About ‘top jobs’


Last year Sydney journalist Miranda Devine interviewed Australia’s first out-of-the-closet transsexual, Carlotta, a cabaret performer and TV actor. Carlotta had what is now called “gender-affirming” surgery in the early 1970s and built a career in show biz. Her advice to teenagers who want to transition to the opposite sex: “Don’t give the child hormones. Wait till 18. You shouldn’t fool around with the body until you’re mature.”

This seems common sense. However, as an article in JAMA Pediatrics (see below) reports, girls as young as 13 are receiving mastectomies to treat their gender dysphoria. Two years later (ie, when they’re 15) the transteens are supposedly as happy as Larry with their “top job”.

This doesn’t seem common sense. How can a girl of 13 give truly informed consent to a life-changing operation which removes both of her breasts? As a growing number of “detransitioners” bear witness, this is crazy. “I’m a real-live 22-year-old woman with a scarred chest and a broken voice and a 5 o’clock shadow because I couldn’t face the idea of growing up to be a woman,” says Carla in a YouTube video.

The risk of turning a young girl’s life into a misery is just too great to allow teen mastectomies before adulthood. In fact, it’s hard to describe it as anything other than child abuse by her physicians and psychologists. What do you think?

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The limits of ‘procreative liberty’


John Robertson was an American scholar in law and bioethics who died last year. He is best known for making a strong case for “procreative liberty”, whether procreation takes place naturally or with the help of technology. As a tribute to his influence, the current issue of the Journal of Law and the Biosciences contains several articles about this theory.  

Robertson’s theme was that reproductive choices which do not harm the interests of others should not be subject to regulation or prohibition. In his best-known book, Children of Choice, published in 1996, he discussed abortion, IVF, surrogacy and pre-natal genetic modification. But time has moved on. The principle of effectively unconstrained “procreative liberty” is being used to justify other developments, some of which are discussed in the Journal, including unisex gestation.  

What I found interesting was that Robertson, in a paper written not long before his death, agreed that a male pregnancy (after a womb transplant) could be ethically justified, but only if it were necessary for genetic reproduction. Even he wanted to draw a line somewhere.

However, the author of one of tribute essays questions this restriction. Enjoying the experience of gestation is reason enough, she says. (See below). I suppose that this raises the question of whether it is possible to draw any lines, anywhere, once we agree that reproductive rights should not be limited.

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Moral fluoridation


Why do I keep screwing things up? This is, IMHO, the first question of moral philosophy. I know what the decent, sensible and right option is, and yet I choose the nasty, mad and wrong option. Bad ideas, said Plato. Bad education, said Rousseau. Desire, said Buddha. Capitalism, said Marx. Nature red in tooth and claw, said Darwin. Myself, I’m partial to the notion of Original Sin, which, as G.K. Chesterton observed, is the only Christian doctrine which can be proved by reading the newspaper.

The second question is how do I stop screwing things up? Theoretically, this can be solved without answering the first question. A number of bioethicists believe that we could live the good life if we spiked the water supply with a kind of morality fluoride. This sounds a bit too much like living as a Delta in Brave New World for my taste, but their concern is preventing very bad hombres from destroying the world. Perhaps the loss of a wide range of human emotions would be worth it.

However, there are other considerations – should we force people to drink the water? Should we tell them that their water has been spiked? All interesting questions – read all about in this week’s newsletter below.

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Remembering the Unabomber


The Norwegian bioethicist Ole Martin Moen has published an unusual but intriguing article in the journal Bioethics. He analyses the arguments in the half-mad manifesto of the Unabomber, Ted Kaczynski. For those whose memories don’t stretch back that far, Kaczynski was a brilliant mathematician who became obsessed with the decay of American society. He retired to a backwoods cabin and worked as a serial postal bomber whose handiwork killed three people and maimed 23 between 1978 and 1995. The New York Times published his 35,000-word manifesto in 1995 which eventually led to his capture.

Moen says that Kaczynski’s concerns should be taken seriously and refuted philosophically, even if he is a terrorist. “Although philosophers can only play a modest role in fighting terrorism, it is striking that, today, the most obvious line of response to one’s adversaries—to listen carefully, to show that one has understood their position, and to explain why one believes they are mistaken—is hardly even attempted as a means to discourage terrorists.”

His words can usefully be applied to many other areas of public discourse today, not just dialogues with ideologically-motivated terrorists. It’s very seldom that opposing sides listen carefully to each other. In the Middle Ages, academic battles took the form of “disputation and debate”. Stating the other side’s argument in the strongest possible form was an essential part of the process – before demolishing it, of course. We need a bit more of this fairness, even for madmen like Kaczynski.

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The dangers of selfies


It’s not an original thought, but with every amazing technological advance comes an unheard-of and very dangerous drawback. Smashing the atom gave us nuclear power and the atom bomb. The automobile gave us hitherto unimaginable mobility and tens of thousands of deaths on the road. The Pill gave women control over their fertility and led to birth rates so low that some countries are in danger of disappearing.

And the mobile phone? Where do we start? This week, with selfies. They give Millennials a buzz, but according to cosmetic surgeons, they also can lead to a psychological disorder which has been dubbed “Snapchat Dysmorphia”. Young women (mostly) are so used to altering their images with apps that they demand the same service from cosmetic surgeons.

“This is an alarming trend because those filtered selfies often present an unattainable look and are blurring the line of reality and fantasy for these patients,” report the authors of an article in JAMA Facial Plastic Surgery.

It would take a sharper mind than mine to define the problem, but our relationship with technology is problematic. We don’t foresee the problems and we can’t control our dependence. Since so much of contemporary bioethics revolves around the proper use of technology, this is something we always have to bear in mind.

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Animal euthanasia


Every year, about 1.5 million cases of euthanasia take place in the United States. Does this have a negative impact on healthcare workers? Sorry, about 1.5 million cases of cat and dog euthanasia take place. But the question is still relevant. Veterinarians, veterinary assistants and shelter workers experience great stress at having to put animals down.

The emotional connection between the work of human doctors and animal doctors is closer than you might think. Owners often react to a pet’s death with the intensity of grief which appears equivalent to the loss of a beloved relative.

So the moral stress which vets experience is relevant. Suicide amongst vets has been the topic of several studies. “Veterinarians are four times more likely than members of the general population and two times more likely than other health professionals to die by suicide,” according to a 2012 study in the journal of The American Association of Suicidology, Suicide and Life-Threatening Behaviour.   

Why? Performing euthanasia day in, day out, also appears to make some vets less able to resist the temptation to commit suicide. The authors of the 2012 study found that “... all else being equal, veterinarians may be more likely than members of other professions to enact a lethal attempt when they desire suicide because their exposure to euthanasia has rendered them less fearful of death."   

Aren’t there lessons in these finding which are relevant to doctors who euthanize their patients? Sometimes doctors in Belgium or the Netherlands are quoted as saying that the death they helped was beautiful or peaceful. Could that be bravado masking their own nonchalance about human death?

How many times have we all heard the argument, “You wouldn’t let a dog suffer like this...” Its logic is that if the suffering of animals and humans is essentially the same, they both should be released from suffering in the same way. But if the animal-human parallel works for the patient, why not for the doctor? If we allow euthanasia, surely we can expect the same burn-out rates and the same suicide rates as veterinarians ... at least the same. That should scare us all – especially the doctors who will be responsible.

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The Sea and Poison


Today, I'll take a break from controversy. Let's talk about literature. 

In 2003 the President’s Council on Bioethics published an anthology about bioethical dilemmas. It was a surprising contribution by a government committee. Such bodies are better known for generating reports which are dismal, dull, dreary and destined for pulping.

The selections in the anthology ranged from J.M. Barrie’s Peter Pan to Plutarch. Not only were they thought-provoking, but also enjoyable. At the time I thought it was the last word in the literature of bioethics, but since then I have discovered other texts.

One of these, which I highly recommend, is the Japanese novel The Sea and Poison, by Shusaku Endo, who, like Graham Greene, was a perpetual also-ran for the Nobel Prize. Endo is better known in the West as the author of Silence, which Martin Scorsese recently made into a film.

Silence was a 1966 historical novel about the apostasy of a Catholic priest in 17th Century Japan. The Sea and Poison, an earlier work published in 1958, is also about tormented consciences. It is based on an incident which happened shortly before the end of World War II, when Japanese doctors vivisected several American POWs. The focus of the story is not the gory procedure, which is described very briefly at the end of the novel, but the inner lives of the doctors and nurses. How could they have allowed themselves to participate in something which was so clearly evil? It’s extraordinarily insightful – and very relevant at a time when we are debating conscientious objection.

The Sea and Poison is out of print in English, but can easily be obtained second-hand on the internet. It’s well worthwhile for anyone teaching bioethics.  

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Two cheers, at least, for utilitarianism


We tend to give utilitarianism a hard time in “Pointed Remarks”. But sometimes we could do with a bit more utilitarianism. It might keep the media – and many doctors, too – from being so dewy-eyed about apparent successes. Take IVF, which celebrated, so to speak, its 40th anniversary this week, with the birthday of Louise Brown.

In some respects, IVF has been quite a success. An estimated 8 million IVF children have been born since then. A thriving industry has grown up, worth some US$15 billion, making lots of doctors, scientists, technicians and administrators very wealthy. That is the happiness side of the ledger.

But how about the women who endured cycle after cycle of IVF without conceiving? Their lives have been filled with suffering as a result. And there are far more of them than women who eventually conceived. How about the destruction of millions upon millions of human embryos? And how about the disturbing future of IVF – designer babies and genetically-engineered children? That is the pain side of the ledger. It hasn’t been quantified, of course, but it must be acknowledged. I would venture to say that the balance is negative.

Whether I’m right or wrong about that, I do think that we need a clearer vision of the negative side of assisted reproductive technology.

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Selling bioethics


We’re back! Holidays are over and BioEdge has resumed publication. Now, while we’re still fresh and enthusiastic, is the time for our readers to make suggestions for improving our coverage.

This week the lead story focuses on a report from the Nuffield Council on Bioethics in Britain which has given an in-principle endorsement to germline modification. While the report is purely advisory, most of its recommendations on similar topics have eventually become law in the UK. For this reason, its advice to the British government is bound to have a world-wide impact.

Most people, including members of Parliament, will only read newspaper articles about this radical development in genetics. But it is fundamentally a philosophical, not a scientific question: what makes us human?

The Nuffield report fails to answer this, but the full report is scathingly critical of what it calls “genomic essentialism”: we are not our genes. Instead, as I read it, it has framed the question as a consumer rights issue: provided that the technology is safe, don’t couples have a right to have the kind of children they want?

What do you think?

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Nabbing the “Golden State Killer”


The Economist recently highlighted growing concern about “the surveillance state”. It argued that “the digital world, like the real one, [should have] places where law-abiding people can enjoy privacy. Citizens of liberal democracies do not expect to be frisked without good cause, or have their homes searched without a warrant.”

And it concluded, “Police rightly watch citizens to keep them safe. Citizens must watch the police to remain free.”

This is useful advice for anyone sending DNA to a genealogy website. Our lead story below is an example of how easily police vigilance, open source data, and personal privacy become scrambled. Earlier this year California police used the DNA of a vicious serial killer who had been off the radar for more than 30 years and identified him through a popular website.

I can imagine that some users must have been outraged. This could happen to me: what gives police the right to trawl through my relatives? Perhaps we should follow the advice of The Economist and require warrants for searching family trees on the internet.   

On another note, you probably know that we're coming to the end of our fund-raising drive. Please think about a donation -- BioEdge has no sugar daddy, no big institution, behind it. We depend on the generosity of our readers for survival. 

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