bioethics we'll talk "research." Things like clinical trials and research involving animals and their rights, and genetics, and epidemiology. We'll look at the funding gap between what we need to cure and where our research dollars are actually going, and at the moral imperative of genuine and informed consent. We'll look at disturbing instances of fraudulent and dishonest research. And we'll consider Peter Singer's claims about "speciesism."


The future of research is a daunting source of apprehension and speculation. Michael Sandel and Bill McKibben have aired serious concerns about genetic and other "enhancement" research as potentially catastrophic for our capacity to achieve or even recognize "meaningful" lives. Enhanced may not mean improved.

1. Name one of the basic requirements agreed upon by all codes devised to protect individuals from malicious research.

2. What decree states that consent must be gained in all experimentation with human beings?

3. Name one of four areas of research discussed in the book.

4. Which famous contemporary philosopher coined the term speciesism?

5. Name one of four R's used in international legislation pertaining to animal rights in research?

6. What is the term for altering the numbers in a calculation to make the hypothesis more convincing, with no justification form the research findings for such members?

BONUS: What is the "10/90 Gap"?

DQ:

• Can there really ever be "fully informed" voluntary consent, given the many unknown variables and unpredicted consequences involved in most research?
• Discuss: "Trials of pharmaceuticals may be driven as much by commercial considerations as by the likelihood of real therapeutic gain." 122
• What concerns do you have about the use of animals in medical research? Is speciesism one of them? 10 medical breakthroughs due to animal testing... PETA... Touring an animal research facility
• What limits, if any, would you like to see imposed on genetic research and the uses to which it may be put?
• Were ethical improprieties committed in the case of Henrietta Lacks, whose cells (HELA cells) were harvested without her consent? (Rebecca Skloot... BBC...CBS...)
• If "dreams of perfect health by the better-off will determine the research agenda" in the future, resulting in soaring health care costs and greater health "enhancement" opportunities for the wealthy, what should be done to insure adequate attention to "the health problems of most of the world's population"? 129
• Should we be worried about a "Prozac revolution" and a "brave new world" of somatically-induced apathetic bliss? 130
• Would you give special priority to any of Campbell's five enhancement categories (130)? Is "Transcendence"-style enhancement beyond the realm of reasonable concern (given the considerable monied interest of people like Larry Page)? 
• Comment: "Why would we want such a 'posthuman' future? Are our lives better if we become physically stronger or more agile, or have an increased intelligence, or live for centuries?" 131
• Is the outsourcing of clinical drug trials to developing countries ethically defensible? 132
• How would you propose making research priorities "aligned to the needs of the majority"? 133
• Is it likely that biobanks and other communitarian initiatives will in the future "prioritize health research according to need rather than profit," particularly in the U.S.? Would you support such a reprioritizing? How?
• Have you seen Sicko? Care to share a review? Or of Michael Moore's latest doc'y?

==
Also of note:

To enhance our SuperBowl experience-

	The New York Times (@nytimes)
2/3/16, 6:05 AM N.F.L. Great Ken Stabler Had Brain Disease C.T.E. nyti.ms/1R1vYYw

==
It's the birthday of the first woman to graduate from medical school, Elizabeth Blackwell, born on this day in Bristol, England, in 1821. She wanted to become a doctor because she knew that many women would rather discuss their health problems with another woman. She read medical texts and studied with doctors, but she was rejected by all the big medical schools. Finally the Geneva Medical College (which became Hobart College) in upstate New York accepted her. The faculty wasn't sure what to do with such a qualified candidate, and so they turned the decision over to the students. The male students voted unanimously to accept her. Her classmates and even professors considered many medical subjects too delicate for a woman, and didn't think she should be allowed to attend lectures on the reproductive system. But she graduated, became a doctor, and opened the New York Infirmary for Women and Children. WA Feb3

• Researchers are seeking drugs that can slow the rate of aging and the development of the debilitating chronic ailments that typically accompany it.

Midterm group reports

It's time to start deciding on a mid-term collaborative report topic and 3-person reporting group. Reports will consist of an in-class presentation of about 10-15 minutes (each of you holding the floor for 3-5 minutes). One of you should sign up as an "Author" on our site to post a short summary of your group's topic and any relevant text/video/graphics you'd like to share.

Around Valentine's Day I'll ask you all to indicate who you're working with and on what, as well as your group's Author.

I'm open to your original topic ideas, but my suggestion if you need one is to select a general topic from the Campbell Basics text or from Sandel's Case Against Perfection and identify a related subtopic for each of you to focus on

You can use the comments space here to solicit interested classmates who might want to join you in reporting on your topic of interest.

When you've identified your collaborators and topic, stake your claim in a comment below. We want to avoid redundancy, so make sure you're not claiming a topic that's already been taken.

These reports, which will be scheduled to begin later in February, are worth up to twenty (20) runs for each of you. Do your best, have fun, learn something, teach us something.

jpo

Quiz Jan26

BB2 - Moral Theories

1. (T/F) In the Mayor's Dilemma, one of the possible actions considered is to set an example of defiance.

2. Which theory has been dominant in bioethics and often used by many health professionals?

3. In deontological theory, what is the difference between hypothetical and categorical imperatives?

4. What ethical principle (and whose), in the name of rational consistency, absolute dutifulness, and mutual respect, "requires unconditional obedience and overrides our preferences and desires" with respect to things like lying, for example?

5.  What would Kant say about Tuskegee, or about the murderer "at our door"?

6. What more do we want from a moral theory than Kant gives us?

BONUS QUESTIONS
7. What is the distinctive question in virtue ethics?

8. What Greek philosopher was one of the earliest exponents of virtue ethics?

9. Paraphrase the Harm Principle. Who was its author?

10. Name one of the Four Principles in Beauchamp and Childress's theories on biomedical ethics?


DISCUSSION QUESTIONS

• How would you resolve the dilemma, if you were Mayor?
• Do you consider yourself more an ethical consequentialist/utilitarian, pragmatist, deontologist, virtue ethicist, or none of the above? Is it possible to be ethically responsible without first clarifying and claiming your own theoretical ethical commitments? 
• Do you agree with Peter Singer that the ethical choice which best serves the goal of minimizing pain and suffering requires ending lives?
• Is a felicific calculus such as Jeremy Bentham proposed possible, or practical?
• Would life in Huxley's Brave New World really be nightmarish and dystopian, if universal happiness were its result?
• Kant's categorical imperative requires always treating individuals respectfully, as ends in themselves and never as means to any other social or collective good. Can you imagine any scenario in which it would be ethically correct to violate that imperative, in the name of medical progress or social welfare?
• Is virtue ethics "elitist and utopian" in its quest to articulate the conditions of a good life and death for all? Are virtues and vices culturally relative? 36-7
• 
  

Quiz Jan.21

Bioethics: The Basics (BB), ch1

• Bring your written answers to class, we'll swap and grade them. 
• You get a run just for taking the quiz, and if you ace it with six correct answers you'll get another. There's no penalty for missed questions, you've got nothing to lose. The three exams (at the end of February, March, & April) will be drawn from the quizzes, so these questions are part of your growing study guide.
• Supplement my quiz questions with your own, in the "comments" section below, and earn a run.
• Your correct answers to others' supplemental quiz questions count.
• You can also earn additional runs, up to five per class, by posting relevant comments, questions for discussion, links to articles and videos etc.
• Note in your dated personal log if you took the quiz, who graded it, if you aced it, if you posted any comments, questions, or links, or did anything else you think entitles you to a run.
• Don't forget to post your Introduction ("Who are you? Why are you here?")

1.(T/F) Campbell's examples of bioethical questions include whether health care professionals must meet higher standards than businesspeople, the ethics of longevity via pharmacology, designer babies, human/animal hybrids, state paternalism, euthanasia, and environmental ethics.

2. Bioethics just means _______.

3. The _________ required that 'The health of my patient must be my first consideration.' (Hippocratic Oath, Geneva Code, British Medical Association, International Association of Bioethics)

4. What 40-year U.S. study denied information and treatment to its subjects?

5. What did Ivan Ilich warn about in Medical Nemesis?

6. Bioethics has expanded its focus from an originally narrower interest in what relationship?

Some BONUS QUESTIONS:

• Bioethics has broken free of what mentality?
• (T/F) Campbell thinks caveat emptor is a good principle for governing the contractual clinical encounter between doctor and patient. 
• Do descriptive claims settle evaluative issues?
• Name a bioethical website Campbell recommends.

*Some possible Discussion Questions (DQs) - after the quiz we'll select one to kick off a brief class discussion followed by longer group discussion, which some of us may wish to do peripatetically, in the corridors if not out in the chill:

• Are there any important bioethical issues you think Campbell has neglected to mention in ch.1? 
• What do you see as the connection between bioethical and environmental issues? 
• Do you agree that we have "over-medicalized" human experience? 
• Is there anything wrong with "medical tourism"? 
• Do you agree that the doctor-patient relationship is NOT "a straightforward provider-consumer relationship? Why or why not? 
• Etc. etc. - submit your DQ suggestions in "comments" below.

Also of interest:

http://www.nytimes.com/2016/01/20/opinion/is-it-better-to-die-in-america-or-in-england.html?smprod=nytcore-iphone&smid=nytcore-iphone-share Despite all the talk of over-treatment and high costs, end-of-life care in the United States isn’t as bad as you might think.

http://well.blogs.nytimes.com/2016/01/19/supplements-and-safety-explores-whats-in-your-supplements/?smprod=nytcore-iphone&smid=nytcore-iphone-share A new documentary pulls back the curtain on some of America’s most popular over-the-counter dietary supplements.

http://www.nytimes.com/2016/01/21/nyregion/colleagues-express-disbelief-over-arrest-of-doctor-with-picture-perfect-life.html Many colleagues reacted with disbelief after Dr. David H. Newman was charged with sexually abusing two patients in an emergency room at Manhattan’s Mount Sinai Hospital.

http://www.nytimes.com/2016/01/21/health/centenarians-proliferate-and-live-longer.html?hpw&rref=health&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well&_r=0 The number of Americans age 100 and older — those born during Woodrow Wilson’s administration and earlier — is up by 44 percent since 2000, federal health officials reported Thursday.

Introductions

We begin, as in all my classes, with an invitation: tell us who you are, and why you're here. We'll introduce ourselves in class and online (hit "comments" below). I'll start.

I'm the prof for this course, PHIL 3345, Bioethics. I hold degrees from the University of Missouri and Vanderbilt, and I'm here because the ethics of life and death is at the very heart of what philosophy, defined as the love of (and quest for) wisdom, is about. I'm still here in middle Tennessee, after relocating for Grad School, because I met my wife here and decided to stay.

I also teach courses on Atheism, Environmental Ethics, and Happiness, among others.

Enough about me.

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The Doomsday Invention

Will artificial intelligence bring us utopia or destruction?

BY RAFFI KHATCHADOURIAN

New Yorker, Nov.23, 2015

Last year, a curious nonfiction book became a Times best-seller: a dense meditation on artificial intelligence by the philosopher Nick Bostrom, who holds an appointment at Oxford. Titled “Superintelligence: Paths, Dangers, Strategies,” it argues that true artificial intelligence, if it is realized, might pose a danger that exceeds every previous threat from technology—even nuclear weapons—and that if its development is not managed carefully humanity risks engineering its own extinction. Central to this concern is the prospect of an “intelligence explosion,” a speculative event in which an A.I. gains the ability to improve itself, and in short order exceeds the intellectual potential of the human brain by many orders of magnitude.

Such a system would effectively be a new kind of life, and Bostrom’s fears, in their simplest form, are evolutionary: that humanity will unexpectedly become outmatched by a smarter competitor. He sometimes notes, as a point of comparison, the trajectories of people and gorillas: both primates, but with one species dominating the planet and the other at the edge of annihilation. “Before the prospect of an intelligence explosion, we humans are like small children playing with a bomb,” he concludes. “We have little idea when the detonation will occur, though if we hold the device to our ear we can hear a faint ticking sound.”

At the age of forty-two, Bostrom has become a philosopher of remarkable influence. “Superintelligence” is only his most visible response to ideas that he encountered two decades ago, when he became a transhumanist, joining a fractious quasi-utopian movement united by the expectation that accelerating advances in technology will result in drastic changes—social, economic, and, most strikingly, biological—which could converge at a moment of epochal transformation known as the Singularity. Bostrom is arguably the leading transhumanist philosopher today, a position achieved by bringing order to ideas that might otherwise never have survived outside the half-crazy Internet ecosystem where they formed. He rarely makes concrete predictions, but, by relying on probability theory, he seeks to tease out insights where insights seem impossible.

Some of Bostrom’s cleverest arguments resemble Swiss Army knives: they are simple, toylike, a pleasure to consider, with colorful exteriors and precisely calibrated mechanics. He once cast a moral case for medically engineered immortality as a fable about a kingdom terrorized by an insatiable dragon. A reformulation of Pascal’s wager became a dialogue between the seventeenth-­century philosopher and a mugger from another dimension.

“Superintelligence” is not intended as a treatise of deep originality; Bostrom’s contribution is to impose the rigors of analytic philosophy on a messy corpus of ideas that emerged at the margins of academic thought. Perhaps because the field of A.I. has recently made striking advances—with everyday technology seeming, more and more, to exhibit something like intelligent reasoning—the book has struck a nerve. Bostrom’s supporters compare it to “Silent Spring.” In moral philosophy, Peter Singer and Derek Parfit have received it as a work of importance, and distinguished physicists such as Stephen Hawking have echoed its warning. Within the high caste of Silicon Valley, Bostrom has acquired the status of a sage. Elon Musk, the C.E.O. of Tesla, promoted the book on Twitter, noting, “We need to be super careful with AI. Potentially more dangerous than nukes.” Bill Gates recommended it, too. Suggesting that an A.I. could threaten humanity, he said, during a talk in China, “When people say it’s not a problem, then I really start to get to a point of disagreement. How can they not see what a huge challenge this is?”

(Continues here...)

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Readers reply in Dec.21/28 issue:


Bostrom video

Watch this video on The Scene.

Wise editing

	TED Talks (@TEDTalks)
10/24/15, 7:06 AM We can now edit our DNA. But let's do it wisely: t.ted.com/jUtRCzU

"Memory Enhancement: A Perspective within Bioethics"

Posted for John Holloway

“There is no such thing as philosophy-free science, just science that has been conducted without any
consideration of its underlying philosophical assumptions. “ – Daniel C. Dennett, Intuition Pumps and Other Tools for Thinking

Memory enhancement modern day via nootropics, or brain-enhancing drugs, has been swelling
since Piracetam in the 60’s with a potent subtlety.  While this movement of sorts has quickly washed
over the modern day college student, and other groups, the waters grow increasingly muddled as the
number of nootropic users rise. I would like to discuss some of the risks and dangers of nootropic use, the disparaging fairness to differing socioeconomic levels, neurochemical repercussions that are slowly but very surely being included in the literature, and how I believe these substances could make for a misrepresented level of functioning among seemingly untraceable individuals in populations where such functioning is rewarded and admired.  

Nootropics drugs can increase memory encoding and recall, overall mental acuity, brain-derived
neurotrophic growth factor, attention and even analytical ability (variably and respectively.)  There are nootropic drugs that have expansive mechanisms of action and are widely available without prescription or clinically noted cognitive defect. Primarily, these drugs work to increase hemispheric communication, raise levels of availale acetylcholine (acetylcholinesterase uptake inhibitors, the racetams), antagonizing NMDA receptors (Namenda), or simply boosting attention with substances like amphetamines so more astute and fine-cut observations/connections can be established while
distractibility is minimized. Taking a step back to the availability, is it fair that some people can afford quality nootropic substance while others may not have the means to do so, or may only be fiscally prepared for a substance from an disreputable brand? What kind of edge do the people who are knowledgeable on, and can afford, these products have on others who are oblivious to their existence or don’t have the means in the classroom? What about standardized tests? There is a lofty
misrepresentation of the thought-action repertoire and overall capabilities of an individual’s mental
faculties that can occur in someone taking these drugs- and this misrepresentation can make for a slew of ethical concerns. I suppose misrepresentation would only be appropriate if the drug works when you decide to take it, but holds no foregoing benefits of use after discontinuation.

Often an oversight in this area is that of long-term nootropic use with improper cycling. While
with certain nootropic families who have been around for decades (the racetams, piracetam in
particular) and have no reported adverse effects in chronic use, other newer formulas have serious
potential adverse effects on one’s biochemistry as a whole. For example, Huperzine A, or huperzia
serrata, a Chinese club moss is popularly thrown into nootropic blends and sold over the counter
without proper labeling of the risks or instructions of proper cycling. Huperzine A, an acetylcholine
esterase uptake inhibitor, breaks down the enzyme that removes acetylcholine (holds a strong role in
learning acquisition and memory) from the cell cycle after it binds to its postsynaptic receptor. In
individuals who are “healthy” and take Hup A, this means the acetylcholine continues to be recycled
through the cell cycle and builds up in comparative abundance, eventuating into more cholinergic
postsynaptic receptors being constructed, so more acetylcholine can take effect at once. What
eventually happens through daily use (it should be cycled), is the levels of acetylcholine become so high that its very production is slowed (downregulation). As the production of your endogenous (naturally produced within the body) acetylcholine is slowed, you are also building a tolerance to the Huperzine A. What do you do when a medication stops working? Most people will either increase the dose or switch medications, but increasing the dose here will simply exacerbate the precise issues I am writing of. The combination of ACh downregulation, tolerance build up, and ceasing the medication can result in major cognitive impairments in the way of learning acquisition and memory encoding/retrieval as now what little ACh is being produced is only binding to a fraction of the available postsynaptic receptors, plus the acetylcholine is leaving the cell cycle as opposed to being recycled through, making for a large leap away from our body’s natural homeostatic state. We now have very little acetylcholine being produced, our memories are shot and the question arises of is your motivation/willpower strong enough to push through these defects and into the waters of intellectual pursuit to try- pressuring your brain through intensive stimuli and hurdles of analytics to create more acetylcholine, or upregulate it- and succeed with a likely fickle and tentative neurochemical state?

Moving to the future with genetic enhancement of memory, in Sandel’s The Case against Perfection, it was discussed how researchers produced “smart mice” via mouse embryos containing extra copies of a memory-related gene. The impressive, and terrifying, factor to note from this research was that the mice passed their enhanced cognitive abilities onto their offspring. Sandel says “such use would straddle the distinction between remedy and enhancement.” With respect to the concern noted in Sandel’s book, I believe two subspecies of human may very well be a logical eventuation of the cognition enhancement wave- especially with the increasing disparity between socioeconomic levels.
Should we even aspire for such use of our bioengineering capabilities? My theory, being that we are
very social creatures and the peer influence effect is ever so potent, humans will continue to do what
makes them feel good and what they see makes their closest friends feel good. Nootropics could
become the “drug of choice” for a swelling mass of individuals who take pride in perceived cognitive
capabilities over sedation or transcendence-abating stagnancy. This could be especially so if in a world where the population could be seemingly splitting in such a way Sandel spoke of. I believe most with a healthy prefrontal cortex would find the means to become “enhanced.” I say this, just as many impoverished find the means to get “high” in today’s society. Who knows, with so many bold and astute intellectuals bumping heads, the drive to succeed seems likely to skyrocket in such a scenario. Assuming the nootropic game isn’t streamlined in the future where everyone is taking the same concoction, many people will be enhanced with respect to specific areas of cognition, but not all will be the same. Certain jobs are particularly catered to different modes of cognition, like a taxi driver’s need for spatial awareness and memory. While the idea the opposites attract is but a myth, it means we as humans generally like people who are similar to us- but not necessarily similarities with respect to how much we can memorize. Though, we also tend to like people who possess traits we ourselves wish to possess, so in that way the danger of two subspecies of human (intellect) developing may whisk about in a world where people aspire to be sharp-minded. The average Joe with a baseline working and short-term memory taking an Icelandic vocabulary test will do better than “enhanced joe” who took a nootropic, one that has a mechanism of action working on GABA receptors for test-anxiety relief and enhanced concentration (due to less rumination), because joe is likely to be inducing impairments to his memory via the sedating influx of GABA or GABA agonists.

Will we reach a point where in order to keep up with the rat race everyone must ingest some
form of brain-boosting compound, or otherwise be deemed lowly or seen in an inferior light of sorts
when it comes to matters of the mind? Even more problematic, isn’t everything we do on a day to day
basis a series of personal choices, so all of our thoughts and consequential behavior are a “matter of the mind” in essence? Maybe, however, your endogenous levels of acetylcholine are actually too low, and you need the boost to function at some level of equivalency to others of your age of your level of
education. Well, first off, how do you know past pure speculation or experience of a subjectively
withered mental state that you are deficient in some regard? We don’t quite have the tests to
accurately measure neurotransmitter levels- while claims are made on this topic and some tests offered- I believe, in line with the literature, you cannot accurately measure these levels through blood serum.

How would you know where you stand in comparison to others with regard to mental functioning?
Neuropsychological evaluation, sure, but in all reality this wouldn’t be feasible for all, or many.
So what, then, should be the cause for pause or the green light when it comes to supplementing
with these “smart pills?” Should it be done at all? To feel better about yourself in that you function at a perceived higher level of cognitive faculties than you once did? Than your competition currently does?

We do many things to feel better about ourselves, to patch up invisible defects within our homeostatic
state, but nootropics bring about that point where feeling better meets with being psychologically more resilient through a widened spectrum of thought and perception on matters at hand and to come. There could likely be a perceived lacking of innate abilities, I should say, and a danger is exactly that. If one feels a lacking, sometimes a pill of any sort, or a prayer, etc. is enough to make the lacking dissipate into feelings of contentment with one’s own self. A placebo- it can be anything, not just some inert pill. Let’s talk about, not the potential of two subspecies of human, but rather a perceived split-self. Instead of filling a perceived lacking you may possess (you #1) by examining what areas of your life may be lacking in attention, why not take the drug that will make you smarter and more equipped to handle the situation? So, the novel smarter you (you #2) comes about as the nootropics take effect, or even before, and this creates two semi-fixed points on two different spectrums of self. You held consistency of self in your non-nootropic state (barring experiments in inebriation) until you switched gears into the realm of perceived higher mental functioning you didn’t think you were capable of, and the two selves dance and glance about one another, fighting for prominence of being. When not on the nootropics, an intellectually-trying situation may arise where instead of comparing your perceived detriments of cognition to other individuals’ seeming superior abilities, you may now also compare your perceived detriments in an area to something you #2 could have handled with ease. 

The science is far too scarce on the collateral effects, or undesired effects, these drugs may have
in the long-run. Further, if it is true that these drugs can induce a profound deviation from the body’s
homeostatic healing mechanisms even after having been ceased, for the better or worse, are you, as
Hesse would say, “living in accord with (your) true self?” Or James, living in synch with your “habitual center of personal energy?” If an individual approaches you and tells you of a, truthfully, very brilliant idea- one he later says arose after taking a nootropic substance- would you attribute a greater degree of the brilliance to this individual or one who had the same unprovoked idea, by means of his ‘natural’ mind? An issue here within the field of AI would be known as “credit assignment.” Whom, or what, do we attribute the great idea to? If an employee receives a promotion due to landing 4 accounts in one week while experimenting with nootropics, should the individual’s boss be made aware of the substance use? Can he make the promotion contingent on a necessitated continuation of his nootropic regimen?

Further, if individuals use these substances to get ahead in the job market, it is possible one may simply feel obligated to remain on the nootropic they used throughout college. Possibly to impress an
interviewer for a job in your field with “enhanced” mental fortitude and veracity, in fear of a
consequential subpar quality performance of work.

Well the waters start to get muggy when you also consider the fact that by definition, food in
general is a drug. Many foods- like blueberries, lion’s mane mushrooms, sauerkraut, and wheatgrass-
have nootropic effects. Anything consumed that benefits the body nutritionally will inevitably aid in
brain functioning via the very pertinent gut-brain connection, where constant communication is taking place. The gut is considered our 2nd brain, wherein resides close to the number of neurons as your spine possesses, so we are impacting far more than our hippocampus or prefrontal cortex (or other ideal/designated areas) when we consume a nootropic substance, or any substance for that matter, which is important to know but rarely said. A distinction I would make, however, is the literature on nootropics compared to the literature on whole foods would note a statistically significant profundity in psychoactive effects with respect to attention, etc., that is rarely experienced of similar degree after consumption of blueberries. All of this to note that nutrition and whole foods aren’t offering the, generally, instantaneous and flagrant cognitive benefits that nootropics offer- so they are surely something we should examine further, no?

It would seem that, as is typical, knowledge of the realm is pertinent to travelling safely within
its parameters. Those who know how to use these drugs so downregulation (for example) of crucial
neurotransmitters is avoided, those who know where to get the highest quality for the best price, those who know that even after chronic exposure to the substance and a ‘proper’ cycling of your brain-boosting regimen, there is still a chance that one may incur some serious cognitive defects because every individual is different--- these are the ones who will be of a more-informed, and consequently (arguably) superior (in some respects), stature with risk variably but significantly more minimized than those approaching these substances expecting intelligence in a pill with the blind faith positing that if it weren’t safe it wouldn’t be sold over-the-counter, or so popularly used (or abused.) There must be a certain level of knowledge acquired before one can safely swim these waters, just as for driving a motorcycle or knowing how much sugar is too much. If nootropics do become commonplace, considering the multitude that exist nowadays, harm reduction must be priority.