I must be getting old. For most of my life, I have been reading about the global need to curb births and the unmet demand for contraception. And then I opened this week’s edition of The Economist and discovered that the main problem facing couples is the unmet demand for children.
The Economist surveyed 19 countries, asking people how many children they wanted and how many they expected to have. The results were astonishing.
“For more and more couples, the greatest source of anguish is that they have fewer children than they want, or none at all. … In every rich country we surveyed, couples expect to be less fertile than they would like, and many in developing countries suffer the same sorrow….
“The pain of having no or fewer children than you desire is often extreme. It can cause depression and in poor countries can be a social catastrophe. Couples impoverish themselves pursuing ineffective treatments; women who are thought to be barren are divorced, ostracised or worse.”
I hope that executives at Marie Stopes International (see article below), the United Nations Population Fund and all the other global agencies dedicated to shrinking family sizes read The Economist’s advice:
"Governments and aid agencies have turned family planning into a wholly one-sided campaign, dedicated to minimising teenage pregnancies and unwanted births; it has come to mean family restriction. Instead, family planning ought to mean helping people to have as many, or as few, children as they want."
Costa Rica is a small Central American republic of about 4.5 million people which is remarkably stable, compared to other countries in the region. It is one of the few countries in the world without a standing army. Its democratic institutions are robust. A higher proportion of people turn out to vote than in the US. The percentage of seats in parliament held by women is nearly double that of the US – about one-third.
Yet Costa Rica has been dragooned by an international court into enacting legislation which violates its Constitution. In 2000 it became the only country in the world to ban IVF, based on a Supreme Court ruling that this violated a constitutional guarantee to the right to life for the unborn. Last year, after many legal battles, Costa Rica was ordered by the Inter-American Court of Human Rights to enact legislation enabling IVF -- against the will of its legislature and Supreme Court. “Seven foreigners are making decisions about human life in Costa Rica,” said one deputy bitterly. After more legal tussles, clinics began offering IVF procedures last month.
Regardless of where one stands on the ethics of IVF, this seems like a low point for respect for democracy. An article in Nature crowed over the victory and said that the next goal must be the legalization of abortion. There’s something quite cynical about this. If the Inter-American Court of Human Rights struck down the death penalty in the US, all Americans would be united in their outrage. Voters in the UK supported Brexit because EU courts were suborning UK legislation, amongst other issues. Yet no one is defending Costa Rica’s right to make up its own mind on controversial bioethical problems.
The death of Ivo Pitanguy in Rio this week was the intersection of bioethics and the Olympics. The world’s best-known cosmetic surgeon and a celebrity in his native Brazil, he carried the Olympic flame on the day before he died of a heart attack at the age of 93.
A member of the Brazilian Academy of Letters, Pitanguy thought deeply about his specialty. “My operations are not just for my patients’ bodies. They are for their souls,” he wrote. He regarded beauty as a human right and he made cosmetic surgery as popular among the poor as among glittering celebrities.
However, his poetic vision of his specialty clashes with the scepticism of some bioethicists. The Nuffield Council on Bioethics, in the UK, is currently conducting an inquiry into cosmetic procedures, in response to concerns that patients are being victimized and that the industry is sustained by sexist stereotypes. Its discussion paper is particularly interesting. We hope to cover this area in more depth in the future.
The Games of the XXXI Olympiad have just started in Rio de Janeiro. A few thousand young men and women will be sweating in their competitions; a few billion people will be watching them on television screens; and a few bioethicists will be disputing the merits of taking drugs and human enhancement. Stretching the body to its limits, going "Faster, Higher, Stronger", is a thrilling spectacle. But -- this is just a personal crochet -- I've always sought out the human drama in the Olympics, which sometimes has nothing to do with record books.
My favourite Olympic moment comes from the marathon at the 1968 Games in Mexico. John Stephen Akhwari, of Tanzania, began to cramp up because of the high altitude conditions. And then at the 19 kilometre mark, he fell and badly injured his knee and shoulder. But on he ran, or stumbled, and as dusk was falling, he hobbled into the nearly empty stadium, a bandage flapping around his leg, and crossed the finish line an hour after the winner. When they asked him why he bothered, he replied, "My country did not send me 5,000 miles to start the race; they sent me 5,000 miles to finish the race."
You can enhance stamina and speed, but can you enhance courage and loyalty?
However, the question highlights the importance of Britain in the world of bioethics. Britain is the home of utilitarianism, which is the dominant philosophy in bioethical discourse at the moment. The medical and scientific establishment is dominated by a utilitarian mindset which has set the agenda for debates on embryo research, stem cell research and assisted dying around the world. As one cynical writer commented, “when it comes to bioethics, Europe might be better off without Britain”.
There is something in this. Although I am handicapped by a big language barrier, my impression is that from Norway to Italy there is much more depth and diversity in bioethical discourse across the Channel. The Greens and the Christian Churches are much more influential, to say nothing of Continental philosophy, which despises utilitarianism as vacuous and naïve. If England (the pundits all agree that Scotland will secede) loses its biomedical industry to the EU, perhaps utilitarian bioethics will lose some of its funding and its influence. That would be no bad thing, I think.
Sorry, guys, but BioEdge will be taking a holiday during July. Our next issue will be in the first week of August.
I have no love for Donald Trump, but it does seem unfair that only he is being accused of being crazy in this year’s election for president. It is a truth universally acknowledged that any man (or woman) who hankers after high public office must be in need of a psychiatrist. In 2013 psychologists published an article asserting that most recent presidents have suffered from “grandiose narcissism, which comprises immodesty, boastfulness and interpersonal dominance”. Remember that Hillary Clinton has been accused of all these failings, not just Trump. Perhaps they are crafty, not crazy.
That’s why the Goldwater Rule is a good thing. As Xavier Symons mentions below, this is an informal rule of medical ethics for psychologists and psychiatrists which bans them from commenting on the mental state and stability of public figures. It’s very rash to predict that psychological flaws disqualify a person from holding public office. Winston Churchill was depressive and an alcoholic and became the most admired statesman of the 20th century. Abraham Lincoln probably suffered from depression but is the most revered of all American presidents. Mr Trump may be unsuited to the job of president, but I’d prefer to make up my own mind on the subject without airy speculation from psychiatrists who have never spoken to the man himself.
You probably remember the scene in The Matrix in which Morpheus explains to Neo the terrible secret: “You take the blue pill—the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill—you stay in Wonderland, and I show you how deep the rabbit hole goes.”
In the jargon of The Matrix, I’m a blue pill person and believe that I’m in touch with reality. Perhaps I am deluded.
Elon Musk, billionaire co-founder of PayPal, and the boss of Tesla and SpaceX, on the other hand, is definitely a red pill person. Last week he told a conference of geeks in San Francisco that we are probably part of a powerful computer simulation. In fact, he estimates that "There's a one in billions chance that this is base reality”. (See story below.)
Musk is an intelligent man, but I wonder if he understands the ethical implications of the red pill. If we are really marionettes in a super-human intellect’s simulation of reality, nothing much matters. Certainly worrying about right and wrong is a waste of time. Human life doesn’t matter much either, as we are all just blips in a gigantic computer game. There’s not much incentive for social solidarity.
The death of Muhammed Ali at the age of 74 is reminder of the uneasy ethical status of boxing. Only in boxing is the brain the target. Ali’s Parkinson’s disease was probably a result of punishing blows to the head over the course of his career. Gloves probably make the problem worse, as they increase the weight and the force of impact. Headgear may not protect boxers from rotational acceleration.
John Hardy, a neuroscientist at University College London, wrote a couple years ago: “nothing can be more killing of joy than personality changes, violence, substance abuse and dementia. I also think it is demeaning as a society for people to get pleasure out of watching others fight and that we should consign this public spectacle, as we have done public executions, to the dustbin of history.”
What do you think? Should professional boxing be banned? It seems hard to justify a sport which, in the words of Joe Frazier, who beat Ali in the brutal “fight of the century” in 1971, “boxing is the only sport you can get your brain shook, your money took and your name in the undertaker book.”
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This is very encouraging for our work in reporting on significant developments in bioethics around the world.
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Twelve years ago, political scientist Francis Fukuyama described transhumanism as “the world’s most dangerous idea”. In 2004, that sounded a bit daft -- almost no one had ever heard of the idea. For many people it still does, but now transhumanism is going mainstream.
Movies are being made about transhumanist themes; newspapers like the Washington Post are running feature articles on it; and a transhumanist is running for US President. It is indeed dangerous. As Fukuyama said:
The seeming reasonableness of the project, particularly when considered in small increments, is part of its danger. Society is unlikely to fall suddenly under the spell of the transhumanist worldview. But it is very possible that we will nibble at biotechnology's tempting offerings without realizing that they come at a frightful moral cost.
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