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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Suicide rate soars in US


The deaths this week of fashion designer Kate Spade and celebrity chef Anthony Bourdain (see below) focused the media once again on explanations for America’s rising suicide rates. The short answer is: nobody knows. The more nuanced long answer is: nobody knows for sure. But something is driving it. Here are a few paragraphs from the New York Times which suggest that suicide is becoming culturally more acceptable:

The rise of suicide turns a dark mirror on modern American society: its racing, fractured culture; its flimsy mental health system; and the desperation of so many individual souls, hidden behind the waves of smiling social media photos and cute emoticons.

Some experts fear that suicide is simply becoming more acceptable. “It’s a hard idea to test, but it’s possible that a cultural script may be developing among some segments of our population,” said Julie Phillips, a sociologist at Rutgers.

Prohibitions are apparently loosening in some quarters, she said. Particularly among younger people, Dr. Phillips said, “We are seeing somewhat more tolerant attitudes toward suicide.”

In surveys, younger respondents are more likely than older ones “to believe we have the right to die under certain circumstances, like incurable disease, bankruptcy, or being tired of living,” she said.

If this is the case, why, O why, is there a movement for assisted suicide? Yes, it’s hard to prove, but it makes sense: if assisted suicide is a triumph of compassion and autonomy, how can unassisted suicide possibly be a tragedy?

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Left out on euthanasia


Some years ago, I received an unexpected phone call from a Melbourne magazine which described itself as the voice of the Australian Left. One of the editors wanted me to write an article about euthanasia activist Philip Nitschke. “He’s ****ing the proletariat over, comrade,” was his interpretation of Dr Nitschke’s mission. I obliged and was later rewarded with an invitation to the magazine’s Christmas party. I had an interesting chat there with an enthusiastic fan of Stalin’s philosophical works (“much misunderstood”), thus dispelling any misgivings I might have had about the magazine’s left-wing credentials.

Nowadays, “left-wing” almost certainly indicates support for euthanasia. That’s why I was gratified to read that the defeat of a euthanasia bill in Portugal last week was due to the opposition of the Communist Party. Its leader, João Oliveira, told the Portuguese parliament that:

“Faced with the problems of human suffering, illness, disability or incapacity, the solution is not to remove responsibility from society by promoting the early death of people in these circumstances, but to promote social progress in order to ensure conditions for a decent life.” 

That’s what I thought left-wing politics was all about: protecting the disadvantaged. Have left-wingers in the Anglosphere lost their way?

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Ireland chooses


Ireland, which was once Europe’s most socially conservative nation, has voted to repeal the Eighth Amendment to its constitution in order to permit abortion. The vote was roughly 2 to 1 in favour of change, with nearly the whole country supporting it. Taoiseach (prime minister) Leo Varadkar reassured No voters. “Ireland will still be the same country today as it was before, just a little more tolerant, open and respectful.” 

The legalisation of abortion comes hard on the heels of the legalisation of same-sex marriage in 2015. Together they suggest that Ireland is not the same country, at least not compared to 1983, when the Eighth Amendment was passed by a 2 to 1 margin. It is obvious that the country has “changed, changed utterly” in a single generation – although people will differ on whether this signals a “terrible beauty” or a terrible shame.

What is responsible for the turnabout? The decline in the prestige and power of the Catholic Church, which once was synonymous with Irish culture, surely has something to do with it. But there must be other reasons as well, as Ireland is simply treading the well-worn path towards secularisation which has swept across Western Europe. It’s worthwhile trying to understand the dynamics of the change, as the rise of bioethics itself is part of that secularisation. Otherwise we – Ireland and the rest of us – will fail to understand ourselves.

One example of the narrative which is being used to explain the referendum result is the image of Savita Halappanavar, an Indian migrant who died after asking for an abortion in 2012. It was used to show what happens to women who are denied their reproductive rights. However, abortion had nothing to do with her tragic death, a government investigation concluded in 2014. Instead, it was a perfect storm of medical negligence.

“We have voted to look reality in the eye and we did not blink," says Mr Varadkar about the referendum result. If he meant by these self-congratulatory words that Ireland is no longer living in a world of delusion and lies, he has obviously spoken too soon.

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May prisoners be used in clinical research?


Shusaku Endo may be the greatest Japanese novelist who didn’t win the Nobel Prize. He is best known in the West for his novel Silence, about Christianity in 17th Century Japan, which was recently made into a film by Martin Scorsese. But one of his early novels touches upon the ethics of clinical research. Based upon a historical incident which took place just weeks before the end of World War II, The Sea and Poison relates the moral corruption of doctors who vivisected several American prisoners of war.

It’s hard to get, but well worth reading, as it exemplifies the hazards of research on prisoners. Almost no population is more vulnerable to exploitation by clinical researchers than prisoners. Even if they benefit from the research in some tangential way, a more powerful motivation may be their desire to please prison authorities.

Many bioethicists have written about this difficult ethical issue, but this doesn’t make it any easier to make a decision in practice. Below is an article about proposed clinical trial conducted in prisons to determine whether low-salt diets are healthier. What do you think?

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