Questions to ponder

On alternative medicine

On animal experimentation

On assisted reproduction

On body art

On body modification

On circumcision

On clinical trialing

On cloning

On disability

On drugs

On extinction

On fear

On gender

On life-preserving technologies

On LGBTQ health

On mental health

On neuroethics

On posthumanity

On prenatal screening

On the quantified self

On race

On regulation

On the replicability of medical studies

On self

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

  1. What makes medicine “alternative”?

  2. Is “alternative medicine” distinct from “complementary medicine”? Are either or both situated at odds with “traditional”/”Western” medicine?

  3. 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?

  4. 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?

  5. 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?

  6. 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?

  7. Do you think more or less CAM therapies should be given CPT codes?

  8. 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?

  9. Where does something like yoga fall on the Improving Health Spectrum? Do its effects extend beyond those associated with any other form of exercise?

  10. If I gave you a bottle of homeopathic medicine, how many would you feel comfortable taking?

  11. 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?

  12. How important is it that we/someone police the boundaries between “medicine” and “not-medicine”? “Science” and “non-science”? Sense and nonsense?

 


Animal experimentation

  1. Would you personally ever participate in experiments involving animals? To what extent and why?

  2. 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.)?

  3. 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?

  4. 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?

  5. 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?

  6. 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?

  7. 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?

  8. Garattini and Grignaschi claim that “There is no magic recipe” to improving our (animal) experiments, “only trial and error.” Are they right?

  9. 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?

  10. 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?

  11. Myriad forms of vegetarianism seem to be cropping up across the country. Why is that?

  12. To what degree are we responsible for animals?

  13. How can we do better?

 


Assisted reproduction

  1. 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)?

  2. 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?

  3. 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?

  4. 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?

  5. 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)?

  6. 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?

  7. What does it mean to “play god”?

 


Body art

  1. Are you who you present yourself to be? Does your body constitute your identity?
  2. 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?

  3. “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?

  4. Is pain a necessary/sufficient condition of art?

  5. 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?

  6. 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?

  7. To what extent is a “modified” body an “authentic” body?

  8. 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?

  9. What should we make of taxidermy?

  10. Much of anatomical science (and art) has its origins in grave robbing. To what extent should this be atoned for?

  11. 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?

  12. 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?

  13. 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?

  14. Can art be separated from its artist? From its medium of expression?

  15. Who are you and can it be expressed (sufficiently) artistically?

 


Body modification

  1. 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?
  2. 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?

  3. 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?

  4. 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?

  5. Self-cutting, anorexia, and many other “pathological” forms of body modification seem to manifest during our teenage years. Why do you think that is?

  6. 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?

  7. 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?

  8. 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?

  9. Is our body distinct from our “self”?

 


Circumcision

  1. If circumcision did not already exist, would it be necessary for our society to invent it?

  2. 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?

  3. 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)?

  4. 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?

  5. 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?

  6. “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?

  7. 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?

  8. 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?

  9. 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?

  10. If we didn’t circumcise children, do you think we would have circumcised adults?

 


Clinical trialing

  1. 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?

  2. How ought clinical trials to be funded?

  3. 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?

  4. When are human trials necessary?

  5. 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?

  6. Can “informed” “consent” ever truly be obtained by a patient in the doctor-patient relationship?

  7. 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?

  8. Should all hospitals be teaching/research hospitals? When should a hospital/healthcare center conduct research? When should it not?

  9. Must failure be baked into the cake of clinical trialing?

  10. What are the ethical consequences of non-optimal clinical trialing?

  11. What would it take for you to participate in a clinical trial?

 


Cloning

  1. 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?
  2. If the technology existed right now, how would you use complete and perfect “cloning”?

  3. Would you ever want your clone to exist? If your clone came into being, how would you deal with it?

  4. Is a clone more like a twin or a child?

  5. 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?

  6. 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?

  7. Should we resurrect long-dead species? What about the recently extinct?

  8. Should someone be allowed to make their own clone?

  9. Should you be allowed to clone yourself?

  10. What traits are important to define “the self”?

  11. 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?

 


Disability

  1. Who are you and are you enabled to (fully) be your “self”?
  2. 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?

  3. Where should we place the emphasis when thinking about dis/abilities?

  4. 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?

  5. 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?

  6. 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?

  7. 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 Congress. 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.

  8. 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?

  9. 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?

  10. Is the University of Michigan a sufficiently accessible place for all?

  11. “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?

 


Drugs

  1. How do drugs differ from other things?

  2. What does responsible drug use and administration require of the user and the administrator? Should such responsibilities be codified in a nation’s laws?

  3. 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?

  4. “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?

  5. How much would it cost for you to take a random pill?

  6. 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?

  7. Is it better to use more drugs or fewer?

  8. 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?

  9. What is it that drugs do to us that gets us so curious about them?

  10. “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

  1. 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?
  2. Question 1 asks about a time when our brains are absent. What about spaces in which they are? Must one be moral on Mars?

  3. 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?

  4. Is it better to have more extinctions or fewer? More de-extinctions or fewer?

  5. Do human beings (and/or their ethical equivalents) have an obligation towards species stewardship?

  6. Is there an alternative to extinction? 

  7. On the brink of species wide extinction, would you eat another human being to survive?

  8. Would you want to survive a near human extinction?

  9. 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?

  10. “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?

  11. How important is it that human beings prevent extinctions?

  12. Who are you? And, if you will one day be extinct, does it matter?

 


Fear

  1. What do you fear and why?
  2. Is knowing what other’s fear a matter of privacy? What about other emotions? Will emotional/mental states ever be sufficiently measured by human beings?

  3. Describing fear as a bodily response to a threat, Quirk (2015) describes the flight or flight response as a combination of increased breathing rate, increased blood pressure, increased heart rate, decreased pain sensitivity, etc., i.e., fear as a physiological function. Sometimes altered physiological functions allow performance in extreme conditions. For example, a solider on the battlefield may perform their duty better when scared. Would the U.S. Military be justified in using fear as a motivator for its soldiers? What about removing a solider’s fear? Would we be justified in using fear as a tool of war?

  4. Quirk notes that the brain mechanism of fear learning is conserved across species with the amygdala, a subcortical region located in the medial temporal lobe, crucial as a node in fear circuitry. Why do you think, given nature’s variety, that its response to fear is so largely self similar?

  5. Do you have phobophilia? The love of fear? Do you enjoy scary stories, haunted houses, darkened woods? Why would someone like fear in certain contexts?

  6. Duke et al (1993) end by stating “[b]ecause fear resides within the individual, a manager must project beyond personal opinion about what fear issues are important and develop perspectives similar to those of other stakeholders to properly evaluate the effects of a fear appeal.” How can we develop (empathetic) perspectives for those whose fears we might never understand?

  7. On the eve of the 2018 midterm elections, comedian Chelsea Handler remarked, “I think that fear works on both sides: […] I’m doing more than I’ve ever wanted to do in my entire life because I’m fucking scared shitless.” Is fear a legitimate motivator?

  8. Danis et al (2007) conclude that “[f]ear of retaliation from seeking ethics consultation is common among nurses and social workers, nonetheless this fear is not associated with reduced requests for ethics consultations.” Why does the fear for “doing the right thing” exist? 

  9. “Fear,” Fairchild et al. (2018) tell us, “is now commonly used in public health campaigns” going on to examine how fear campaigns against the tobacco industry and HIV/AIDS epidemic began, evolved, and affected those involved. If fear can be used to improve the health of the populace, should the populace live in fear?

  10. Should we be afraid?

  11. “Professor Nobody” says that “Once awareness of the human predicament was achieved, we immediately took off in two directions, splitting ourselves down the middle. One half became dedicated to apologetics, even celebration, of our new toy of consciousness. The other half condemned and occasionally launched direct assaults on this gift.” Do you think that human predicament described – the “[m]adness, chaos, bone-deep mayhem, devastation of innumerable souls–while we scream and perish, History licks a finger and turns the page” of it all – has caused some fundamental shift in human consciousness?

  12. “Fiction, unable to compete with the world for vividness of pain and lasting effects of fear, compensates in its own way. How? By inventing more bizarre means to outrageous ends.” Are their limits to which we should allow our art to induce fear?

 


Gender

  1. Do there exist inequalities/disparities between genders in current American healthcare? Are such inequalities/disparities unjust?

  2. 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?

  3. 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?

  4. 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?

  5. 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”?

  6. 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?

  7. What should a parent do if their child has gender dysphoria and wishes to have their puberty suppressed?

  8. 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?

  9. Is it morally acceptable to preferentially select an embryo for in vitro fertilization for reasons stemming solely from the category of sex/gender?

  10. 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?

  11. 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?

  12. 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.

  13. Are the genders in America equal? If not, when will they be?

 


Life-preserving technologies

  1. What does it mean to preserve life? Is it different than sustaining life? Maintaining life?

     

  2. 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?

     

  3. 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?

     

  4. 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?

     

  5. 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?

     

  6. Can one regret living? Can one regret being saved?

     

  7. 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

  1. 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.

  2. 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.)?

  3. 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?)

  4. 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?

  5. Why did it take so long for America to legalize gay marriage?

  6. 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?

  7. Should marriage be a federal institution?

  8. 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?

  9. 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?

 


Mental health

  1. What does it mean to be healthy mentally?

  2. From whence arises the stigma(s) of mental health?

  3. Is there something that is meant by “mental health” that has no physical (i.e., anatomical, physiological, biology, chemistry, atoms, quarks, gluons) correlate? Put differently, do all “mental disorders” correspond to some set of  “physical disorders”, with no exception?

  4. Must a diagnosis of health have both validity and utility to be used by physician/healthcare provider/healer/psychiatrist?

  5. Five criteria have been generally agreed upon to establish the validity of psychiatric diagnoses: (1) clinical description, (2) laboratory studies, (3) delimitation from other disorders, (4) follow-up studies, and (5) family studies. Are these sufficient?

  6. Kendell and Jablensky note that “Even though the authors of contemporary nomenclatures may be careful to point out that “there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder” (DSM-IV, p. xxii), the mere fact that a diagnostic concept is listed in an official nomenclature and provided with a precise, complex definition tends to encourage this insidious reification.” To what extent can we avoid “pathologizing” disorders with misclassification?

  7. Szasz asserts, somewhat boldly that, “[t]he belief in mental illness, as something other than man’s trouble in getting along with his fellow man, is the proper heir to the belief in demonology and witchcraft. Mental illness exists or is “real” in exactly the same sense in which witches existed or were “real.”” Do you agree with his assertion?

  8. “The term “mental illness””, Szasz says, “is widely used to describe something which is very different than a disease of the brain. Many people today take it for granted that living is an arduous process. Its hardship for modern man, moreover, derives not so much from a struggle for biological survival as from the stresses and strain inherent in the social intercourse of complex human personalities.” Going on further to note that the very “concept of illness, whether bodily or mental, implies deviation from some clearly defined norm.” [Emphasis in original.] Does such “abnormalization” add to our problems?

  9. How ought we be mentally healthy?

 


Neuroethics

  1. To what extent do our brains determine our ethics? To what should they?

  2. “[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?”

  3. Do we have a right to know when someone is lying?

  4. “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?

  5. “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?

  6. 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?

  7. What does it mean to change one’s self?

  8. 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?

  9. Do we have free will?

  10. Is there a “ghost in the machine”?

  11. Have the shifts in our biological and ethical perspectives throughout history generally been to the benefit or the detriment of the human experiment?

  12. Is “neuroethics” the right word for what we’re talking about here?

  13. Who are you? And does it matter?

 


Posthumanity

  1. What is human? What is a human being? Can a human exist independently (at least in principle) of their biological body?

  2. 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?

  3. Would you personally wish to be post/transhuman? Can youever be post/transhuman?

  4. 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?

  5. 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?

  6. 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?

  7. 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?

  8. 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”?

  9. Do we really need to develop a philosophy of cyborgs?

  10. 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?

  11. Take two individuals, A and B. Swap half of their organs after ensuring immunocompatibility. Have the identities of A and B changed?

  12. How do you think the human species will end?

 


Prenatal screening

  1. Can one ethically/morally prefer to have one sex/gender of child as opposed another?

  2. 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?

  3. 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?

  4. What is the distinction, ethically speaking, between medical and non-medical choices?

  5. 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?

  6. 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?

  7. 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?

  8. Is nature a just arbiter?

 


The Quantified Self

  1. 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?
  2. 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”?

  3. Are you comfortable with your quantified self existing in places you yourself have little control over?

  4. 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?

  5. 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?

  6. What would an ideal wearable do?

  7. What would an ideal therable do?

  8. 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?

  9. 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?

  10. I hold that the quantified self is who you see in the mirror of a panopticon. Metaphorically, of course. Thoughts?

  11. Several debates rage:

    1. 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?

    2. 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?

    3. 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”?

  12. What does the noble life of the good citizen of the great society look like?

 


Race

  1. What is race? Does it have a biological meaning we should concern ourselves with?
  2. 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?

  3. 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?

  4. 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?

  5. 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?

  6. 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?

  7. 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?

  8. 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?

  9. 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?

  10. 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?

  11. 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?

  12. 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?

  13. Black lives matter.

 


Regulation

  1. What is the mandate of our current medical enterprise?

  2. What should the role of the (federal) government be with regards to your personal health?

  3. 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”?

  4. 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?

  5. 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?

  6. 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?

  7. 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?

  8. 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?

  9. 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.”]

  10. 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

  1. Must (medical) science be replicable?

  2. 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?

  3. 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? 

  4. 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?

  5. 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?

  6. Have you noticed that you get invitations to a lot of junk journals? How can we address that scourge?

  7. 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?

  8. How can we incentivize (and possibly fund) medical/scientific reproduction?

  9. Should taxpayers have to pay to repeat experiments? How many times?

 


Self

  1. Who are you? Who/What/Where is “your” “self”?
  2. Which of the Borges wrote “Borges and I”?

  3. What does it feel like to “be a self”?

  4. Per Blanke and Metzinger (2008), “what are the minimally sufficient conditions for the appearance of a phenomenal self” or put differently, what is the bare minimum necessary for “the fundamental conscious experience of being someone”?

  5. Blanke and Metzinger posit three defining features necessary for the conscious experience of being a self: (1) “a globalized form of identification with [a] body as a whole”; (2) “spatiotemporal self-location” and (3) “a first-person perspective”. Do you agree that these three elements are the minimal requirements for a sense of self?

  6. (In what ways) Can one be wrong about one’s self?

  7. (In what ways) Can one distinguish between self and others?

  8. Caldwell (2010) identifies “five ethical duties owed to the self which enable individuals to deal more productively with themselves, with others, and with the world around them”. Namely,

    1. “understand how vulnerable we can be when we are unwilling or unable to address incongruity in our lives”,

    2. “acknowledge the underlying internal factors that cause us to deny reality”,

    3. “thoughtfully examine our core beliefs and [] reflect upon those beliefs on a regular basis”,

    4. “evaluate the stresses that cause us to become vulnerable to self-deception, acknowledge those stress factors, and seek to mitigate the potentially destructive influences of stress in our lives”, and

    5. “periodically examine whether our conduct is consistent with the beliefs we proclaim and [] confront incongruities between our beliefs and our behaviors”.

      Do you agree that these circumscribe ethical duties owed to one’s “self”?Do “you” “own” “your” “self”?

  9. Should the individual self be the basis of healthcare?

  10. Are there unethical ways/means by which you can modify your self?

  11. Should there be more or less “selves” in the world? Is there an optimal amount of selfhood for the planet? The universe?

 


Vaccination

  1. Do we have a right to tell others how to live? If so, under what circumstances do we have such a right?

  2. 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?

  3. 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?

  4. 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?

  5. Do we have a right to tell others how to raise their children? If so, under what circumstances do we have such a right?

  6. Under what circumstances can a third party overrule parents’ (medical) decisions?

  7. If vaccines caused autism, should we still give them to children?

  8. 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?

  9. How should a government handle the medical concerns of its governed?

  10. Should all people be vaccinated?

  11. To what extent should we respect the religious beliefs of others in the course of their medical treatment?

  12. How much should vaccines cost?

 


Zombies

  1. Would you ever eat a human being?

  2. 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?

  3. The boring definition question: what are “zombies”?

  4. 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?

  5. What are one’s rights in a pandemic?

  6. Who are we when we are sick?

  7. 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?

  8. 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?

  9. Who do zombies think they are? Does it matter? Does it matter “what it’s like to be a bat”?

  10. 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?

  11. 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?

  12. How much would you have to be paid to let a random person/animal bite you?

  13. What do you do in a zombie outbreak?

  14. Would you want to be as zombie?

  15. 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

  1. 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?

  2. 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?

  3. 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)?

  4. 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)?

  5. 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!

  1. 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?
  2. 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?

  3. 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?

  4. 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?

  5. 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?

  6. 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?

  7. 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?

  8. 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?

  9. What makes a curse unforgivable? Should there be more than 3?

  10. 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?

  11. 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)

  1. 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?
  2. 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?

  3. 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?

  4. 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?

  5. 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?

  6. 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?

  7. 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?

  8. 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?

  9. 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?