Incidental Art

Readings to consider for the Bioethics Discussion Group, Year 3

Posted on June 12, 2019 by Barry Belmont

Self

Body modification

Body art

Fear

Body politics

Cities

Antinatalism

Others

Michigan

Love

Overpopulation

Public Health

Solitude

Responsibility

History

六四

Posted on June 4, 2019May 14, 2019 by Barry Belmont

A Day to Remember by Liu Wei, 2005

“Survivors from the June 4, 1989, Tiananmen Square protests and massacre shared their stories at a House Foreign Affairs subcommittee hearing marking the 25th anniversary of the student protests.”

Their names

Posted on June 1, 2019 by Barry Belmont

Laquita C. Brown, Right-of-Way Agent for four years

Ryan Keith Cox worked as an account clerk in the same division for almost 13 years

Tara Welch Gallagher, an engineer for six years

Mary Louise Gayle, Right-of-Way agent for over 24 years

Alexander Mikhail Gusev, Right-of-Way agent for nine years

Joshua A. Hardy, an engineering technician with Public Utilities for over four years

Michelle “Missy” Langer, an administrative assistant with the Public Utilities division for 12 years

Richard H. Nettleton, an engineer with Public Utilities for 28 years

Katherine A. Nixon, an engineer with Public Utilities for 10 years

Christopher Kelly Rapp, an engineer with the Public Works for 11 months

Herbert Snelling, a contractor from Virginia Beach

Robert “Bobby” Williams, a Public Utilities Special Projects Coordinator for 41 years.

Another place to go when you’re gone

Posted on May 22, 2019May 22, 2019 by Barry Belmont

While our species has never lacked for places they imagine themselves after life (1), these days the options for where one physically goes when they have shuffled off the mortal coil boil down to roughly “buried” or “burned” (2). Thanks to the collective efforts of The Urban Death Project (now “Recompose”), lawmakers in Washington, and quite a few more, we now have a new way to be disposed of legally: “recomposition”.

Or we almost did.

Recomposition, “the contained, accelerated conversion of human remains to soil” as originally proposed in Senate Bill 5001 of the 66th Legislature of the State of Washington, is a peculiar concept in this stage of human history. It is generally recognized that large scale industrialization and urbanization has resulted in a winnowing of places to stack the dead. At least in the United States this has led to increased cremation as a means of disposal (50.2 percent of Americans choosing cremation in 2016) and the continued decline of human burial (“expected to decline […] to 30.3 percent” by 2023). “Recomposition” joins a growing slate of alternatives to these “mainstream” disposal procedures (3).

Though the use of human remains for fertilizer is not a new idea, it is one that can provoke both revulsion and inspiration (4), and to this point has not be a legal option in the United States. In most of the country, death certificates are issued with a box that must either be checked for burial or cremation. The processes involved in human composing, which require no burial or burning, pose a new disposal category currently without regulation.

Until now.

Wet with Governor Jay Inslee’s signature, the recently passed version of S. B. 5001, redefines “human remains” to include those which have been subjected to “alkaline hydrolysis” or “natural organic reduction” and defines the sorts of facilities required to carry out such an operation. This latter legalean term, “natural organic reduction”, has replaced the poetic “recomposition” in the final version of the bill though it still allows for human composting. Where there is progress in liberty, there is often turgidness in prose.

Still.

Bravo to Washington for serving as an incubator for new and ever bolder forms of “life, liberty, and the pursuit of happiness” and all the stuff that comes before and after them. We are, when we are at our best, stewards to ourselves and our earth(s). I am hopeful to see what we make of them.

1. Consider, for example, Annwn, Asgard, the Asphodel Meadows, Barzakh, Diyu, Elysium, Hades, Hamistagan, Heaven, Hell, Iriy, Jahannam, Mictlan, Naraka, Purgatory, Tian, Tuonella, Valhalla, Yomi, and Youdu.

2. Science never lacking for heroic ironies offers at least the following for this specific tale. The evidence that is cited as responsible for convincing elected officials that such a means of disposal would not spread pathogens – “a research trial with six human bodies” led by one Lynne Carpenter-Boggs, Associate Professor of Sustainable and Organic Agriculture at Washington State University – is nowhere yet to be found. At least publicly. And though scant details are known, at least one speaks of a subset of science’s ironic heroes. The half dozen intrepid volunteers who wished for their remains to be used for the research trial demonstrating the safety/efficacy of composting human remains, had their own, “[b]ecause […] the university required” it, “incinerat[ed].” They join the ranks of the nameless who boldly strove across the biomedical landscape toward their horizon.

3. A short list of which includes but is not limited to “cryonics” in which as much as one’s body can be frozen is frozen as solidly as it can be frozen, “eternal reefs” in which the crushed bone material left over from cremations is mixed with concrete and dropped into undersea habitats, “mummification” in which one can get a taste of the pharaonic life, “plastination” in which one’s remains can be injected with plastic to remain semi-recognizable, “resomation” in which one’s tissues are dissolved via heated water and potassium hydroxide and the bones pulverized into fragments (a procedure made legal statewide with the recently passed Washingtonian legislation), and “space burial” in which a fraction of a fraction of an ounce of one’s cremated remains can be jettisoned into low-earth orbit for awhile.

4. A proponent of the bill, state Senator Jamie Pedersen is quoted as saying “The idea that your loved one could become soil that would be the basis for planting a lovely rhododendron or oak tree or whatever you want could be really popular.”

Consequences of the Quantified Self

Posted on May 15, 2019 by Barry Belmont

It’s not that you ever learn

Posted on May 14, 2019 by Barry Belmont

It’s not that you ever “learn” not to touch fire. That’s not the lesson from the burn. You “learn” the cost, the risk, the pain. You learn to account, to gamble, to tolerate. You learn to measure, to jump, to get the warm and fuzzies every now and again. The lesson is not to stop. It is to know what it takes to keep going.

You should be okay with dying

Posted on May 9, 2019 by Barry Belmont

You should be okay with dying. It’s going to happen.

You should be okay with being okay with dying. It’s inevitable.

You should be okay with being okay with being okay with dying. Most times you will be this without you ever knowing.

Kinda like how you are once you die.

You really won’t notice most times. And you won’t even notice that you don’t notice. Most times.

Sometimes you will notice that you are afraid of dying. Sometimes this will only happen when you’re about to die.

Those times are the worst.

If you only ever fear death once, you died scared. Having feared death many times, I can tell you a life lived past each fear is better. Most times.

Because with fear we reach the end of our understanding. We buckle at the knees.

Fear lies at the boundary of the known and the unknown.

Only by crossing the border do we learn.

Or forget.

Knowing there is a line is enough. There is a demarcation. There is an end.

You will die.

And that’s okay.

It should be okay.

It will inevitably be okay.

Because it will happen. And that’s okay.

It has happened to every single thing that has been. We are invariably all past tense.

Whether it’s now or sometime in the future, eventually you will be gone.

And that’s okay. It happens to all of us.

And there could be no injustice so great it happens to all of us. A god so cruel I could not curse. Imagine how much worse it can be.

And no matter how bad it is, it will end. And sometimes that will be okay.

And sometimes it will be okay that it’s okay.

Sometimes it won’t be. And that’s okay too.

Sometimes it’s not.

It will happen all the same. To the just and unjust will be both justice and injustice, not always in that order. Not always in equal measure. But always.

The inevitable has at least that much in its favor. Inertia from mass, mass from matter, something to matter.

It happens. It happened. It will happen. It once will have happened. It’s happening now. And then. Other times too. Most times. All the times we know about.

The times we don’t know about scare us. Some of those times we are dead. Most times. And that scares us.

And that’s okay. It’s going to happen.

And it’s okay that it’s okay.

And it’s okay to be okay with it being okay. And that shouldn’t scare us.

You really won’t notice most times.

And you won’t even notice that you don’t notice. Most times.

And that’s okay.

It’s called living.

And some of us are doing it. And some of us have done it. And some of us might still do it yet. And then we don’t.

A window between two nonexistences, life is lived. Always eventually lived.

To say one has lived is the highest praise that the living and the lived have yet thought to call life.

We wish to live as maximally in all directions we have yet measured in/of life. So long as we are in/of that life.

Afterward we don’t care. We do not write our own postscripts. And that is okay.

We should eventually let others have a turn. We had ours.

May you have yours as you want it. It’s okay to want it that way. Most of the time. So long as you let others have it theirs as they want it.

It’s called living. And letting live. And we are doing it.

But eventually life will be done with us and/or we will be done with it.

And that will be it. For us at least. For others eventually.

And that’s okay.

All whom we will ever learn of and/or forget, all that is known and unknown, ending — ends — ended.

End.

Their names

Posted on May 8, 2019 by Barry Belmont

Kendrick Castillo, an 18-year-old senior at the STEM School Highlands Ranch

Students, Winter 2019

Posted on May 7, 2019 by Barry Belmont

110 Students Taught!

Number seven (7). A. L. In describing yourself on our recent quiz, you describe us all: “stressed, sleep deprived, ambitious, want to design medical devices in the future.” Pithily are we put. May you relieve your stress, find your rest, and ambitiously pursue your future.
Number ten (10). A. R. One of the hitches that comes with having me as a professor more than once is that I can recall what I said of you last time. “You will be remembered by me’, I had said, “and likely by E. as being the fellow who swooped in for those [extra] points in helping with our [discussion regarding] dying with dignity laws.” I said it then and I said it now “I like your gumption”. May you keep it ever with you.
Number sixteen (16), A. S. Mr. S. has the distinction of being the first to complete the Belmont Triple Crown. Though, several of you have had me for a few classes, A. walked into my ENGR 100 class his first year here with his head held high, strolled into my BIOMEDE 211 class holding his head higher, and he’s walking out of this class with it held even higher. You have learned a great deal and I hope to have aided that learning in some way. May you keep learning from this day on.
Number nineteen (19). L. N. Describing your journey through this class you started as someone “who knew nothing about circuits” and now complete your journey “understand[ing] the importance/relevance to the world and [biomedical engineering] as a whole”. Such a trajectory is the arc toward which the engineering universe bends: to go from not knowing, to knowing, to wishing to know more. May you continue on your trajectory.
Number twenty-one (21). B. P. Though I was unable to provide you with an official “B Glorious Quiz”, I believe you had the magic when you crossed out the “A” and put your own B. P. “B” on it, as you did quite well on this third quiz (as the others). This is but a minor example of the larger point here: you can change the world for the better. May you always make the world better, with a capital B.
Number twenty-three (23). A. B. While it appears that our sausage casing idea to help with bone healing might not work, I suspect it will certainly not be the last of your thoughts the matter and hopefully not the last words we share. Thoughts, ideas, experiments, they require continuance, perseverance, and those with the desire to move them forward. May you persevere in your studies and keep sharing your thoughts.
Number twenty-four (24). Y. H. “This class”, I have you down as saying, “has proved surprisingly interesting to me […] it’s insane how much we’ve learned in such a short amount of time.” Though I might wish to attenuate the surprise a bit (we should expect our subjects to be interesting!), I am glad to hear that you have learned a lot. May you continue to surprise yourself and learn intensely.
Number twenty-eight (28). J. D. Poetry can be found everywhere. Though I have somewhat forcibly infused it here, you gracefully incorporate it into most of your actions. In your recent quiz the answer describing you was broken into lines of a stanza that I quote here
someone who works hard to gain

a clear and deep understanding of everything

that I learn, even when the topic is not something I enjoy.

May you continue in your poetic grace.
Number thirty-three (33). E. B. Though at times you have been frustrated, I have never see you flag or waiver. You show up, you try, and you see what happens. Even more than a principled understanding of circuits, systems, and signals in biomedical engineering, such an approach to life — to \textit{try try try} — will count for something significant. May you always try your best.
Number thirty-four (34). A. R. You have recently remarked upon the “many cool and crazy things you can do with complex circuitry.” And believe it or not it just gets cooler and crazier from here. All the same, may you keep your cool when things get crazy.
Number thirty-seven (37). R. B. One of the chief joys in this profession of mine is the front-seat view of many minor eureka moments. I reminded here of one instance in which you attended my office hours, asked several keen questions, and upon realizing that you had done it all all right from the start, commented “oh, is that all it is?” Yep, this is all that it is. While there’s plenty yet more to learn, you have grasped well what I have put in front of you. May you ever realize what you know.
Number forty-one (41). I. H. To go that extra step is one of the surest signs of the helpful. To share what you have learned is one of the surest signs of the charitable. To do what you can for others is the highest calling of the engineer. As it was you and Ryan put together one heck of a good tutorial on how to create an actual bandpass filter with actual circuit components in an actual circuit lab, we in this class owe you that debt of gratitude. May you continue on your engineering journey helpfully charitable to all you encounter.
Number forty-two (42) E. L. I still find the words you wrote in my ENGR 100 ringing around my head every once and awhile: “nothing should go so beyond the way of nature that it goes against it”. As this philosophy has been an experiment in my conception of Nature and our natures, knowing where the limits lie in each is profoundly important. Thank you this poetry which has accompanied me ever since. May similar poetry accompany you the rest of your days.
Number forty-eight (48). A. S. A personable sort, you have helped to humanize the subject for those around you. Perhaps they have not said so directly to you, but I have been told by others that you have been boon both in class and in study groups. For helping others, I thank you. May you continue to humanely serve.
Number fifty-one (51). M. M. Sunny when skies are gray, chipper when others are dour, you have kept your head up in class and down in your studies. May you find yourself happy in every space you occupy.
Number fifty-five (55). S. D. Not all this language must be so grand, so verbose. In describing yourself you simply stated that you are “[s]omeone learning new things to implement later in life to hopefully help people.” To do what you ought, for who you can, when you are able is the responsibility of each and every engineer. May you continue on in your education, humbly, nobly.
Number sixty (60). D. J. At times, I have seen you doubt yourself. Allow me to allay your concerns: Simply put, you are precisely the sort of engineer I want to see more of in the world. You are thoughtful (as I’ve seen in our bioethics discussion), you are motivated (as I’ve seen in your laboratory research), and you are learning all you can (as I’ve seen in at least two classes now). May you doubt less your once and future success.
Number sixty-eight (68). A. S. You aptly note that “[You and your peers] are the future of this field, which is super cool :)”. Beyond cool, it’s necessary for the continuance of our discipline here. The trick of it all is that you all go off and design medical technologies that folks like me then convey to folks like you who go off and design medical technologies that folks like me then convey to folks like you who then… There can be meaning in repetition. May you find meaning, peers, and a future in this field.
Number seventy (70). E. K. I find it easier to use the words of others when they are substantially better than own on a matter. To wit, of this class you have said that it “consists of many people w[ith] many different backgrounds and many different goals in life, all brought together in a single classroom at 12:30 every Tuesday and Thursday by the shared intent [of] contributing to the biomedical world. […] We all have chance at making an impact on the world.” I could not and dare not say it better myself. May you continue to find the words necessary to charge others full with the charge of soul.
Number one-hundred fourteen (114), K. Y. Another Triple Crown, K. has been instrumental to the in-class dialogue of 211, 241, and 458 and I am not alone in appreciating his tireless input into these classes and no doubt others. May you continue to foster the intellectual camaraderie of your peers.
Number one-hundred fifteen (115), M. K. Yet another. Taking a different tact than that of Mr. Y, you, M., tend more toward the quiet, competent type than the loud boisterous members in our midst. As you will find in life, talent speaks for itself. May your abilities say all that you need.
Number one-hundred sixteen (116), R. A. It takes a certain kind of crazy, a certain amount of smarts, and more than a small dash of patience to succeed here, in medical school, and in life. Though I can only speak to your performance here, it bodes well for your future prospects. May you always keep that balance.
Number one-hundred seventeen (117), E. B. You are the reason I know Michigan sports half as well as I do. Coming into those afternoon sections I knew I better have my stats ready. This speaks, if but tangentially, to a natural “teamfulness” you seem to bring to situations. Where ever you are, you seem to always be part of the team. May you always play on the right team. And Go Blue!
Number one-hundred twenty-two (122), T. H. In the first sentence of one of your first Big List submissions, I have you down as once writing that some device “was created to optimize the cholangiopancreatoscopy procedural process” and the mere fact that such a concept could be understood and communicated is nothing short of astounding. And this is but one of the many ways in which you have shone brightly. May you continue to astound.
Number one-hundred twenty-three (123), R. H. I have noticed that at least in my classes you tend to reside in the quieter meadows of our landscape. Whether it be in 211, 241, or here, where you reside, reflects something of who you are. You are, who you surround yourself with. May you be a peer to those you wish to be a peer to you.
Number one-hundred twenty-eight (128), E. E. In the first one of these I remarked that “You ha[d] the single nicest looking homeworks I [had] seen all year.” I noted that “Such good work consistently demonstrated, even for things as simple as homework, demonstrates consistently good abilities.” I still hold to this as your work has continued to improve time and again. May you ever possess and improve such faculties.
Number one-hundred twenty-nine (129), D. H. Upon entering the first class I had him in, D. confidently declared to all in the room that he was going to be bringing the fannypack back. And while I don’t those fannypacks coming back any time soon, it has been good these past three semesters to see you back again and again. May you always find a way to comeback.
Number one-hundred thirty-one (131), B. R. I have had the privilege of seeing you take your first circuits notes way back (almost 500 days ago) and watching you put together, test, and debug real actual biomedical instruments. Seeing your trajectory is the reason folks like me get out of bed, type up a speech, and want to do it all over again. May you continue to progress and inspire others to do the same.
Number one-hundred thirty-six (136), E. S. It takes a special kind of person, who, having just felt an electric jolt, places the electrodes back on their head. In my mind it is akin to the physics teacher and the bowling ball pendulum. If you know how it works, you have nothing to fear. Such confidence, I hope you hold in your chest. May you be fearless all the rest of your days.
Number two-hundred sixty-four (264), T. P. Not to express any sort of preference or favoritism in the assessing of assignments, but I did have something approaching eagerness regarding your Big List submissions. On the one hand, it was great to learn about a whole segment of medical technology that I am woefully ignorant of (sports medicine, athletic training), on the other, I worried each time of what new injury befell you. But, you’re still here and Nietzsche reminds of the strength that comes from adversity. All this to say, may you stop hurting yourself so much, but continue on in your biomedical engineering pursuits.
Number two-hundred sixty-six (266), N. B. Rare is it for me to compliment someone here for work they did in another class, but I have to admit your functioning child’s wheelchair is one of the coolest things I’ve gotten to see this semester. Sorry to say we can’t claim all the credit for it here, but I hope some of the electronics skills you learned here carried over effectively. All the same, may you ably help the disabled and care for those who need it.
Number two-hundred sixty-eight (268), Z. S. It goes to show that though I learn to know a bit about each and everyone of you while here, it’s in the hallways where we can sometimes be known best. Outside of this class I have learned that you have done a great deal outside of this class including volunteering at Veterans Affairs hospitals and with the Red Cross. May you continue to hold important both what you have learned in this class and what you have learned out of it.
Number two-hundred seventy-one (271), L. E. I particularly enjoyed your Big List summary of the torniquet, where in addition to explaining its basic function and purpose, you go on to situate its use in everything from “the conquests of Alexander the Great” to the microprocessor controlled modern day versions. Such contextualizing I believe aids in understanding. Indeed, I have tried much the same myself. May you find the context which best suits you.
Number two-hundred seventy-two (272), A. J. Affable, driven, sometimes funny, I hope you take no offense in me deeming you one of the friendliest people I have met. You are a natural on a team and a confidant one-on-one. As you journey through your biomedical landscape, may you ever find yourself among friends.
Number two-hundred seventy-three (273), T. L. No one in this room knows better the this true and fundamental fact: you either run with The Pack or you run from The Pack. And though we both be far from “Home Means Nevada”, you, I, and all of us here have grown closer in the larger biomedical community. Home, as they say, is where the heart is. May you continue to improve the pack and find your heart at home.
Number two-hundred seventy-four (274), A. M. I didn’t know what quite to expect when I first put together the Big List assignment. While most appear to have submitted random devices, your were one to stick to a theme writing up summaries for dental implants, dental cone beam computed tomography, an electronic apex locator, and dental curing lights. Sounds like you’ve got an interest in teeth. And that’s good because for most of human history poor dental hygiene was killing most people. May you continue to have an interest in the smiles of others.
Number two-hundred seventy-five (275), D. R. Few are those as motivated as you to help as much as you do. Whether it’s for client-based projects, bioethical discussions, STEM outreach, or taking a gamble with the Michigan Wearable, you possess a preternaturally helpful disposition. May you continue to help all you can.
Number two-hundred seventy-six (276), J. S. As among the first and the few to complete a Michigan Wearable assignment, thank you for your efforts. As you have no doubt begun to appreciate, there is an inherent “fog of war” within experimentation. And our attempt at that assignment, well, it was plenty foggy. Yet, you were the first to brave the unknown and there is something to be said for that. May you continue boldly on to greet the unknown.
Number two-hundred seventy-seven (277), J. S. I am assigning you the Softest EOG Mask For Newborns To Track REM-Cycle Sleep Award. While perhaps a small prize, it is well earned. I have seen you deftly handle hardware, software, and importantly (both in this class and in the last) laboratory documentation. May you continue to be adept at all you handle.
Number two-hundred seventy-eight (278), J. S. There is a special place in an instructor’s heart for those who sit in the front row. There is also a special place in an instructor’s heart for those who actively participate in the class-wide dialogue (again, we best learn from each other). Have occupied both roles, let me say that my heart is glad of it. May yours guide you well in the future as you find a place near the front to share.
Number two-hundred eighty-two (282), M. W. I once wrote of you, “In all of [her] endeavors, she has demonstrated a knack for problem solving and team building. M. truly does embody what we might call the leaders and the best that we expect of this university.” As a fixture in M-HEAL and with an eye towards global health, may you continue to lead and be the best of us.
Number two-hundred eighty-four (284), E. F. Last year I said of you in that long, rambling speech, that were a ”consistent participant in our laboratory exercises and seem much appreciated by your team mates.” Thus far I have been presented with no evidence to the contrary that you work well with others and others, when working with you, do well. May you and all those you partner with do well and do good.
Number two-hundred eighty-seven (287), C. N. Good humor and a good skill base will get you far in life. Better humor and better skills will get you farther. In the academic year that I have gotten to know you, you seem only ever to be improving in each. May you continue to better what you are good at and laugh at the rest.
Number two-hundred eighty-nine (289), C. P. When last I was singing your praises up here I was underlining your observation that “everything in America is ‘awesome’”. Again, you are goddamned it is. But, that is due in large part to welcoming awesome people like you from around the world to make it so. When you leave for your eventually-to-be-Brexited home, carry with you all the best that you have learned here and may it make you awesome, wherever you go.
Number two-hundred ninety (290), B. K. To spare you a quote from Socrates this time, allow me to say that there is always something to admire in the person willing to be the test subject. There is often risk, with minimal direct reward. It is the prerogative of the charitable. As I have seen you hook yourself up with all manner of electrodes for every team you have been a part, you have shown yourself to be a selfless self, here to help. May you continue to help others as you test yourself.
Number two-hundred ninety-two (292). M. A. I have written of you recently, “[b]eyond being an objectively good student, Matt is one of those driven types whose flame behind the eye is apparent to all who meet his gaze. He has spoken of his desire to pursue advanced education after college (an M.D., a Ph.D.), having planned so far ahead for that possibility that he sought out research experience as early as his freshman year, a dedicated spirit that is remarkable even in the fertile and competitive grounds of Michigan.” I meant every word. May you continue to keep alight that flame behind the eyes.
Number two-hundred ninety-three (293), J. L. A woman after my own heart, quite literally. You were the first (and only so far as I can tell!) person to submit a wearable medical device, in fact the first clinical grade personal electrocardiogram approved by the FDA (happening just a couple of years back). Understanding that cut edge is necessary here out in the biomedical frontier. Your concise and precise distillation of the current will serve you well in the future. May you continue your concision.
Number two-hundred ninety-four (294), R. L. You have shown yourself to be a woman dedicated. Every extra hour I saw your team in the lab, I saw you there. Every extra effort, I saw you push. Every little thing, I saw you take a big swing at. And while we do not always connect with the ball (that bioimpedance sensor has been a lot of fun, hasn’t it?), stepping up to the place is the first thing you got to do. May you continue to dedicate yourself every time you step up.
Number two-hundred ninety-five (295), K. F. I hope you got to play around with that Argus II system to your heart’s content. While I have tried here to give you as much exposure to “real world” medical instrumentation, there is nothing that can substitute for “real world” experience. (Again, some of this, I think you should understand, is artifice.) May you continue to learn from the “real world” and do what you can to make it a little bit better.
Number two-hundred ninety-six (296), M. M. Not to say that there is a difference between the work ethic of undergraduate students and graduate students, but there is a difference between the work ethic of undergraduate students and graduates students and you, M., embody it well. Even the to casual observer it is obvious that you are a serious thinker and doer. What you set your mind to achieve stands little chance of not being achieved. May you advance to your candidacy, pass your defense, and go on to do any and all great things you set your mind to.
Number two-hundred ninety-seven (297), M. O. I know I didn’t give any template for how to submit things to the Big List, but you created order where there was none, turning in clean, clear, and well laid out information regarding your devices. Such a spontaneous ordering of thoughts to achieve worthy ends is what we’re all after here. And as you go after it, may you calm the chaos and keep steady your ship.
Number two-hundred ninety-eight (298), A. P. While I hope you have learned much here, I suspect you’ve learned much elsewhere. Having presented your own research at an academic surgical conference in Texas, while balancing your responsibilities to the rest of your teammate’s within the first month of classes, shows that you probably knew a lot before entering this classroom. All this to say, you are shaping up to be a mighty fine biomedical engineer. May you do that and more in the future you want.
Number two-hundred ninety-six (299), M. K. I have gotten the chance to see your skills in a number of arenas. I’ve seen you swiftly handle even my trickiest questions during share-outs, I have gotten to see the work you have conducted with Scott Lempka and Tim Bruns in microposter format, and I have seen what you have made in our laboratory. And in each case it echoes your belief that “we learn better when we work to solve problems ourselves.” May you continue to learn by solving as many problems as you can.
Number three-hundred (300), H. S. A reserved fixture in this class, I have found that you are not a man to mince words, saying it straight, “telling the truth the best way that [you’re] able”. One finds, the more one goes along, that those saying few words are not saying little. May we continue to hear from you.
Number three-hundred one (301), R. S. Though the second Rachel on this list, you are second to none in your efforts here. As continue on in your Master’s may you master the material with effort, not burden.
Number three-hundred two (302), D. C. You are a man driven. You are a man driving. You will get where you are going, of that I have no doubt. It is my hope to have taught you something of what you ought to do once you get there. The rest is up to you. May you enjoy the journey as well as the destination.
Number three-hundred three (303), A. K. Your Big List discussion on radiofrequency ablation was well articulated and interest generating. Though you stated starkly that such devices are “used to destroy tissue” you quickly noted that it is meant to remove what is unwanted while keeping the rest.May you remove from you life all that is unwanted and just keep the rest.
Number three-hundred four (304), R. D. In explaining why you wished the homework question you proposed should be included you said that “after completing lab 1 I had a pretty good idea of how to measure the electrical activity of the heart”, yet you wished to know more about the role of electrodes in this whole system. It takes a keen eye to observe the happenings at the interface, be it between electrodes and skin or this room and the next. May you continue to refine your keenness.
Number three-hundred five (305), J. G. A man determined is a hell of thing. Those who peer to the horizon with some sense of how they might seize it, those are the types we want in this room. You have been a man with a plan from the moment you walked through the door. And I can appreciate that. May others do as well.
Number three-hundred six (306), L. H. Odd as it is to call out, I believe your in-class explanation of venous pressure measurements systems was among the best I have ever heard. Having spent some time in this space, I’ve heard many explanations of why the measurements are important, how they are typically measured, and what sort of problems arise. And yours was right there at the top of it. May you your ascent to the peaks in front of you.
Number three-hundred seven (307), A. B. Not that it’s a contest or anything, but I think your submissions to the Big List had the consistently best names in my mind, including: ECMO, Hemolung, an acetabular system, NERVANA, FallSkip, and iPill. It’s a skill to identify the poetry of the art, but you seem to have a natural affinity for it. May you continue to find the grander poetry of the routinely mundane.
Number three-hundred eight (308), M. C. In your loop of the hospital you noticed a lot of “doctors”, “nurses”, “patients”, “security guards”, “art”, “landmarks”, “ways of getting lost”, and “the dog Bambi that [the hospital has] that goes around the hospital giving comfort”. Being able to take in the intimate details of the larger whole is a true talent. May you continue to see the trees and the forest well.
Number three-hundred nine (309), M. C. To have an opinion — the mind to conceive it, the heart to express it, the liberty to share it — to have an opinion is one of the most useful things a person can have. (Consider its mere inverse, the consolations of the naive.) To have an opinion on markets in healthcare is one damn interesting and useful opinion to have. May you continue to hone yours and share with all you can.
Number three-hundred ten (310), K. G. Though I have down as saying that you “did enjoy finding out more about Michigan healthcare” during your tour of the hospital, I think it was also important for you to discover that you “really don’t enjoy hospitals, [e]specially the hectic atmosphere of the ER[, which you] found [] anxiety inducing.” Indeed it is quite one thing to “know the truth” of something (doctors assess patients, send for tests, analyze results, consult with colleagues, and document the whole thing) and quite another to “know the reality” of it. I hope this class has enabled you to know both. May you know that and more.
Number three-hundred eleven (311), J. R. Though strictly anonymous, your single spirometric data point shifted the classes curve significantly. That kind of influence emphasizes what sort of singular individual you are. May you continue to stand above the crowd and find yourself there.
Number three-hundred twelve (312), L. V. You are one of those strong, quiet types in this class, competently and confidently putting out quality work with few extraneous words. As a man of many extraneous words, I can only sit and admire your fortitude (and your grade). May you continue on in confidence.
Number three-hundred thirteen (313), A. V. I credit much of the future success of the Michigan Wearable as an assignment in this class to your clever module-based solution. It’s one of those clear strokes of genius that forces folks like me to smack our forehands and cry to the heavens, “why didn’t I think of that?’” May you continue to have such clever ideas.
Number three-hundred fourteen (314), M. Y. You were the first to discover that you could complete the Big List assignment quickly, submitting twice the first time and knocking it out the second. Taking chances to improve and expedite outcomes is our job description. May you continue to discover as many ways as you can to efficiently solve the problems before you.
Number three-hundred fifteen (315), A. G. Not that there was any right or wrong way to go on the tour of the hospital, but I think your version of it probably ranks among the better of it. We do not all get to see Big Bird in our journeys. Indeed, we best heed Big Bird’s wise words such as “asking questions is a good way of finding things out” and “it’s better to be who you are, turns out people like you best that way”. May you continue to find the unique in your journey, ask questions along the way, and be who you want all the while.
Number three-hundred sixteen (316), R. K. As someone whose work often has the appearance of disjointed chicken scratch, I must admit that the clear ordering of your thoughts on homework (as seen here), in the middle of debugging, and during share-outs has me envious. This is a skill that will serve you all the rest of your days. May you continue to make clear the order of your thoughts to all will hear them.
Number three-hundred seventeen (317), Z. Z. I hope your “real world” exposure to actual ambulatory medicine has been complemented by the technical content you’ve learned here: how the devices work, what can be done when they don’t, how to make better ones. But an important part of that, namely patience in the face of the unknown, you already have in spades. May you continue to help those in need of it, ever surer of your abilities.
Number three-hundred eighteen (318), V. M. I hope some of the skills you’ve developed here can carryover into your instrumented van. Moreover, I hope the ponderings on extinction shared over salad with L. and a couple of researchers, complements your education here. We are working to prevent that. How? May you always find an answer.
Number three-hundred nineteen (319), S. S. Your personal experience with medical technologies is profoundly more intimate than can be provided within the confines of this classroom, this schoolhouse. That you have taken what you know to be true, to be real, and to be experienced and combined them effectively in the design of your own medical device, speaks to skills I hope you continue to develop. May you always know what is true and real and experience nothing less than the best in life.
Number three-hundred twenty (320), T. R. As a Ph.D (pre-)candidate, I expect that I will see you around these parts for the days and years to come. Thus, in this case, I offer no “good bye”, but a “see you next time’” At that time I’d like to hear about your research, your time in Ann Arbor, see who you’re shaping up to be. To that end, may you be who you want, learn what you need, and help all you can.
Number three-hundred twenty-one (321), M. P. I do not envy anyone having to take this class with no prior electronics experience. It’s been awhile since I’ve read Dante, but if I remember right that was a facet of one of the first rings of Hell. Yet, for all the struggle that must have accompanied your journey through this class, I have never seen it affect your disposition or your work product. May you continue to keep a steady course wherever you may roam.
Number three-hundred twenty-two (322), A. A. Another woman after my own heart, I have you down as once saying that you “really liked learning about electrodes are used in a more chemical sense, […] pH electrodes, polarizable/non-polarizable electrodes & how redox equations & Nernst potential play a role.” In fact, it was my own revelations regarding the electrode/electrolyte interactions in an electrochemical sense that sent me along many of my own research avenues. May you find you like more the more you learn.
Number three-hundred twenty-three (323), S. O. Considering that only within the past month have I learned that you prefer K., I feel I still have much to know you. The hundred days bounding this class frame only a moment in time of the woman known as K. May you continue to prompt others to know you further.
Number three-hundred twenty-four (324), M. H. How a person manages to get into both this class and its genuinely required prerequisite class (BIOMEDE 241) speaks to a persistence and fortitude found in few. May you continue on your own path just as surefootedly as you walked in this door.
Number three-hundred twenty-five (325), S. E. It’s amazing the things you can learn about a person from a single email signature. And though you might not brag on it here, allow me to say that I think the fact that you have been able to do what you do here in this class while simultaneously serving as President of Michigan’s chapter of the Student Veterans of America and as a Peer Advisor over in the ECE Department is nothing short of incredible. May you continue to serve ably in all you apply yourself to.
Number three-hundred twenty-six (326), W. L. I especially appreciated your summary and discussion of CardioMEMS™ HF System the first FDA-approved wireless heart failure monitor. You note only discussed the human impact the device has, but when to great lengths to explain how the a hermetically sealed capsule containing an inductor coil and a pressure-sensitive capacitor, whose resonant frequency changes with blood pressure. Being able to hold both the human and the technical, both the biomedical and the engineer, in your head is what puts us all in this room. May you continue to understand both the human and the technical.
Number three-hundred twenty-seven (327), J. B. In you I see emphasized the focusing of effort we all go through within the semester. Starting off by describing a “centrifuge” as your first Big List device, you finished by summarizing the “Visian Toric ICL artificial lens”. Which is to say, that you, we, have gone from not quite knowing what it is we were looking for or supposed to be doing to competently communicating to one of skill in the art key aspects of a modern medical instrument. Having done this much, I am not sure what further I can do to help you. You are now beyond me. May you to hone your focus and go beyond what others envision.
Number three-hundred twenty-eight (328), N. D. I am sorry to hear of your recent tragedy. I am sorry further to say that life ahead of you has many such tragedies. We are beset on all sides with fortune and misfortune, destiny and chance, happenstance and circumstance. To find or to mine or to create some kind of purpose in all of this is the unspoken task assigned to each of us at birth, perhaps sooner. To do so with friends and family is one of life’s chief joys. May you continue to cherish both.
Number three-hundred twenty-nine (329). S. P. I hope your recent trip to Champagne-Urbana as a manager of the University of Michigan’s Men’s Gymnastics team was enriching. As it turns out, there is more to learn and do and see than the confines of this class allow for. May you continue to learn and do and see more after our time here.
Number three-hundred thirty (330). R. S. An honest person is worth more to this world than all the talents all the liars may muster. From the first homework to the last, you have written right at the top of your homework who it is you worked with during your attempts. Such forthright admission is admirable and I hope you continue on your path honestly and forthrightly.
Number three-hundred thirty-one (331). R. R. I hope you have begun to appreciate that there is more to each subject than what a single class can say. You have gone from the briefest of glimpses of neural engineering in that incubator class to the slightly less brief view of the electrical engineering undergirding that discipline here. Yet, we were here only for a moment, however brief and wondrous. May you find more such moments in life.
Number three-hundred thirty-two (332). W. C. Those students in the back of the room have the reputation of being the disengaged, the disinterested, the uninclined-to-do-well. Not so in your case. Consistently dominating the homework and the quizzes, you have shown that learning can happen anywhere in the room. May you learn where ever you are.
Number three-hundred thirty-three (333). J. G. You striven greatly, learned immensely, participated fully. You have done each and everything I could ask you to do and you have done it well each and every time. Consistency of such efforts will take you far into the healthcare landscape. May you continue in your stride.
Number three-hundred thirty-four (334). K. S. I have enjoyed and been thoroughly enriched by your independent research this semester. While almost wholly devoid of bioelectrical content, it has nevertheless enabled me to see your scientific mind in action and your experimental approaches on display. And though just the first steps of an endeavor that may end in heartbreak (experiments rarely go as expected), I know from your recounting the existential happiness you get from such Sisyphean efforts. May you continue stepping forward.
Number three-hundred thirty-five (335). D. K. Though I am man of many, far too many words, I can appreciate when others have better words than I. Indeed I have found no better compliment of this class than in your recent comments on the subject . This “[c]lass”, to quote you verbatim, “was pretty fucking dope.” What more can I say, then to say, you’ve express all I ever wanted this class to express. May you continue to find the rights words and express yourself accordingly.
Number three-hundred thirty-six (336). I. M. Some people quietly come in, crush their assignments, and walk out. You, in this case, are some people. As an aspiring doctor and/or engineer, you have deftly handled the material in front of you. Of the three quizzes you have been given, you have lost the fewest points. For that, you should be proud. For other things too. May you continue your competence deftly, developing confidence along the way.
Number three-hundred thirty-seven (337). N. P. “Just a man” or so I have you saying “trying to excel at what he does so he can make an impact in some way, shape or form […] to help people and solve problems.” The hopes and dreams of an engineer manifest. May you excel and help others while doing so.
Number three-hundred thirty-eight (338). E. R. You have said that you are “here to learn [and] understand as much as I can and hopefully have some fun along the way.” Here, at the end of this class, I hope you have learned and understood as much as you could and had a little fun along the way. To know and to grow in the subject is the responsibility of every engineer. May you learn how fun it all be.
Number three-hundred thirty-nine (339). H. S. Your consistent conceptual questions have aided you, the students around you as you ask them, and me as well! You have a mind structuring itself to reality. This positions you well to “ultimately save or benefit more people’s li[ves].” May you continue to ask good questions.
Number three-hundred forty (340). M. W. Again, when I find others saying what I wish to say, I merely quote them. To quote you: “As an engineering student, this class has given [you] a basic understanding of circuits, system response, and many other topics along the way. Our methods of analysis and logic have improved [your] critical thinking. [You]’ve seen actual applications of the material we’re learning and [you] have a basis off of which [you] can learn more about things like instrumentation.” From such a description it is obvious to that you have understood the purview of the process: to learn, to know, to learn more. May you learn more to know more to learn more still.
Number three-hundred forty-one (341). K. A. In my short time teaching I have come to discover that those saying few words are not those saying little. May we continue to hear more of what you have to say.
Number three-hundred forty-two (342). M. B. I personally believe in mildly embarrassing the truly talented among us as humor is all the rest of us have. (Or tears.) To that end, allow me to state here for the record that earned the highest grade on the hardest test that I’ve yet put together. And that is one hell of an accomplishment. Join me in a round of applause. May you continue on with such an embarrassment of talents.
Number three-hundred forty-three (343). F. H. You have described yourself as “optimistic, excited for the future, [and] interested in improving the quality of life for others.” May I say, I think you have found your calling here. Our glasses are fuller, our futures are brighter, our lives are improved by those driving to do so. May you keep your optimism as you excitedly dash into the future.
Number three-hundred forty-four (344). S. J. Every year there is a student who comes in, says about half a dozen words, and collects one of the highest grades in the class. This year, you are that student. Though I may not have had the opportunity to learn about you in a more personal setting, your work speaks for itself. Talent needs few words to express. May you achieve all you want and say all you need.
Number three-hundred forty-five (345). D. N. One of the things I genuinely appreciate is when someone in the back discusses the subject with me up here at the front. As we exchange words with one another, a few stray phrases find their way to ears that may benefit. Such indirect helpfulness often accompanies those honestly searching for the truth. May you continue to help others as you honestly search.
Number three-hundred forty-six (346). M P. Though I think there is much that can be improved in your handwriting skills (as a lacker of those skills, I can identify their lack in others); I think you have learned just about all I can teach you with regards to electronic circuitry. May you continue to learn long after this class. And write it up well!
Number three-hundred forty-seven (347). S. S. I have you as saying that you are “always on the verge of freaking out”. One of the lesser used definitions of a “verge” is a rod carried by a high official as an emblem of the office. Wear that badge of the engineering student “freak out” proudly. Just be sure those precarious steps along the precipice are accompanied by similar travelers. May you never walk alone.
Number three-hundred forty-eight (348). E. S. Your submission to the GitHub modeling the the neuron via Python is downright fascinating and I would encourage everyone in this room to read it if they have not already done so. You go through a basic description of a neuron, establish a set of equations governing the openings and closings of various channels, and you code the whole thing up for us to see. Application of knowledge is ultimately what they pay us engineers for. May you continue to apply what you learn.
Number three-hundred forty-nine (349). D. C. If no one has yet done so, I would like to thank you for your consistent participation in this class. Your questions are not the only ones in lying in the hearts of those here, yet you gave voice to them and asked what others did not, dared not. May you continue to give voice to the voiceless.
Number three-hundred fifty (350). C. C. Rumor has it that you are interested in going into pediatric medicine. You may not know this, but that was what I wanted to do when I was younger, around middle school. But, upon learning of the mortality of babies, their finitude, I crumbled. I lack the bravery necessary to help those most vulnerable. I am humbled to see that you do not. May you have the courage to help the meek, the bravery to help the mild.
Number three-hundred fifty-one (351). N. H. You have said that as engineering student you have to work hard. (I believe your actual quote was “I have to work a lot hard than the LSA kids”, but let us not compare ourselves to them!) But you noted that “it will be worth it when I am the reason people can stay alive.” Indeed, your tireless efforts here will prepare you for just worthwhile activities. May you keep your reason alive and help others in the future.
Number three-hundred fifty-two (352). F. Q. I always appreciate when someone “gets” what I am after, when they pick up on what I am putting down. You have said that “this class has taught me so much more than I expected. Not only have I learned about the fundamentals of circuitry, but I also learned the importance of genuinely understanding material versus just getting correct answers.” If you have learned this much, then I have little else to teach you. May you continue to learn importance, genuinely understand, and always get out of this life more than you expected.
Number three-hundred fifty-three (353). A. R. You have claimed to suffer from “mental blocks at times”. You could have and did fool me. I have seen you as hardworking, intuitive, and able to integrate what you have learned into your problem solving. May you continue to work hard, intuit well, and smash through each and every mental block foolish enough to get in your way.
Number three-hundred fifty-four (354). C. S. It is a shame that I had to get to the penultimate-penultimate student of this to see my own philosophy stated better. To you, you have said, “being an engineer means holding myself to a certain standard and having the ability to solve problems directly by creating [] physical system[s].” Indeed, you must rise to your own standard. You must test your own mettle. You must measure the charge of your own soul. May you continue on with both high standards and high hopes.
Number three-hundred fifty-five (355). J. W. Though obviously not your favorite subject matter in the world, you have shown up each day to this class to learn what you can. You participated early both in our board work and in our GitHub document. You have tried. And the fortitude of those who can try their best at what they like least is character-trait I dare say more important than electronics knowledge. May you continue to show up where there’s a challenge and face it, shoulders squared.
Number three-hundred fifty-six (356). A. S. A late great addition to our class, showing up on day one without a seat to your name and continuing on here til, right up front, ready to learn. Tenacity does wonders for the tenacious. Often it is the tenacious that do wonders for the rest of us. May you continue tenaciously on in every class you find a a seat in.

232 questions to ponder

Posted on May 3, 2019 by Barry Belmont

Over the course of the two years the Bioethics Discussion Group has been around, at least the following questions have been asked and considered. May they help you in your own ponderings.

On alternative medicine

On animal experimentation

On assisted reproduction

On life-preserving technologies

On LGBTQ health

On neuroethics

On posthumanity

On prenatal screening

On race

On regulation

On the replicability of medical studies

On vaccination

On zombies

Pop culture-based (Created by Bobby Graham of BIONIC)

On Game of Thrones

On Harry Potter

On Star Wars

Alternative medicine

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

Animal experimentation

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

Assisted reproduction

Is infertility a disease? Should it be treated as such? Should it be covered by insurance? Should it be included in universal healthcare programs (that is, should its diagnosis, treatment, and prevention be funded via tax payer money)?
What role should the age of potential parents play in weighing decisions of assisted reproduction? Should those past their “reproductive primes” get lesser priority, greater or the same as their younger counterparts?
Does in vitro fertilization cause a negative externality to society in suppressing the impetus adopt children? Put differently, what is the correlation between adoption and assisted reproduction and does it come with any moral obligations?
During in vitro fertilization, many embryos will be fertilized but only a few will be implanted. May we test on the non-implanted embryos? Who should bear the cost of sustaining frozen embryos?
Assisted reproduction is increasingly used by same-sex couples to have children. In some cases of lesbian couples, one mother is the biological mother (providing the fertilized embryo) and one is the birth mother (carrying the baby to term). Should one of these mothers enjoy a preference under the law (such as is currently the case for mothers v. fathers in custody cases)?
Often babies conceived through assisted reproductive means have co-morbidities, that is, they will often have lower birth weights, are susceptible to birth abnormalities/defects, and are at a significantly higher risk of having future health problems. To what degree should such future costs be factored into the initial decision-making process of going through with assisted reproduction?
What does it mean to “play god”?

Circumcision

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

Clinical trialing

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

Cloning

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

Drugs

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

Extinction

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

Gender

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

Life-preserving technologies

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

LGBTQ health

To what extent is a person’s gendered/sexual information morally/ethically relevant to decisions made by and with regards to that person? To what extent ought this information be relevant in our lives? What principles would you call upon to justify your “ought” belief.
Confidentiality is often taken as a bedrock principle of medical fields. “It is founded” as Safken & Frewer (2007) note “on two main principles: first, there is the physician-patient relationship; only a patient who fully relies upon the physicians’ confidentiality will reveal personal and intimate details about his state of health. The second is keeping the patient’s secrets, which is essential for public confidence in the medical profession and an efficient health care system.” However, from time to time there arise situations that might compel a physician to warn a third party. What are some examples of situations in which a physician might have an obligation to warn some third party about a patient (e.g., about or because of an illness that might infect them, etc.)?
Is it ever okay for a medical professional to disclose a patient’s gendered/sexual information to a third party? What if it is against the expressed wishes of the patient? (Put plainly, is it okay for a doctor to “out” someone for their LGBTQ activity/identity?)
What are a few medical/societal conditions that uniquely affect LGBTQ communities? How might one go about positively influencing such conditions so as to bend the moral arc of history in a preferred direction?
Why did it take so long for America to legalize gay marriage?
What are current environments out there like for LGBTQ communities? What has gotten better, what has gotten worse with time? Why do you think that is? Is there anything we can do to, again, bend that moral arc?
Should marriage be a federal institution?
To what extent should we suppress the puberty of children? Can a parent make that decision without the input of the child? How much weight should we give to the child’s preference/wishes in making such a decision? What about other medical decisions? Is there something unique to gender-altering procedures that are different than other medical procedures?
What’s next? We know our country hasn’t yet mastered “liberty and justice for all.” What further liberties ought we to extend to one another / recognize for one another?

Neuroethics

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

Posthumanity

What is human? What is a human being? Can a human exist independently (at least in principle) of their biological body?
Is there an ethical distinction between treatment and enhancement that we should be aware of and respect as legitimate? Could people, for example, be justified in genetically modify themselves simply because they felt like it or because it was a Tuesday?
Would you personally wish to be post/transhuman? Can youever be post/transhuman?
Do you believe, as does futurist Ray Kurzweil, that the singularity is near? What implications does the nearness or farness of human-level artificial intelligence have on our moral decision making?
If only one half of the population could be effectively treated/enhanced by a technique/technology, can we justify its broad use? Must a technology be as egalitarian as possible to be as morally upright as possible?
I have some sense of what a “crime against humanity” might be, but what might a “crime against posthumanity” look like? Would the crime be “more” or “less” severe?
Can a robot have rights? Could those rights ever become equivalent to human rights? Are they greater, less than, about equal to, or incomparable to animal rights?
Should human beings seize control of their own genetic dispositions, evolutionary progressions, and biological status? Or ought some of these things be left to “nature”?
Do we really need to develop a philosophy of cyborgs?
Haraway refers to a cyborg as “a hybrid of machine and organism, a creature of social reality […] lived social relations, our most important political construction, a world-changing fiction.” She goes on to state that “taking responsibility for the social relations of science and technology means refusing an anti-science metaphysics, a demonology of technology, and so means embracing the skillful task of reconstructing the boundaries of daily life, in partial connection with others, in communication with all of our parts.” What do you make of her use of a construct from 20th century science fiction to describe 20th century women and (how) does it apply now to our own age?
Take two individuals, A and B. Swap half of their organs after ensuring immunocompatibility. Have the identities of A and B changed?
How do you think the human species will end?

Prenatal screening

Can one ethically/morally prefer to have one sex/gender of child as opposed another?
The elimination of disease/disability is often given as a justification for prenatal genetic diagnoses. Moreover, this argument is used in favor of some selective abortions, such that if a fetus is exhibiting signs or genes that show it would have a disability later in life, that genetic alteration or selective abortion might be called upon. Is the argument-from-disability a philosophically sound argument for the implementation of prenatal genetic screening? Is its extension to use of genetic manipulation, genetic elimination, justifiable?
If you could have known what sort of biological situation you were getting yourself into (please consider your past, current, and perceived future life) and you yourself could have changed it to one you might consider more desirable (being a man/woman, lacking a certain ailment, etc.), would you choose to make use of such information? Would you want to be aware of such information at all?
What is the distinction, ethically speaking, between medical and non-medical choices?
Were we to develop pre-prenatal screening techniques, such that we could choose what type of child we could/would have before conceiving of that child, what reservations in regards to prenatal screening would be alleviated? What new reservations would be added?
How does the relative inequity of the availability of means in prenatal screening affect our ethical considerations? Put conversely, what if everyone had the means of controlling the birth of human beings they bring into this world?
Do parents have a right (and/or a responsibility) to do all they can to ensure their child(ren) have the best possible lives, even if that means selecting from their best possible children?
Is nature a just arbiter?

Race

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

Regulation

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

The Replicability of Medical Studies

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

Vaccination

Do we have a right to tell others how to live? If so, under what circumstances do we have such a right?
To what extent can/should a special organization (e.g., a trade union, a corporation, a school, a government) have a say in the health of its members? When can an organization force a member to subscribe to its health “mandates”? Are there certain medical decisions in which third parties have a legitimate stake in?
What is the “public good”? Is it distinct from the “common good”? Should the public and/or common good influence medical treatments, healthcare, and/or public policy? How so?
Are there times when the public and/or common good outweigh individual liberties? If so, under what circumstances? What does this greater public/common good look like and why is its presence more desirable than that of individual liberty?
Do we have a right to tell others how to raise their children? If so, under what circumstances do we have such a right?
Under what circumstances can a third party overrule parents’ (medical) decisions?
If vaccines caused autism, should we still give them to children?
To what extent should we tolerate pseudoscience? To what extent should we tolerate quackery? Alternative medicine? Complementary medicine? Holistic medicine? How should we police the boundaries of our biomedical landscape?
How should a government handle the medical concerns of its governed?
Should all people be vaccinated?
To what extent should we respect the religious beliefs of others in the course of their medical treatment?
How much should vaccines cost?

Zombies

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

Game of Thrones

(By Robert Graham) Welcome to the Biointerfaces Interlaboratory Committees’ (BIONIC) discussion on the ethics of A Song of Ice and Fire (a.k.a. Game of Thrones)! Below are some questions to get you thinking about the ethics of the magic and events of the ASOIAF universe, but feel free to pose your own questions to the group! SPOILERS ALERT

House Stark – Winter is Coming. The Stark words – Winter is Coming – warn that eventually the hardships of winter will arrive, though they cannot predict exactly when. Would you want to know when your personal medical-winter is coming? In other words, would you want to know the exact date you will die, or develop a debilitating disorder (or any other medical phenomenon, for that matter)? What if you only knew an approximate likelihood? Companies like 23andMe allow us to check which genetic disorders we may be predisposed to. How accurate would a test need to be for you to willingly peer into the murky possibilities of your medical future? How precise would the test need to be for you to take preventative measures to possibly mitigate a condition you might not develop?
House Targaryen – Fire and Blood. At the end of the first season, Daenerys reintroduces dragons, magical beasts with immense destructive power, into the world. Over the last two decades, anti-vaxxers have helped reintroduce measles (and other diseases), a very real virus with immense destructive power, into the world. Luckily, Daenerys can exert a certain amount of control over her dragons. Unfortunately, anti-vaxxers have no control over measles, and their choice to not vaccinate reduces herd-immunity and places the immuno-compromised at risk. To what extent should individuals be allowed to exercise personal choice, personal philosophy, and religious belief exemptions in medical decisions which immediately affect those around them? At what point can a herd demand immunity?
House Lannister – Hear Me Roar! Cersei and Jaime engaged in ‘selective breeding’ to ensure Cersei’s children receive what they might call ‘better’ genes than if Cersei explored other avenues of the gene pool. Are some genes more desirable than others? If so, should we select certain traits to pass down to our children, to set up their best possible future? Are we already doing so? To what extent should new technologies (e.g. CRISPR) play a role in designing the human species (e.g. removing SNP-caused diseases vs. choosing your children’s eye color)?
House Baratheon – Ours is the Fury. Robert Baratheon usurped the Targaryen throne in an attempt to ‘rescue’ Lyanna Stark from the Mad King. Several candidates for the 2020 US election propose Free Universal Health Care (i.e. Medicare For All) as a policy to usurp privatized insurance. Do the potential benefits of Universal Health Care (e.g. every US resident being able to afford healthcare, returning the focus of medical practice to healing rather than billing, giving those with pre-existing conditions coverage) outweigh the potential drawbacks (e.g. subjecting all healthcare to the shortcomings of federal bureaucracy, a possible loss in innovation and individual ingenuity, a loss in doctors’ personal autonomy in lieu of government-mandated regulations)?
House Greyjoy – We Do Not Sow. Though not their official words, the Greyjoys say ‘’What is dead may never die,” with nearly absurd frequency. Some scientists speculate that the first person to live to 150, or even 200 years old has already been born. As our capacity to accumulate years increases, we may reach a point where the Greyjoy words become “What is born doesn’t necessarily have to die.” How old would you want to live? Under what conditions would you want to live forever? How would eternal life change our perspective on suicide, physician-assisted or otherwise?

Harry Potter

(By Robert Graham) Welcome to the Biointerfaces Interlaboratory Committees’ (BIONIC) discussion on the ethics of Harry Potter! Below are some questions to get you thinking about the ethics of the magic and events of the Harry Potter universe, but feel free to pose your own questions to the group!

Book 1: Harry Potter and the Philosopher’s/Sorcerer’s Stone. Harry prevents Voldemort from acquiring the Philosopher’s/Sorcerer’s stone, which produces the immortality-inducing Elixir of Life. Would you want the option to take the Elixir of Life to live indefinitely? Would you eventually choose to stop taking the Elixir (a la Nicholas Flamel)? How would such a substance be regulated? Should it be regulated? Who should or should not be allowed to take the Elixir? If you begin taking the Elixir and choose to stop, is it suicide? If we believe it is unethical to take one’s own life, is it thereby unethical to stop taking the Elixir once you start? What do you think the Elixir of Life would taste like?
Book 2: Harry Potter and the Chamber of Secrets. In the second book, Harry, Ron, and Hermione drink Polyjuice Potion to turn themselves into Crabbe, Goyle, and a cat-human hybrid. When one takes Polyjuice Potion, is one still oneself? Or does the concept of the self change? Should such a potion be legal? Would you drink Polyjuice Potion? Who would you become? Would you let someone drink Polyjuice Potion to become you?
Book 3: Harry Potter and the Prisoner of Azkaban. Harry and Hermione use a time-turner to travel back in time to keep Sirius Black from being persecuted for a crime he did not commit. Paradoxes aside, is Harry and Hermione’s alteration of the past ethical? Should they have altered the past more dramatically and prevented Pettigrew from escaping and returning to Voldemort? If time travel were possible, would we have a right to change our own past? Is time something no human should have dominion over?
Book 4: Harry Potter and the Goblet of Fire. Several of the fourth book’s major plot points are driven by what appear to be intelligent, conscious, magical creatures (e.g. house elves, goblins, and sphinxes, oh my!). There is a department in the Ministry of Magic for the Regulation and Control of Magical Creatures, where magical humans make decisions affecting the livelihood of beings with human-like intelligence. What right does wizardkind have over creatures like merpeople and centaurs? Do all intelligent magical creatures deserve the same rights? If not, how should rights be delegated amongst species? House elves seem perfectly happy being subservient to witches and wizards, while centaurs and goblins prefer independence. Should the cases be handled differently?
Book 5: Harry Potter and the Order of the Phoenix. Cornelius Fudge, the Minister for Magic, uses his political station to force a negative portrayal of Harry and Dumbledore in the media (The Daily Prophet). Given the dangers of fake news, should the Prophet have succumbed to Fudge’s demands? Are there any circumstances where freedom of the press needs to be checked or balanced? Should the government be allowed to influence the flow of information to the public? Does the public deserve to always know the full truth?
Book 6: Harry Potter and the Half Blood Prince. A large portion of the sixth book follows Harry and Dumbledore through memories in Dumbledore’s pensieve. Would you want the ability to re-experience your own memories firsthand? Would you let someone else experience your memories with you? Given the huge unreliability of human memory, should memory (or pensieve exploration of memory) be used in a court of law? Should memory be seen as reliable evidence when attempting to take down an evil wizard? Horace Slughorn was able to procure a (badly) modified version of one of his memories – could this be seen as perjury?
Book 7: Harry Potter and the Deathly Hallows. Eventually, we learn the ins, outs, and flaws of Dumbledore’s master plan to defeat Voldemort. Dumbledore, for all his good qualities, was secretive, deceptive, and cunning. He did not disclose the full contents of his plan to anyone, including his most trusted followers. As a result of Dumbledore’s actions, many lives were lost – both intentional and unintentional, good and evil. Did the ends justify Dumbledore’s means?
More Ethical Dilemmas of the Wizarding World. There is a society of witches and wizards living in secret all over the world. Hagrid explains that they do not reveal themselves to the non-magical population (muggles) because “everyone would be wantin’ magical solutions to their problems.” Does the magical community have a moral obligation to use their magic to help muggles? Is it possible to have a peaceful society of muggles and magical folk living together? Are magical people a higher-class citizen than non-magical people?
What makes a curse unforgivable? Should there be more than 3?
Hogwarts students are divided into one of four houses the moment they enter the school. Is it advisable to immediately tell students where they belong based on qualities they might not know they have, particularly when there is historic bad blood between certain houses? Is the Sorting Hat a more or less equitable way of distributing education than we use currently?
Is Severus Snape a good guy? Does his crush on Harry’s mom absolve him of his horrible treatment of school-age children?

Star Wars

(By Bobby Graham)

In Episode I, Qui-Gon Jinn tries to use a jedi mind trick on Watto to bend him to his will. Unfortunately for Qui-Gon, it does not work. With continual advancements in Brain-Machine Interfaces, coupled with Elon Musk on his way to becoming a Bond villain through ventures like Neuralink, mind control may be a feature of future civilizations. Is mind control ethical? Are there any possible situations when mind control is ethical (for example, the freeing of a slave like in Episode I)? How would we control this?
In Episode II, the republic enlists a huge army of clone soldiers to combat the Sith. Cloning is a relatively common laboratory procedure and news headline. Is it ethical to develop an entirely clone army? What about for organ harvesting? Would you want a clone of yourself for “spare parts”, e.g. in the case of liver failure from drinking after you watched Episode II? What if you could genetically remove traits like fear or desire to retain functioning organs? Are clones disposable?
In Episode III, Anakin Skywalker a.k.a. Darth Vader has most of his limbs cut off by Obi-Wan Kenobi. His body is augmented with a multitude of robotic prosthetic devices (he’s more machine now, than man) by a team of robotic doctors, and he ultimately becomes a tyrannical leader intent upon stamping out the rebellion. How does this affect the public perception of bionics? Should we be concerned with who receives prosthetic devices? Do we care what the public thinks about certain medical procedures, if it alleviates suffering in the end? Are robotic doctors, that are unable to choose who they operate on and who they refuse treatment, ethical? Is there a necessary human element to being a clinician?
Throughout the series, with its debut in Episode IV, traveling at lightspeed is a handy way to get from Point A to Point B (or escape from imperial pursuits). However, traveling at lightspeed would lead to time dilation due to large relative differences in velocities between two observers. In other words, those traveling at lightspeed would age slower than those they left on their home planets. Theoretically, this could lead to populations interacting with one another that age at remarkably different rates. If we are to eventually colonize our local galactic area once the Earth is no longer a viable home, is it ethical to travel from planet to planet via lightspeed? How would we account for the different ethical boundaries of populations that age at different rates? Are we seeing these effects now in the current administration which seems to hold dramatically different ethical boundaries than its constituents?
At the end of Episode V, (SPOILER AHEAD) Luke’s father Darth Vader cuts off his hand. Luke is fitted with a highly realistic prosthetic hand that appears to have the form and function of a normal hand. Should Luke be allowed to compete in sporting events with non-prosthetic enhanced individuals? Should he be allowed to fight the Emperor, or only Vader since Vader is outfitted with similar technology? Would it be necessary for Luke to obtain a concealed carry permit if he decides to wear gloves?
In Episode VI, the forest moon of Endor is occupied by the Empire to house a shield generator for their new Death Star, causing the removal of many healthy trees and likely supplanting several Ewok (the indigenous population of Endor IV) families. Is it ethical to invoke deforestation to protect the lives of thousands of government employees working at the Death Star? When is deforestation ethical and when is it not?
Episode VII was met with criticism that it was similar in plot to Episode IV. How should we feel about the constant rehashing of beloved intellectual property for monetary gain? Was it still a good movie, though the plot was unoriginal? What does this mean for incremental upgrades on Biomedical IP? Should there be measures in place to prevent companies and researchers from releasing incremental improvements in their work/devices in order to maximize research output and profits?
In Episode VIII, Finn and Rose travel to Canto Bight, home to a massive casino that likely accounts for a large portion of Canto Bight’s GDP. Is gambling ethical? What about the development of gambling addiction in response to medical treatment? Therapies for movement disorders (e.g. Parkinson’s disease, essential tremor) include L-dopa and deep brain stimulation. Both of these therapies can, in rare cases, lead to the development of addiction to compulsive behaviors like gambling and hypersexuality. Are there ethical considerations to make when you consent to these treatments? What if you have a spouse or family that could be negatively affected by a changes in compulsive behaviors? To what extent should those around you be part of your consideration in your choice in disease therapy?
Throughout the films, seemingly human species interact mostly peacefully with other forms of intelligent life. If Elon Musk were to discover intelligent life somewhere near our Earth, and the decision was made for humans and this other species to live among one another, what ethical considerations need to be made to integrate multiple forms of intelligent life into a peaceful and hopefully mutually beneficial society? Are the same ethical considerations made currently between humans of different cultures, especially as technologies like the internet and air travel (which enable rapid communication and interaction at unprecedented levels) become more widely available? Is peace an achievable goal? What if the new species was unwaveringly hostile towards humans? Is it ethical to stamp out another species of intelligent life to support our own?

Self

Body modification

Body art

Fear

Body politics

Cities

Antinatalism

Others

Michigan

Love

Overpopulation

Public Health

Solitude

Responsibility

History

110 Students Taught!

Alternative medicine

Animal experimentation

Assisted reproduction

Circumcision

Clinical trialing

Cloning

Drugs

Extinction

Gender

Life-preserving technologies

LGBTQ health

Neuroethics

Posthumanity

Prenatal screening

Race

Regulation

The Replicability of Medical Studies

Vaccination

Zombies

Game of Thrones

Harry Potter

Star Wars

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