Interview with Julian Savulescu

Twitter has just expanded its character limit from 140 to 10,000 for direct messages. Yay Smile. However, this is only for DMs, not for public tweets Frown. Which means that for the foreseeable future, Twitter will not be the ideal medium for debating contentious bioethical issues. In 140 characters there is not much room for nuance or complexity. 

Which means that bioethics journals, which have a much bigger characer limit, still have a role to play. In our lead story today Xavier Symons interviews the editor of the Journal of Medical Ethics, Julian Savulescu, who is also a professor at Oxford. He says that the internet has made his job harder. 

"What I have learnt is that it is not Big Brother who is watching, but everyone. In the current era, everything that is published can be instantly accessed by nearly everyone. Ethicists have to be prepared for titles and one-liners to be pumped around the internet. You have to be prepared to defend what you have written or published against the harshest criticism."

It's a fascinating conversation. Check it out. 

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V is for victory for pink Viagra

This week the FDA approved the controversial drug Addyi, aka "pink Viagra". This wonder drug is supposed to be a treatment for a condition whose latest name is “hypoactive sexual desire disorder”. It has also been dubbed "female sexual dysfunction" and "female sexual arousal disorder". Its manufacturer claims that 1 in 10 women sufffer from HSDD. But critics say that drug companies are exploiting women's anxieties. 

"Approval of Addyi could see widespread overprescribing of a drug with marginal benefits and real safety concerns," says Ray Moynihan, a campaigner against the medicalisation of normal human behaviour. One of the most trenchant critics of the medicalization of women's sexual issues is Leonore Tiefer, a psychologist at New York University School of Medicine. She suspects that demand for the drug has been manufactured: 

"People fed a myth that sex is 'natural'—that is, a matter of automatic and unlearned biological function—at the same time as they expect high levels of performance and enduring pleasure, are likely to look for simple solutions. This sets the stage for disease mongering, a process that encourages the conversion of socially created anxiety into medical diagnoses suitable for pharmacological treatment."

Has the cause of women's rights taken a big step forward, as the manufacturer alleges, or are women going to be drawn even further into the nets of a pharmaceutical company whose sales pitch is that happiness depends on regular consumption of its product? What do you think? 

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Splurging on euthanasia

Apologies! Apologies! Nearly everything in this week's newsletter revolves around euthanasia. It was not planned that way; it just happened. However, some important new data has been published about the Netherlands and Belgium which are of great interest. 

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Remembering Nagasaki

A survivor prays at Nagasaki   

I am afraid that the newsletter is late. I hope that we will return to our normal schedule next week. However, the small delay means that our publication date is August 9, the 70th anniversary of the dropping of the atomic bomb on Nagasaki.

It has always amazed me that the ethical debate over the bomb has not advanced much since 1945. For most people, the moral reasoning was, and is, pretty simple. Hundreds of thousands of American lives were saved, so shut up. As an example, a popular conservative American website published an article last week about Hiroshima and Nagasaki. “Japan deserved to be nuked and it deserved it ten times over,” wrote columnist John Hawkins. “They needed to be stopped by any means necessary, that’s exactly what we did and the world, INCLUDING JAPAN, is a much better place for it.”

This is a fine example of consequentialist reasoning: it is ethical because it worked. But consequentialism is a double-edged sword. If foetal stem cells work, using tissue from aborted foetuses must be ethical, too. I wonder if defenders of the bomb connect the dots.

The Japanese regime was brutal. But so was the United States. The number of Japanese who died in Hiroshima and Nagasaki was about 250,000 – more than twice the number of American soldiers who died in the whole war in the Pacific (106,000). Nearly all of them were civilians, including 3,000 American citizens of Japanese ancestry who had been caught in Japan at the beginning of the war. Nowadays, we call attacks on innocent civilians terrorism.

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Journalistic ethics at work

A team of a team of undercover freelance investigative journalists called the Center for Medical Progress has been making life miserable for abortion provider Planned Parenthood over the past few weeks (while we were on holiday, sorry about the gap in coverage).

In a recent editorial the New York Times accused this unknown group of being, um, journalists. “The Center for Medical Progress video campaign is a dishonest attempt to make legal, voluntary and potentially lifesaving tissue donations appear nefarious and illegal.”

Well, actually, that’s not quite the case. It’s an attempt to see whether the donations are in fact legal and voluntary. Journalists tend to do that sort of thing. Being sceptical about bland reassurances from organisations with budgets of over $1 billion is kind of part of their job description.

This clothespeg-on-the-nose attitude is odd for a newspaper whose motto is “All the News That’s Fit to Print”. And even odder for a newspaper which defied the President of the United States by publishing revelations obtained illegally by whistleblower Edward Snowden. It editorialised at the time:

“Mr. Snowden was clearly justified in believing that the only way to blow the whistle on this kind of intelligence-gathering was to expose it to the public and let the resulting furor do the work his superiors would not.”

Large organisations like the National Security Agency, Phillip Morris or the Galleon Hedge Fund tend to deny that they ever have done, are doing or ever will do anything which is nefarious and illegal. That’s what their public relations staff are paid to say. What is extraordinary is that America’s paper of record has become an unpaid extension of Planned Parenthood’s PR office.

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Supreme Court fall-out

The Supreme Court has handed down a landmark ruling on same-sex marriage which effectively legalises it throughout the United States. President Obama welcomed the decision. “Today,” he declared, “we can say, in no uncertain terms, that we have made our union a little more perfect.” A rainbow light show was projected onto the White House as a sign of the Administration’s joy.

Although it’s a bit churlish of me to open the door of the party and let in the cold air, are there any bioethical challenges which follow in the wake of Obergefell v. Hodges? I can think of three.

First, most married couples want children. Where are the children of gay and lesbian couples going to come from? An adult outside of the relationship has to supply gametes to create the child. This has already led to a tangled web of relationships with multiple parents for a single child. This trend will accelerate. In due course, it may be possible to “manufacture” sperm and eggs from stem cells. This could provoke another stem cell debate.

Second, many gay couples will need surrogate mothers. Much of the demand for surrogate mothers in developing countries is generated by this consumer group. A couple of years ago BioEdge surveyed Indian IVF clinics. Most of them were expected a surge in demand if same-sex marriage was legalised. Surrogacy is dangerous work and only poor and desperate women take it on – which is why so few surrogate mothers live in New York’s Park Avenue. Surrogacy is a kind of exploitation which raises important ethical questions.

Third, conscience rights will be tested. In his dissent Justice Alito said, “the majority attempts, toward the end of its opinion, to reassure those who oppose same-sex marriage that their rights of conscience will be protected … We will soon see whether this proves to be true. I assume that those who cling to old beliefs will be able to whisper their thoughts in the recesses of their homes, but if they repeat those views in public, they will risk being labeled as bigots and treated as such by governments, employers, and schools.” Conscientious objection is already a big topic in bioethics journals. It will grow bigger.

I am sure that there are others. Any ideas? 

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Creating memories.

One of the most famous obiter dicta from the US Supreme Court is Justice Anthony Kennedy’s “mystery” passage in the 1992 case Planned Parenthood v. Casey. “At the heart of liberty is the right to define one's own concept of existence, of meaning, of the universe, and of the mystery of human life.”

I’m sure that you will often hear it cited in the years ahead. It expresses perfectly the notion of freedom which underlies same-sex marriage and transgenderism, both of which will be on the boil for some time to come.

Kennedy’s eloquent words do sound appealing, but following them can lead us into an Alice in Wonderland world. For instance,  Giuliana Mazzoni, a professor of psychology at the University of Hull in the UK, has suggested that artificial recreation of happy memories may become the next big weapon against depression. Depression blocks access to happy memories, but it might be possible for depressed people to artificially recreate good memories to allow for positive thinking.

If this technology becomes available – a big if – it could have very profitable commercial applications. Elderly people whose lives have been unhappy could get a loving spouse and a successful career for a few bucks. A drug addict could remember a steady job and an unbroken marriage. Bad memories could be erased.

According to Justice Kennedy’s understanding of liberty this would be completely ethical. If freedom is the opportunity to reshape reality, artificial memories would be a good thing. But somehow this defies common sense. A freedom that allows us to escape into a fantasy world rather than confronting reality is a peculiar freedom. 

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So much falseness in the world

As a journalist, I tend to be impatient with fussy terminological precision, a character flaw which occasionally raises the hackles of readers with more exacting standards. However, I do believe that terminology shouldn't ever be fudged, especially in public debates over bioethical issues.

That’s why I was so disappointed to read this admission by Gerald Dworkin, an academic who has been lobbying with Compassion & Choices for assisted suicide in California. Professor Dworkin is the author of a 1998 book, Euthanasia and Assisted Suicide. Looking back, he admits that it was injudicious to use straightforward language in the book’s title:

“I should note that the use of the term ‘Physician-assisted suicide’ is now politically incorrect, for tactical reasons. I understand that the popular prejudice against suicide makes it more difficult to rally support for the bills I favor. And even some potential users of such measures object to their death-certificate reading ‘suicide’. But to list the cause of death, as many such bills do, as the underlying disease process seems to me simply a lie. What caused the person diagnosed with terminal cancer to die now, rather than somewhat later, is the secobarbital the patient took. But learning to keep silent about such terminological matters was only one of many lessons I had to learn.”

What a shame it is to win a debate by muddying the waters. As Samuel Johnson said, “It is more from carelessness about truth than from intentional lying, that there is so much falsehood in the world."

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Bruce/Caitlyn Jenner. Assisted suicide in California

The big story in the tabloids this week was the transformation of Bruce Jenner, decathlon gold medalist and reality TV star, into Caitlyn Jenner. When the new Jenner, with flowing brunette locks, an ample bust and a corset, appeared on the cover of Vanity Fair, social media went mad. Within hours, the Twitter account of Caitlyn Jenner went from 0 to 1.1 million followers (BioEdge has about 5,000).

Beyond the titillation, there’s a lot to think about in the Jenner story. Is gender all in the mind? Is transitioning really possible? Is Jenner being cynically exploited by commercial interests? Where is a society based on self-defined identity going?

But the most thought-provoking comment, for my money, came from Nuriddeen Knight, an African-American woman writing in The Public Discourse. She compared the trans experience with Toni Morrison’s first novel, The Bluest Eye, in which an African-American girl longs to become a blue-eyed white girl.

“We, as the readers, don’t applaud this … We know that it’s not really blue eyes she wants, she wants something much deeper—love, acceptance, respect, honor ... the intangible human desires we all crave but are not equally given,” she writes.

“But what if, instead of wanting to be white, I wanted to be a man?” she continues. “What if, instead of crying to my parents that I was really a white person, I told them that I was really a man and that I desperately wanted to change my body to match my mind? If, in this scenario, you think that my parents should applaud my courage, accept my new gender identity, and run to the nearest surgeon, please ask yourself: ‘Why?’”

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White House backs review of gene-editing technology. Peter Singer on speciesism.

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