- Who are you and are you enabled to (fully) be your “self”?
- Generally, there two models of disability: a “medical model” that stresses the physical limitations inherent to disability, taking as its norm a self-sufficient, non-disabled body and a “social difference model” that defines disability primarily as a social condition resulting from society’s failure to accommodate physical differences of the disabled. Is there one we ought to prioritize over the other? Which and why?
- Where should we place the emphasis when thinking about dis/abilities?
- Given the ever-increasing capability to prenatally screen unborn children, should conditions that would “disable” a child be looked for (by parents, by physicians)? If found, what, if anything, should be done about such conditions?
- In some recent popular culture representations, autism (spectrum disorder) has been portrayed as advantageous, quite possibly “the next stage in human evolution”. How should this be viewed? Is this a misrepresentation of a developmental disorder? A glorification of human variety? Exploitation of the disabled? Awareness building?
- According to the Bureau of Labor Statistics, in 2018 “jobless rates for persons with a disability were higher than those for persons without a disability” with “[p]ersons who are neither employed nor unemployed […] with a disability [equal to] about 8 in 10.” Given those facts, should more people with disabilities be encouraged to enter the workforce? How could this be accomplished in practice?
- Introduced by Senator Chuck Schumer in the Senate and Representative F. James Sensenbrenner in the House the “Disability Integration Act of 2019” (S. 117 and H.R. 555) is one of 10,071 bills before the 116th Of the total, 949 bills currently standing before Congress address disability in some way. Do you believe the lives of the disabled will be improved by the federal government in the foreseeable future? Why or why not? What could be done to improve their lives.
- Analyzing incidents of people killed by police (from 2013 to 2015), the Ruderman Family Foundation found that “[d]isabled individuals make up a third to half of all people killed by law enforcement officers.” While media coverage often focuses on issues of race in police brutality, this can obscure how disability also factors into police interactions. Why do marginalized groups suffer more at the hands of police? What can be done to prevent such adverse interactions?
- Since about the late 1970s, psychologists have identified individuals with “apotemnophilia” – a condition characterized by an intense, long-standing desire for amputation of a (specific) limb. Such individuals can be thought of as challenging stigmas of disability by literally wishing to embody alternative conceptions of “bodily integrity”. They may also be thought of as experiencing a type of body dismorphic disorder in which (physical) self-identity is pathologically warped. Should an individual be allowed to remove a body part for non-medical reasons? Can we lop off a nose, pluck out an eye, hack off a limb for no clear medical benefit?
- Is the University of Michigan a sufficiently accessible place for all?
- “The last mile” – the distance between an individual’s residence and their transit – can be particularly long for people with disabilities. In what ways can we shorten it?
- Are you who you present yourself to be? Does your body constitute your identity?
- Often our culture is thought of as “consumerist”, as it is by Sweetman (1999). With regards to artistic expression(s) of the body, what (if anything) is being “consumed”? Are there risks in commodifying our corporeal identity? For example, “tattooing and piercing [have been] previously ‘classed’, ‘raced’ and gendered practices, associated with specific marginal and subcultural groups [that] have now become so ‘mainstream’ as to almost be considered ‘passé’.” Is this something to guard against?
- “Body art” can vary from make-up to plastic surgery, encompassing both the fashionable and the beautiful, the temporary and the permanent. Given these spectra, how should “the body” be viewed by modern audiences?
- Is pain a necessary/sufficient condition of art?
- Whose, if anybody’s, rights were violated when prisoners (or homeless people or psychiatric patients) are/were used for anatomical displays? What about displays of (unborn) fetuses? What is it that gives us pause in using corpses/cadavers for art?
- As van Dijck (2001) and Barilan (2006) relay, in plastinated cadavers, a large quantity of the original organic matter is replaced by a plastic surrogate (about 80% plastic and 20% organic material). That being the case, are we really looking at a “body” when we go to BodyWorlds? What about figures made only of muscles? Only blood vessels? When all that’s left is bones?
- To what extent is a “modified” body an “authentic” body?
- If we look at a cadaver without a head, are we looking at “someone”? What about a body cut in half? Just a hand or a foot? A torso? What about a full body assembled from multiple individuals?
- What should we make of taxidermy?
- Much of anatomical science (and art) has its origins in grave robbing. To what extent should this be atoned for?
- Should organ donation (after death, i.e., from cadavers) be an opt-out or an opt-in system? Would it be wrong to pay someone during their life for their body or some subset of it (e.g., their organs) after their death?
- Washington state recently legalized “recomposition” – “the contained, accelerated conversion of human remains to soil” – as a method of disposing of human bodies. Would you ever wish to have your body converted to fertilizer?
- An extraordinarily accurate anatomical atlas (“Pernkopf’s Atlas”) was created by an ardent Nazi who (might have) used victims of the Nazis’ tyranny to arrive at the data. Should we use it? How so? Why?
- Can art be separated from its artist? From its medium of expression?
- Who are you and can it be expressed (sufficiently) artistically?
- Body modification includes the deliberate altering of one’s anatomy and/or physical appearance and can include explicit ornamentation (piercings, tattoos, transdermal implants), surgical augmentation (breast implants, circumcision), and physical alteration (foot binding, scarification, branding). Should we endeavor to prevent any of these methods of body modification from being done (commonly)? Why?
- One of the most common forms of body modification practiced at scale is the circumcision of babies/children, yet often the alteration of genitals later in life (piercing, removal, “enhancement”, etc.) is met with opprobrium from (polite) society. What accounts for this difference?
- Featherstone (1999) notes that “[n]ormally to be a self is to be distinguished from  other[s]” but that the “body form of conjoin[ed] twins challenges both the distinction between mind and body and body and body.” Ought the medical establishment treat as its mandate the separation of conjoined twins?
- In the early 1980s, it was found that administering a constant level of GnRH “desensitizes” an individual’s pituitary, leading to a decrease in secretion of luteinizing hormone and follicle-stimulating hormone. A child can be prevented from going from the gonadarche stage to the somatic growth spurt during puberty, in essence having their puberty “suppressed” and thereby not becoming a gender with which they do not (self-)identify. What should a parent do if their child (has gender dysphoria and) wishes to have their puberty suppressed?
- Self-cutting, anorexia, and many other “pathological” forms of body modification seem to manifest during our teenage years. Why do you think that is?
- Bridy (2004) relays stories of individuals with “apotemnophilia” – a condition characterized by an intense, long-standing desire for amputation of a (specific) limb. Should an individual be allowed to remove a body part for non-medical reasons? Can we lop off a nose, pluck out an eye, hack off a limb for no clear medical benefit?
- Schramme (2007) contends that “the case of extreme body modification is an ultimate test-case for liberal bioethics. It directly confronts two characteristics of a liberal attitude, namely to accept competent decisions even where they seem to be clearly unwise (antipaternalism) and not to impose particular conceptions of the good on other people (neutrality).” How ought the balance between (anti)paternalism and neutrality be struck in the case of body modification?
- Schramme presents five possible arguments against voluntary body mutilation (modification): “i) Self-mutilation is never really voluntary, but is caused by pathological beliefs and desires, or is a side-effect of mental disorder; ii) it violates moral duties to oneself; iii) it violates moral duties to others or harms other people; iv) it contravenes nature’s purposes; v) it is unreasonable or irrational.” Do you subscribe to any of these arguments against body modification?
- Is our body distinct from our “self”?
Given as part of the BIONIC bioethical lunch series on the particular topic of “The Quantified Self”. September 24, 2019.
- What is the self being “quantified”? That is who are you? Who/What/Where is “your” “self”? And what in what way(s) can we measure it?
- A quantified self is said to have any number of facets – “self-knowledge through numbers”, “life-logging”, “patient-generated health data”, “data as a mirror into our own activities” – all of which require an immense amount of personal data to be collected. Things like your consumption habits, bodily functions, physical activity, medical symptoms, spatial information, physiological statistics, and mental health can all be tracked. Are there any forms of personal data that are particularly revelatory of a “self”?
- Are you comfortable with your quantified self existing in places you yourself have little control over?
- While life-tracking has been part of the human experience since the beginning – consider, cave painting, journaling, scratching heights into a door frame, etc. – it can now be done with an ever-increasing resolution into the particularities of one’s self: how many calories you (claim to) have eaten; the time you stood up last Tuesday; the last time you saw a friend. Resolution is needed to make use of focus, but is this the new hyperreality we want to prepare ourselves for?
- The reality of the wearable situation is much of the data can be a mess and the fidelity of biomedical data is at least questionable. To what extent should physicians act on consumer-grade data?
- What would an ideal wearable do?
- What would an ideal therable do?
- Happenstance and circumstance. It’s an old chestnut at this point that “your ZIP code often says as much or more than your genetic code.” It’s a modern reframing of nature v. nurture. Does a quantifiable self help tease out the effects of those two?
- Gamification has been inherent to the quantified self since inception. Humans, as naturally social animals, like to cooperate with, compete against, challenge each other. Making a game out of behaviors makes them fun(ner). But rarely are medical approaches made out to be games, nor are they generally fun. How does this impact the legitimacy of digital health as a tool of healthcare?
- I hold that the quantified self is who you see in the mirror of a panopticon. Metaphorically, of course. Thoughts?
- Several debates rage:
- Empowerment v. surveillance and discipline. Patients have gone from minimally informed to active participants in their own health; however, their literal every step can now be tracked. What benefits are worth what risks and what are the worst possible consequences of adverse effects?
- Improved health v. breakdown of responsibility for public health. Some individuals might see vast improvements to their personal health; however, decollectivizing (public) healthcare can have unintended long-term effects. How should quantified selves be situated within a public health schema?
- Great (self-)knowledge v. reductionism and non-impartiality. One can now numerically follow the Delphic command to “know thyself”; however, a number of steps and a heartbeat do not a soul make. How do we make biomedical data more revealing of our “selves”?
- What does the noble life of the good citizen of the great society look like?
Megan Betts, 22
Monica Brickhouse, 39
Nicholas Cumer, 25
Derrick Fudge, 57
Thomas McNichols, 25
Lois Oglesby, 27
Saeed Saleh, 38
Logan Turner, 30
Beatrice Warren-Curtis, 36
Jordan Anchondo, 25
Andre Anchondo, 23
Arturo Benavides, 67
Angie Englisbee, 86
Maria Flores, 77
Raul Flores, 77
Jorge Calvillo Garcia, 61
Adolfo Cerros Hernandez
Alexander Gerhard Hoffman, 66
David Johnson, 63
Luis Alfonzo Juarez, 90
Maria Eugenia Legarrega Rothe, 58
Elsa Libera Maequez, 57
Maribel Loya, 56
Gloria Irma Marquz, 61
Margie Reckard, 63
Sarah Esther Regaldo Moriel, 66
Javier Amir Rodriguez, 15
Teresa Sanchez, 82
Angelina Sliva-Elisbee, 86
Juan Velazquez, 77
or, How to measure a heartbeat in approximately twelve steps
The heart in your chest beats every minute of your life.1 Accompanying each new beat is an electrical dance whose waves ripple throughout your body. The same is true of every single human being you will ever come across. What you will do is measure those waves between two points in space and thereby detect the exact moment a heart’s muscles contract for a few minutes of someone’s life one fine day.
To do this, you will construct a system, an electrocardiogram, comprising the following:
Specifically, you will (1) power up a prototyping electronics board to create the system, (2) build an instrumentation amplifier to amplify a signal, (3) construct a filter to remove unwanted noise from the signal, (4) detect a heartbeat from a willing participant, and in the process (5) become a biomedical engineer.
1. Except in those rare instances of individuals with artificial hearts or transplants, techniques being ever more perfected by biomedical engineers and their collaborators.
Review material inventory
Begin by reviewing the inventory of your kit. Ensure it contains the following materials:
- Twenty (20) jumper wires, ~5 cm each (4 red, 4 black, 4 green, 4 yellow, 4 blue)
- Three (3) long wires, unstripped, ~15 cm each (1 red, 1 black, 1 green)
- Three (3) resistors
- RG: 1.5 kΩ; Actual value: ________________ Ω
- R1: 330 kΩ; Actual value: ________________ Ω
- R2: 10 MΩ; Actual value: ________________ Ω
- Two (2) capacitors
- C1: 10 µF Actual value: ________________ F
- C2: 100 pF Actual value: ________________ F
- One (1) AD620 instrumentation amplifier (Figure 1. AD620)
- One (1) LM741 operational amplifier (Figure 2. LM741)
[Note: You will need to measure each of the passive components (i.e., the resistors and the capacitors) to determine their value. To do this, a volunteer will show you how to measure these values with a multimeter.]
[Note still further: Sometimes smaller valued capacitors can be difficult to measure precisely.]
Review workstation equipment
Please also check your workstation for the following equipment:
- A breadboard (Twin Industries TW-E41-1060, Figure 3. A breadboard with posts, rails, trench, and terminals)
- A power supply (Agilent E3630A, Figure 4. A power supply with (A) voltage adjustment, (B) port selection, and (C) output ports)
- An oscilloscope (Tektronix TDS 2012C, Figure 5. An oscilloscope with (A) position and vertical scaling, (B) input, and C) horizontal scaling)
- Three (3) 2m banana cables (one red, two black; with connectors, Figure 6. Banana cables (2m))
- Three (3) 1m banana cables (one red, two black, Figure 7. Banana cables (1m))
- One (1) BNC-to-splitter cable (Figure 8. BNC-to-splitter cable)
1. POWER A BOARD
The instructions that follow assume you build your circuit in a vertical orientation. That means centering work around a breadboard “trench” (Figure 3). To follow along, locate one trench on the breadboard. From here on, everything to the right side of that trench is on the “right” and everything to the left side is on the “left”. Feel free to consult the Reference sheet or to ask any of the volunteers any questions you may have.
Step 1. Connect a power supply to a breadboard
- ¡Turn on! the power supply
- To adjust a particular output port voltage, push in the “METER” button to select that port voltage, and adjust the voltage via the “VOLTAGE ADJUST” knobs
- Set the +20 V port voltage to be approximately +5 V
- Set the –20 V port voltage to be approximately –5 V
- Attach a 1m red cable from the +20 V port of the power supply to the red breadboard post
- Attach a 1m black cable from the –20 V port of the power supply to the black breadboard post
- Attach another 1m black cable from the COM port of the power supply to the green breadboard post, this will serve as a reference point, where voltage is 0
Step 2. Wire the breadboard posts to its power rails
- Wire the red breadboard post to the red (+) column of the right rail
- Wire the black breadboard post to the blue (–) column of the left rail
- Wire the green breadboard post to the blue (–) column of the right rail
- Where on the board is it +5 V?
- Where is it –5 V?
- What voltage is it at the reference point?
Before you continue: ¡Turn off! the power supply (for now)!
2. BUILD AN AMPLIFIER
In your kit there should be two eight-legged chips that look quite similar. They both should have a little notch at the “top”. Only one of them will have a polished circle next to that notch. That is the LM741 and it will be used to CONSTRUCT A FILTER. For this step, find the AD620, the instrumentation amplifier. It will not have a polished circle.
Step 3. Place an instrumentation amplifier on the breadboard
- Orient the instrumentation amplifier to align with the top of the board and place across the trench so that each of the “legs” of the amplifier is electrically independent
- Center the amplifier between the powered rails
Step 4. Wire the instrumentation amplifier for power
- Wire the positive rail (the one with +5 V) to Pin 7 of the amplifier (+Vs)
- Wire the negative rail (the one with –5 V) to Pin 4 (–Vs)
- Wire the reference rail (the one with how many volts?) to Pin 5 (REF)
Step 5. Create gain, inputs, and an output for the instrumentation amplifier
- Use RG to connect Pin 1 to Pin 8
- This will enable the amplifier to increase the difference in voltage by a predetermined amount known as gain
- Create two loose wires and insert one into each Pin 2 and Pin 3
- These two points will be the inputs across which you DETECT A HEARTBEAT
- Wire Pin 6 to a free space to the left of the trench and below the amplifier
- This output will contain the amplified signal
- The gain, G, of the amplifier is defined by the following formula
G = (49.4 kohm / RG) + 1
What is the gain of your signal, G, given the measured value of your RG resistor?
3. CONSTRUCT A FILTER
The LM741, the chip with the polished circle on its upper-left hand side, is a generic operational amplifier, “op-amp” for short. The particular wiring used here allows one to construct a “filter” that gets rid of parts of the signal that are not wanted. Specifically, we are creating a “bandpass filter” that will get rid of low frequencies and high frequencies.
Step 6. Place an op-amp on the breadboard
- Place the op-amp across the same trench as the instrumentation amplifier, oriented such that the op-amp’s top side aligns with the top of the board
- Wire R1 and C1 in series from the output wire of the instrumentation amplifier to Pin 2 (–IN) of the op-amp
[Note: electrolytic capacitors have a specific direction they are designed to work in. Connect the big leg of C1 to R1 and its little leg to Pin 2]
Step 7. Wire the op-amp for power
- Wire the positive rail to Pin 7 (+Vs)
- Wire the negative rail to Pin 4 (–Vs)
- Wire the reference rail to Pin 3 (+IN)
Step 8. Finish the filter
- Use a parallel combination of R2 and C2 to connect Pin 2 (–IN) to Pin 6 (OUTPUT)
- Create a loose output wire and connect it to Pin 6; this will be our “system output”
- The “lower corner frequency”, C.F.L is the region below which we attenuate low frequencies and the “higher corner frequency”, C.F.H is the region above which we attenuate higher frequencies. These are calculated by
C.F.L = 1/(2*pi*R1*C1)
C.F.H = 1/(2*pi*R2*C2)
Using your values of R1 and C1, what is your lower corner frequency?
Using your values of R2 and C2, what is your higher corner frequency?
4. DETECT A HEARTBEAT
In this portion of the activity, you will actually be measuring actual heartbeats from an actual person. To observe the heart’s signal, you will use an oscilloscope, an instrument that allows for the precise measurement of electrical signals detected by our system – a humble electrocardiogram. Before moving on to the next steps, work with a volunteer to ensure your circuit is correct, then ¡turn on! the power supply and the oscilloscope.
Step 9. Connect an oscilloscope to the output
- Using a BNC-to-splitter cable, attach the BNC-end of the cable to the Channel 1 terminal of the oscilloscope
- Using the same cable, attach the black portion of the splitter to the reference post on the breadboard
- Connect the red portion of the splitter (the one with the alligator clip) to the loose wire with the system output
Step 10. Connect a participant to the inputs
- Attach two electrodes to the wrists of a (willing) participant
[Note: the electrodes are sticky, but not too sticky. So if one of them falls off, just replace it with another!]
- Connect one of the electrodes via a 2m cable to one of the inputs of the instrumentation amplifier (loose wire at Pin 2 of the AD620)
- Connect the other electrode via a 2m cable to the other input of instrumentation amplifier (loose wire at Pin 3 of the AD620)
- Attach a third electrode, a “reference electrode” to an electrically neutral part of the participant’s body (generally a body part like your elbow or your ankle)
- Connect the reference electrode to breadboard’s reference post via a 2m cable
Step 11. Ask someone to let you measure their heartbeat
- Use the oscilloscope to observe the signal coming from the participant’s heart (it may require adjustment of the oscilloscope’s abscissa and ordinate scales)
- Can you think of a way to determine a heart rate?
- What is the participant’s heart rate (in beats per minute) right now?
5. BECOME A BIOMEDICAL ENGINEER
Step 12. Experiment!
- Think of a way to make the heart rate of the participant go lower. How low do you think the rate can go? Test your hypothesis if the participant is still willing and record the results
Lowest heart rate observed?
What did you do to make it go so low?
- Think of a way to make the heart rate of the participant go higher. How high do you think the rate can go? If the participant is still willing, test your hypothesis and record the results
Highest heart rate observed?
What did you do to make it go so high?
- ¡Turn off! all equipment. Return everything to the order you founding it in,
if not a little better
- The filter you built actually snuck a little extra gain into our system. The filter amplifies by an amount H = R2/R1, thereby making the Overall Gain
Overall Gain = G x H = ( ) x ( ) = __________
- If the signal you are measuring has been amplified by the Overall Gain, what is the size of the original signal? [Hint: The measured signal is the original signal multiplied by the Overall Gain.]
Next steps. Share what you learn, learn how to share
- Write down one or two things you learned today.2
- Is it important to ask someone’s permission before measuring their heart beats?
- Can you think of other biomedical data whose integrity, security, and privacy we want to guarantee?
- How could we secure such guarantees?
- What can we do to make healthcare better?
2. Are you interested in learning more about biomedical engineering? (If so, consider visiting https://bme.umich.edu.)
Stephen Romero, 6
Keyla Salazar, 13
Trevor Irby, a 2017 graduate of Keuka College
Section 3 of the Senate Committee on Science and Technology’s substitution to H.B. 481 begins “Chapter 2 of Title 1 of the Official Code of Georgia Annotated, relating to persons and their rights, is amended by revising Code Section 1-2-1, relating to classes of persons generally, corporations deemed artificial persons, and nature of corporations generally, as follows:”
[I provide an image of the text below for posterity. The image having a powerful effect on history.]
Should we find it disconcerting that at least some subset of us are now playing the game of life under a legislated “two classes of persons: natural and artificial”? To be a “natural person”, one need merely be a human, “including [as] an unborn child”. To be artificial, look to those “creatures of the law”, look to those “subject to be changed, modified, or destroyed at the will of their creator”, look to those, “Corporations”. That, on the one hand, we persons are as meager as those with “steady and repetitive rhythmic contraction of the heart within the gestational sac [and who are] a member of the species Homo sapiens”. There, on the other, is the plain and hidden fact: “Corporations are artificial persons […] except insofar as the law forbids”.