Ethics of Transparency in Dining Halls: Choice-Prohibitive Situations

How often do we consider that the food currently on our plates was the product of rigorous genetic and scientific experimentation? The food is, in a sense, designer. We could be consuming food that was designed, selected, and tested to perfection in the same way that any other product made available to us is. Typically, eating ‘natural’ ingredients implies eating freshly grown food from farmer’s markets or ‘organic’ producers. Consuming ‘fresh’ food is marketed throughout the University of Virginia’s dining halls – but is the food that we consume truly organic, or is it a designer product? 

Genetically Modified Organisms (or GMOs) are defined by the U.S. Department of Agriculture as “an animal, plant, or microbe whose DNA has been altered using genetic engineering techniques” [1]. For thousands of years, human beings have utilized selective breeding methods to select for particular phenotypes, so in a sense we have been genetically modifying for thousands of years already [2]. For example, the reason that bananas are yellow is due to genetic modification through years of artificial selection; initially bananas were green and red. Recently, selective breeding has been augmented by modern biotechnology which grants scientists the capability to directly modify the genetic code. Both the crops and animals that produce the food purchased in our local groceries stores – subsequently served in school meals – potentially bear the signature of purposeful genetic adaptation. 

Genetic alteration has allowed for massive advancement in food production, helping increase yields and production of food within the confines of the agricultural space currently available to us. For instance, many genetically modified plants resistant to herbicides allow for greater yields of crops. This is an important innovation, especially with a growing population and already present issues with food insecurity. In the United States, 10.2% of households are food-insecure, 6.4% are households with low food security, and 3.8% of households have very low food security [3]. Genetically Modified Organisms provide a solution that takes us one step closer towards ending food insecurity, as well as provides a potential and feasible solution to solving world hunger. 

Despite the benefits, there are still fears and trepidation as people question the safety of genetically modified food. There are legitimate concerns of the potential allergenic properties of genetically modified organisms, as well as the transfer effects of antibiotic resistance whereby modified organisms could pass resistance to bacteria. Ultimately, there are potentially negative consequences for human health that “could result from differences in nutritional content, allergic response, or undesired side effects such as toxicity, organ damage, or gene transfer” [4]. Many of these fears can be quelled by current science which affirms that genetically modified organisms are safe. However, genetically modified organisms, specifically those that are experimentally-derived, have not been incorporated into diets for long enough to have complete certainty as to potential ramifications on health in the future. Furthermore, many laws and regulations which are designed to govern the world of biotechnology are too archaic and outdated to successfully monitor and control the safety of the food being manufactured. There is a desire and push for greater research and labeling to present the dangers of genetically modified foods to consumers when they are purchasing food in grocery stores. Providing people with that information, I will argue later, is incumbent upon the manufacturer, the Food and Drug Administrator, grocery stores, food distributors, and retailers who utilize those genetic technologies.

The dining halls of the University of Virginia have monopolized the food market filled with students of all years, majors, and dietary preferences without providing full transparency. At the University of Virginia, first-year students are required and expected to purchase an ‘all inclusive dining plan,’ which includes unlimited swipes into dining halls each day. This plan is incredibly expensive and, because first-years are also not allowed to have cars on grounds and are therefore unable to drive to grocery stores, they are left without the option to dine elsewhere. This leaves them without the option to choose whether or not they would like to eat in the dining hall because it is essentially the only on-campus dining option. Thus, the University has effectively monopolized the market and ended any notion of “choice” that students may have in food choice when living on grounds their first-year. 

Nutritional information about the meals being served in the dining halls is available, but there is no information provided as to whether the foods are genetically modified or not. This prevents students from making informed decisions about whether or not they would like to eat genetically modified food. If a student is vegetarian and does not want to eat meat, they are provided with the information necessary to eat within that chosen dietary preference. While if a student did not want to eat genetically modified food, that information is not given to them in order to make an informed decision about the food they would like to consume. In public health, it is a common tactic when approaching issues with food or dietary habits to treat “food as medicine” [5]. Treating food as medicine and viewing people as patients, one can consider the ethical implications of not providing information to students as they make uninformed decisions about what food they would like to eat. 

When treating food as medicine and those who eat in dining halls as patients, lack of informed consent is clearly displayed. If a patient is involuntarily given a medicine, the patient is assumed to have the right to choose treatment – and if that is not given, then the patient will be informed of the implications of the treatment being received [6]. These are basic tenets of informed consent and are not made available to the ‘patients’ in the case of the dining hall, as students are not fully informed of the nature and background of the food being made available to them. 

This is an issue of transparency – UVA Dine (University of Virginia’s dining hall company) has an ethical obligation to inform students if they do not provide them with a choice. The UVA Dine’s website provides no information as to whether or not genetically modified organisms are used [7]. UVA’s distributors include 4PFoods which is a certified organic producer, which means they can’t use any synthetic pesticides, chemical fertilizers or GMOs [8]. However, other distributors like  Produce Source Partners and Cavalier Produce have no information regarding their use of  genetically modified organisms in their food on their websites [9,10]. Students are owed transparency and greater information regarding the use of genetically modified food in order for them to make informed dietary decisions. Furthermore, in the situation in which you treat food as medicine, you are not providing students with the information allowing for informed consent. UVA Dine is not upholding its ethical obligation to inform. 

I believe that Genetically Modified Organisms should be utilized in dining halls, but information and transparency must be given. Through a utilitarian perspective, genetically modified foods allow for the great amount of healthy food to be offered at a low price. The dining halls would advertise themselves as organic, if they were not using genetically modified organisms [11, 12]. UVA Dine says that they prioritize organic food, but this does not mean that all of their food is organic. I believe that in a situation like this, in which students are devoid of choice, they must be given all relevant information. Having a lack of information and choice creates a situation in which students who dine at UVA are unable to make meaningful informed decisions. Genetically Modified foods have a valuable role to play in the fight against world hunger and food insecurity, but they must come with warnings and transparency––people have a right to know. 

Sources: 

1. “Agricultural Biotechnology Glossary.” USDA, https://www.usda.gov/topics/biotechnology/biotechnology-glossary. 

2. “Genetically Modified Organisms.” National Geographic Society, https://education.nationalgeographic.org/resource/genetically-modified-organisms. 

3. “Key Statistics & Graphics.” USDA ERS - Key Statistics & Graphics, https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/key-statistics-graphics/. 

4. SITNFlash. “Will Gmos Hurt My Body? the Public's Concerns and How Scientists Have Addressed Them.” Science in the News, 17 Jan. 2021, https://sitn.hms.harvard.edu/flash/2015/will-gmos-hurt-my-body/#:~:text=One%20specific%20concern%20is%20the,organ%20damage%2C%20or%20gene%20transfer 

5. Graber, Eric. “Food as Medicine.” American Society for Nutrition, 24 Feb. 2022, https://nutrition.org/food-as-medicine/ 

6. Keatley, K L. “Controversy over genetically modified organisms: the governing laws and regulations.” Quality assurance (San Diego, Calif.) vol. 8,1 (2000): 33-6. doi:10.1080/105294100753209174 

7. Davies, Benjamin. “Responsibility and the limits of patient choice.” Bioethics vol. 34,5 (2020): 459-466. doi:10.1111/bioe.12693 

8. “What We Are Doing On Grounds.” UVA Dine, https://virginia.campusdish.com/en/Sustainability/WhatWeAreDoing#:~:text=When%20local%20items%20are%20used,ingredients%20to%20our%20dining%20locations.

9. https://4pfoods.com/posts/what-do-all-those-labels-stand-for/#:~:text=At%204P%20Foods%20we%20get,%2C%20antibiotics%2C%20chemicals%20or%20vaccines

10.  “Read Food Labels like A pro: What You Need to Know.” 4P Foods, https://4pfoods.com/posts/what-do-all-those-labels-stand-for/#:~:text=At%204P%20Foods%20we%20get,%2C%20antibiotics%2C%20chemicals%20or%20vaccines.  

11. “Cavalier Produce.” Cavalier Produce, https://www.cavalierproduce.com/.  

12. McEvoy, Posted by Miles. “Organic 101: Can Gmos Be Used in Organic Products?” USDA, 21 Feb. 2017, https://www.usda.gov/media/blog/2013/05/17/organic-101-can-gmos-be-used-organic-products#:~:text=The%20use%20of%20genetic%20engineering,t%20use%20any%20GMO%20ingredients.  

CRISPR is Revolutionary – but at What Cost?

CRISPR, the groundbreaking gene-editing tool of the last decade, has permanently altered the field of genetics for the science world. The tool efficiently targets specific sequences of genetic code and has revolutionized studies on genomes of a plethora of organisms. CRISPR has played an especially vital role in tackling diseases as the technology enables replacing harmful DNA sequences with healthy ones. 

The first cell therapy study with CRISPR was conducted just in 2019 to treat Victoria Gray’s sickle cell disease symptoms.1 Sickle cell anemia is an inherited disease that results in the formation of crescent shaped blood cells.2 For the disease’s thousands of victims, these crescent shaped blood cells can inflict episodes of pain by blocking blood flow in the body. This can make normalcy for sickle cell patients extremely challenging and prompt those like Victoria Gray to turn to new methods such as CRISPR gene editing. 

Prior to the clinical trial with Gray, the only known cure for sickle cell was a bone marrow transplant, which is where the stem cells responsible for the faulty hemoglobin in sickle cell are found. This process involves killing the stem cells through chemotherapy and replacing them with healthy cells from a donor.3 The main issue with this solution is finding a donor, and the reason why researchers began to experiment with CRISPR as an alternate treatment. 

Scientists focused on using CRISPR to edit a fetal hemoglobin gene that would produce enough healthy cells to counter the defective sickle cells. After extracting and editing Gray’s cells with this process, scientists infused billions of modified stem cells back into her body. For patients such as Gray, CRISPR is life changing – she was able to resume her daily activities without the burden that sickle cell brought upon. However, for others, the outcome can be disheartening and even deadly. 

In October of 2022, 27-year old Terry Horgan passed away during a study testing similar gene editing techniques to Victoria Gray in hopes of curing his fatal condition of Duchenne muscular dystrophy. The muscle degeneration disease is caused by a gene mutation that prevents dystrophin, a protein important for holding muscles intact, from being produced properly. Researchers at the University of Massachusetts are unsure of the exact details of what caused the death, but considering methodology, speculation points toward CRISPR possibly playing a crucial role.4

Based on what examination finds in the next few months, Terry Horgan’s death may be a large setback in research and investments towards CRISPR gene editing. The situation bears resemblance to the death of Jesse Gelsinger in 1999, which heavily set back the field of gene therapy at the time. Similar to Horgan, Gelsinger volunteered to be a part of a clinical trial that involved new gene therapy methods. Gelsinger had ornithine transcarbamylase deficiency syndrome (OTCD) where ammonia builds up to lethal levels in the blood due to a damaged or missing transcarbamylase enzyme.5 To treat OTCD, researchers developed a harmless cold virus to contain working copies of the OTC gene, which would be injected into the patient and integrate the added gene through infection of cells. While the method caused mild side effects in other patients, the viral vector caused a fatal inflammatory response for Jesse Gelsinger and dismantled the field of gene therapy for its deadly risks.6 

After nearly two decades of research, gene therapy slowly overcame its controversy with new policies requiring researchers to be cautious with human subjects.7 However, gene therapy clinical deaths still occur from time to time.8For Horgan’s case, it has called attention to how CRISPR gene therapy methods are still extremely new – and both its other abilities and long term effects are unknown.9 As CRISPR evolves and develops to have new uses, an ignorance towards its capacity to affect the human genome can lead to only more tragic deaths. 

CRISPR’s unique ability to edit almost any part of the genome holds great power, and this is what can give rise to several ethical issues. In the same year of Gray’s successful CRISPR cell therapy treatment, Chinese scientist He Jiankui was sentenced to 3 years in prison for inserting genetically modified embryos unknowingly into two women seeking in-vito fertilization.10While he had positive intentions of absolving them of HIV, an immune disease with great danger towards its victims, it is a reminder that CRISPR puts researchers in potentially-concerning positions of control. 

The controversy surrounding the case arose from how the volunteers in the study were not fully informed of the genetic modification happening to the embryos, and while it made large strides forward in gene editing, this behavior should not be tolerated due to its unpredictable risk for future generations.11 Additionally, gene editing embryos can easily be exploited for nontherapeutic methods, posing questions of autonomy in light of CRISPR. The case raises questions of who should decide what genes must or should be edited. With the wrong mindset, the abilities of CRISPR can be warped into a modern form of eugenics, embodying the same intentions to remove “undesirable” qualities but with gene editing. 

Because of the intense disciplinary action taken in Jiankui’s instance, there has not been another gene editing scandal of that caliber, but this doesn’t mean it cannot happen again. The ethical issues of editing human embryos range from its future unknown effects for the subjects to unnatural creations of mankind. While CRISPR gene editing may seem like it can improve quality of life for an individual, it is nearly impossible to evaluate whether CRISPR could make a substantial impact. In the cases of Gray and Horgan, the risk of CRISPR is understandable as the gene editing methods were utilized to help eradicate diseases they sought treatment for. 

This differs from completely eliminating genes and other genetic material that are considered “undesirable,” which would fall under the HIV case with Jiankui. The eugenic mindset may sound harmless, but it is the same that led to forced sterilization and euthanization in WWII to artificially create the Aryan race Nazis desired.12 This method of complete eradication brings forth an ableist mindset that those with disabilities have nothing to contribute to society. However, those with disabilities are human and have equal rights to life and autonomy just as those without them. Additionally, they have redeemable lessons to share and add another level of diversity to civilization. Disabilities give us the ability to explore different perspectives that pave the way towards kindness, empathy, and generosity. These qualities are essential in ensuring our relationships as human beings to one another are respectable. Beyond modern eugenics, CRISPR can pose another problem, which are lines of social inequality. 

As research with genetic diseases and CRISPR progresses, a division between those who can afford the treatment and those who must suffer will begin to emerge. For example, to treat a child with spinal muscular atrophy, the cost of a single gene therapy treatment Novartis is upwards to 2 million without insurance.13 With insurance, the price of one treatment is reduced to $10,000, but the number is still extremely unaffordable for most families. Here, the responsibilities fall on companies to make these treatments more affordable or pose a risk of alienating those with disabilities further out from society. 

This is not to say that we should do without CRISPR gene therapy, but to recognize the broader health and social effects that exist as much is unknown about the tool. While CRISPR has been able to significantly alter the lives of those who suffer from genetic diseases, it has also been responsible for deaths and exploitation. 

We must continue to acknowledge that CRISPR is a privilege full of medical uncertainties. If examined thoughtfully and integrated into the medical field carefully, CRISPR possesses the capacity to cause incredible healing. If not, it may become another point of division – decisions made today that will influence all of our shared tomorrows. 

References: 

1. Stein, Rob. “First Sickle Cell Patient Treated with CRISPR Gene-Editing Still Thriving.” NPR, NPR, 31 Dec. 2021,  https://www.npr.org/sections/health-shots/2021/12/31/1067400512/first-sickle-cell-patient-treated-w ith-crispr-gene-editing-still-thriving. 

2. “What Is Sickle Cell Disease?” National Heart Lung and Blood Institute, U.S. Department of Health and Human Services, https://www.nhlbi.nih.gov/health/sickle-cell-disease. 

3. BeTheMatch.org. “Sickle Cell Disease (SCD) .” Be The Match, https://bethematch.org/patients-and-families/about-transplant/blood-cancers-and-diseases-treated-by-t ransplant/sickle-cell-disease--scd-/. 

4. Ungar, Laura. “Death in US Gene Therapy Study Sparks Search for Answers.” AP NEWS, Associated Press, 4 Nov. 2022, https://apnews.com/article/science-technology-health-business-genetics-79f4a9b76426ec40c367957e3 bb9cf4a. 

5. “Ornithine Transcarbamylase Deficiency.” MedlinePlus Genetics , U.S. National Library of Medicine, https://medlineplus.gov/genetics/condition/ornithine-transcarbamylase-deficiency/#causes.

6. Rinder, Meir. “The Death of Jesse Gelsinger, 20 Years Later.” Science History Institute, 16 July 2019, https://www.sciencehistory.org/distillations/the-death-of-jesse-gelsinger-20-years-later. 7. Savulescu, Julian. “Harm, Ethics Committees and the Gene Therapy Death.” Journal of Medical Ethics, Institute of Medical Ethics, 1 June 2001, https://jme.bmj.com/content/27/3/148. 

8. Liu, Angus. “2 Deaths after Novartis' Zolgensma Put Gene Therapy's Liver Safety in the Spotlight Once Again.” Fierce Pharma, 12 Aug. 2022, https://www.fiercepharma.com/pharma/two-deaths-after-novartis-zolgensma-bring-gene-therapys-liver -safety-spotlight-again. 

9. “The Gene Editor Crispr Won't Fully Fix Sick People Anytime Soon. Here's Why.” Science, https://www.science.org/content/article/gene-editor-crispr-won-t-fully-fix-sick-people-anytime-soon-h ere-s-why. 

10. “Chinese Scientist Who Produced Genetically Altered Babies Sentenced to 3 Years in Jail.” Science, https://www.science.org/content/article/chinese-scientist-who-produced-genetically-altered-babies-sent enced-3-years-jail. 

11. Lanphier, Edward, et al. “Don’t Edit the Human Germ Line.” Nature, vol. 519, no. 7544, 2015, pp. 410–411., https://doi.org/10.1038/519410a. 

12. “Eugenics .” United States Holocaust Memorial Museum, United States Holocaust Memorial Museum, https://encyclopedia.ushmm.org/content/en/article/eugenics. 

13. “Paying for CRISPR Cures: The Economics of Genetic Therapies.” Innovative Genomics Institute (IGI), 18 May 2022, https://innovativegenomics.org/news/paying-for-crispr-cures/.

Physicians Have a Duty to Treat Patients in Times of Personal Risk

Covid-19 has led to renewed interest and discussion regarding the duties of physicians in a high risk environment. The pandemic resulted in large shortages in emergency and critical care providers, and those that remained were overworked and dealing with shortages of key equipment such as personal protection devices. In one study during the pandemic, about 25% of physicians and nurses thought it was ethical for health care providers to abstain from treating patients given the personal risk to themselves and their families [1]. Those who choose healthcare as a career certainly assume certain risks relating to psychological stress, long hours, and personal risk such as exposure to harmful and potentially deadly infections. When these challenges increase dramatically, which moral and ethical duties are inherent in the jobs of physicians? I argue that there is an ethical duty for physicians to treat patients despite the personal risk involved during events such as pandemics.

An important consideration in discussing physicians’ duties and responsibilities is that of implied consent. Since it is commonly accepted that some patients are infected and contagious, it is reasonable to assume that risk is inherent in the field of medicine, and by entering the field certain risks are implied and accepted. Although this does not imply that a duty to treat exists, it establishes an accepted reality regarding physician practice.

In 1847, the American Medical Association published its first Code of Ethics stating, “When pestilence prevails, it is their [physicians’] duty to face the danger, and continue their labors for the alleviation of suffering even at the jeopardy of their own lives” [2, p. 3]. While this wording no longer exists in the AMA code, it points to the long tradition of self-sacrifice in the field of medicine, a concept which draws many to pursue the profession. In addition, pledges made by physicians such as the Hippocratic Oath reference the special nature of physicians’ duties. The World Medical Association has a similar pledge, although like the Hippocratic Oath, does not address risk to physicians [2].

When discussing the difficult concept of physician duty to treat, it is also useful to consider the ethical concept of beneficence. In their work entitled, Bioethics: The Islamic Perspective, Al-Bar and Chamsi-Pasha argue that the principle of beneficence has special meaning for health care workers, and implies unique moral obligations. They state, “beneficence is a continuum…professionally things which are considered as supererogatory for the public become obligatory for the professional, e.g., a physician or nurse in a hospital where he is tending patients with highly infectious diseases” [3, p. 132]. This perspective goes a step further in applying unique moral duties to physicians.

Making broad arguments about moral and ethical duties is particularly challenging, because physicians may face health risks that extend to others–family members at home may be especially vulnerable to an infectious disease. Although contentious, the concept of beneficence still applies: physicians have a unique commitment to provide. In the case of a future epidemic, perhaps one that is more lethal than Covid-19, a physician who pauses their labors to protect members at home may indirectly result in deaths of others. Risks that extend into a physician’s personal life should not interfere with priorities when health care is valuable and dire. These duties should be clearly outlined for prospective health care providers, as ambiguities in a code of ethics will not guarantee care from physicians.

References

1. McConnell D. (2020), “Balancing the duty to treat with the duty to family in the context of the COVID-19 pandemic”, Journal of medical ethics, April 24, 2020

1. Kirsch T. D. (2022), “Heroism Is Not a Plan-From "Duty to Treat" to "Risk and Rewards”,” The American journal of bioethics, March 4, 2022

1. Al-Bar MA, Chamsi-Pasha H. “Contemporary Bioethics: Islamic Perspective”, Cham (CH): Springer, May 28, 2015

Towards a Brave New World: The Huxleyan Reality of Using Pharmacological Neuroenhancement

Among all possible contingencies, there has been an evident progression toward the dystopian future foretold by visionary writers such as Aldous Huxley in particular. Huxley’s 1932 novel Brave New World alluded to the pre-existing epidemic that concerned the use of pharmacological neuroenhancement for improved cognitive and affective functioning (i.e., attention, memory, mood, etc.) via legal or illicit drug use [1]. But at what costs? As portrayed in the novel, the drug “soma” induces feelings of happiness while nullifying any kind of discomfort and pain [2]. Such quixotic concepts have been exploited to serve as a form of enhancement to construct the best version of our brains, especially in the postmodern era [3]. The use of pharmacological neuroenhancement, synonymously known as brain doping, by healthy subjects for non-medical purposes to enhance performance and work has been a common practice that can be traced back to the ancient Greeks who used pharmacological neuroenhancement when competing in the Olympic Games [4]. Although intense polarization has been ceaselessly ongoing between transhumanists and bioconservatives in the neuroenhancement debate.

While transhumanists argue in favor of utilizing pharmacological neuroenhancement as a form of genetic engineering to increase human cognitive abilities and thereby radically change the ways through which our species develop, bioconservatives are skeptical of such propositions and dismiss any morally permissible ideas related to modifying our natural intelligence. In their views, bioconservatives criticize the transhumanist ideal of perfection and their hubristic ambition to override the inherent principles of nature, which echoes the warning conveyed by Huxley that the perturbing influence of eugenics-inspired biotechnologies must be resisted. It is therefore imperative to critically examine and analyze the philosophical basis for both stances in relation to the ethics of using pharmacological neuroenhancement and to ultimately unveil the truth of the Huxleyan reality—a nightmarish, oppressive vision that Huxley once envisaged and feared.

In utilitarian terms, an alluring aspect as promised by the effective use of pharmacological neuroenhancement is increased cognitive functioning, which transiently improves performance in any given activity such as learning and memorization [7]. One familiar example is the use of psychostimulants like methylphenidate (brand name: Ritalin) among college and university students. Taking such neuroenhancement drugs lead to improved working memory and increased attention, which reportedly helps students study for longer hours and study more productively with reduced anxiety. Of note, however, is that the original purpose of the stimulant is meant to be prescribed to treat individuals with ADHD, [7] and not for augmenting one’s cognition for the benefit of improving the human cognitive condition [9]. All progress throughout the course of human civilization is rooted in the fundamental belief of climbing to the next step in the evolutionary hierarchy, which motivated the need to intervene and manipulate the systematic complexities of the human mind for the sake of continuing progress. In the instance of using pharmacological neuroenhancement to increase one’s cognitive abilities, an intelligence-based hierarchy as modeled after the social infrastructures that exist in the Huxleyan reality would thus be born [2]. Living under this type of hierarchy implies that even though an individual would rather prefer not to take neuroenhancement drugs, he or she would nevertheless be pressured to take the drug in an increasingly competitive environment to be on par with someone who is already conditioned to take the drug on a regular basis [5]. The aftermath would then result in the problem of, does the individual still retain his or her autonomy?

Calling transhumanism “the world’s most dangerous idea,” the political scientist Francis Fukuyama suggests that when giving in to the temptations of transhumanist thought such as in the goal of enhanced cognition, the impulse to buy into such ideas oftentimes would cause the individual to be blinded to the actual price [10]. Notwithstanding the utopian ideal, it is noteworthy to mention the health risks along with the addictive effects associated with taking neuroenhancement drugs that may pose harm to the individual, to which many of the users are oblivious [11]. By taking the use of neuroenhancement drugs out of its medical context for unintended purposes such as serving as a studying aid, the thin line that distinguishes enhancement from treatment is blurred as a result. In doing so, the individual becomes vulnerable to, among other things, increased blood pressure, nausea, and irregular palpitations from the effect of altered brain chemistry as a result of taking psychostimulants [12]. Ironically, the case of memory enhancement may also cause impairment to memory retrieval by interfering with the balance between remembering and forgetting due to information overload in the higher-order capacities of the brain [3]. Hence, while it is reasonably acceptable for individuals with mental illnesses or cognitive deficiencies to take neuroenhancement medications to reinstate normal brain functioning, the inverse is true in the case of enhancement where safety is a primary ethical concern. 

A supporting argument used to oppose bioconservatism is that pharmacological neuroenhancement promotes fairness and equity, notably for individuals who may be disadvantaged in some ways when compared to others in the context of applying to schools or finding employment [13]. Interventions by unnatural, pharmacological means thus allow underperformed individuals to have improved capabilities by elevating their lower cognitive functioning to match the normal baseline functioning [5]. However, this argument fails to take into account the socio-economic barriers that influence how justly neuroenhancement drugs will be distributed among a given population [13]. Problems would arise when disparities become apparent by considering the fact that neuroenhancement drugs may not be affordable for everyone, especially for the lower classes and those without health insurance coverages. Hypothetically, even if neuroenhancement drugs were made universally accessible through public policy solutions or government mandates, ethical concerns may be raised with regard to losing one’s liberty as a direct result of being coerced into taking neuroenhancement drugs. The likely outcomes of this hypothetical scenario have already been reflected in vaccine mandates throughout the course of the COVID-19 pandemic, where some individuals expressed antagonism in response to such mandates to protect their liberty and personal choice [5]. However, in the Huxleyan reality, liberty simply does not prevail. While coercion may be justified in the context of vaccine mandates for disease prevention, this hypothetical scenario as it applies to enhancement supports the bioconservative argument by resembling the events that were detailed in Brave New World, in which the citizens of Huxley’s dystopia all became mentally compromised by virtue of taking soma as administered by the World State [2]. Hence, when the cause for coercion is unjustifiable, it becomes worthy to ponder upon the question, is there any degree of freedom to our actions when under the influence of neuroenhancement drugs?  

Bioconservatives, moreover, continue to reinforce their objections to the use of pharmacological neuroenhancement with rationales that are beyond the preceding arguments related to safety and fairness, one that reveals the psychological horror of using pharmacological neuroenhancement. Imagine a baseball player taking neuroenhancement drugs such as steroids to increase their competitiveness on the playing field; as a result, ten home runs were hit in a single game. Contrast this with a baseball player who accomplished the same feat but without the use of neuroenhancement drugs; instead, it was the result of rigorous training and real effort [13]. The questions now present themselves as, which of the two players is more undeserving of his achievement and unworthy of praise? Does integrity not matter? The answers, of course, are obvious. Our intuition is capable of telling us what is morally responsible and what is not. In the case of the baseball player who used neuroenhancement drugs, the erosion of human agency rendered his achievement to become “hollowed” and his character to become morally “defective”, supplemented by the loss of personal dignity and overall humanity according to the foundational ethical framework that governs our morals and values [14]. Because at the end of the day, the credit does not go to the baseball player, but rather to the pharmacist who prescribed the drug or to the dealer who sold the drug.

The hubris objection as illustrated by the aforementioned example denounces the transhumanist methodology of undermining intrinsic values such as grit and tenacity and underappreciating our “gifted” character and powers with which we derived from nature, and further ridiculing the Promethean desire to be dominant over the natural order [15]. This objection was originally configured by political philosopher Michael Sandel and supported by physician-scientist Leon Kass. Kass added to Sandel’s argument of “giftedness” by emphasizing the dire consequences of substituting our moral virtues with pharmacological neuroenhancement-induced effects. Consider this thought experiment: If drugs that were originally meant to treat patients with PTSD become easily accessible to anyone, how many people without mental illnesses would be willing to take such drugs for the purpose of preventing bad memories from consolidating in their minds? While the feelings of trauma or sorrow from an unfortunate experience is undesirable, taking neuroenhancement drugs to block out those feelings and the associated painful memories of that experience would hinder our ability to develop the necessary mechanisms to cope with the myriad of negative feelings that are essential to our psychology [16]. In consequence, we would miss the opportunity for personal growth upon losing our self-control and fail to integrate the adversities of our lives to our character development. We no longer feel the sharpness of that feeling of pain, but do we still retain the courage to stand up and walk forward? This question often appears in the Huxleyan reality in which the character John “the Savage” is refused the right to be unhappy because unhappiness is not a realized concept [2]. When an individual wishes to take soma to relish in pleasure and escape from disillusionment, but in exchange, the individual would forever be trapped in a peaceful fantasy that juxtaposes the cruel reality, where does real happiness lie? To John, real happiness lies in enduring excruciating pain but knowing that it will all be worthwhile—like acing a test after hours spent studying or winning a game after the amount of effort that was spent during practice. Thus, it is within reason that taking shortcuts via artificial means offers no meaning in our pursuit of accomplishments—irrespective of the scale—and such conducts only pathologize our imperfections. 

To live with dissonance and the unanticipated are preconditions to appreciating what life has already given us and its beauty, thus enabling us to live a flourishing life that is fulfilling without external interventions that could potentially disfigure the relationship that we have with ourselves and restrict our exercise of freedom. In reference to the words of John who chose to be unhappy, we can cherish the notion that unhappiness is bliss, for it ensures that we still preserve our individual identities and the autonomy to taste the flavors of life: “I don't want comfort. I want God, I want poetry, I want real danger, I want freedom, I want goodness. I want sin” [2]. While the endeavor to advance the evolution of human cognition is appealing, one must be cautious of the dubious means represented by the unnaturalness of pharmacological neuroenhancement, as it is irresponsible to toy with our very own subjective experiences and personality traits in the midst of ambiguities [3]. Let it be known that the aspiration to enhance our cognition may lead to the inability to achieve a complete understanding of ourselves and ultimately to the downfall of our own humanity; even more so, it is at odds with our inalienable human rights in which the happiness that we would find from pharmacological neuroenhancement is only illusionary under this fallacy. The Huxleyan reality of using pharmacological neuroenhancement is not an inevitable future, and can be averted if we first consider the question: What am I willing to lose? 

References

1. Heller, S., Tibubos, A. N., Hoff, T. A., Werner, A. M., Reichel, J. L., Mülder, L. M., ... & Dietz, P. (2022). Potential risk groups and psychological, psychosocial, and health behavioral predictors of pharmacological neuroenhancement among university students in Germany. Scientific reports, 12(1), 1-10.

2. Huxley, A. (1998). Brave new world. HarperPerennial. 

3. Fuchs, T. (2006). Ethical issues in neuroscience. Current opinion in psychiatry, 19(6), 600-607.

4. Bowers, L. D. (1998). Athletic drug testing. Clinics in sports medicine, 17(2), 299-318.

5. Roskies, A. (2021, March 3). Neuroethics. Stanford Encyclopedia of Philosophy. Retrieved October 21, 2022, from https://plato.stanford.edu/entries/neuroethics/ 

6. Sandel, M. J. (2009). The case against perfection: Ethics in the age of genetic engineering. The Belknap Press of Harvard University Press. 

7. Schleim, S., & Quednow, B. B. (2018). How realistic are the scientific assumptions of the neuroenhancement debate? Assessing the pharmacological optimism and neuroenhancement prevalence hypotheses. Frontiers in Pharmacology, 9, 3.

8. Marazziti, D., Avella, M. T., Ivaldi, T., Palermo, S., Massa, L., Della Vecchia, A., ... & Mucci, F. (2021). Neuroenhancement: state of the art and future perspectives. Clinical Neuropsychiatry, 18(3), 137.

9. Liszka, J. (2021). Pragmatism and the Ethic of Meliorism. European Journal of Pragmatism and American Philosophy, 13(XIII-2).

10. McNamee, M. J., & Edwards, S. D. (2006). Transhumanism, medical technology and slippery slopes. Journal of Medical Ethics, 32(9), 513-518.

11. Shipman, M. (2019, May 8). The ethics and challenges surrounding neuroenhancement. NC State News. Retrieved October 22, 2022, from https://news.ncsu.edu/2019/05/neuroenhancement-ethics-challenges/ 

12. Nootropics. Cognitive enhancers - Alcohol and Drug Foundation. (n.d.). Retrieved October 22, 2022, from https://adf.org.au/drug-facts/cognitive-enhancers/ 

13. Forlini, C., & Hall, W. (2016). The is and ought of the ethics of neuroenhancement: mind the gap. Frontiers in Psychology, 6, 1998.

14. Faber, N. S., Savulescu, J., & Douglas, T. (2016). Why is cognitive enhancement deemed unacceptable? The role of fairness, deservingness, and hollow achievements. Frontiers in Psychology, 7, 232.

15. The president's Council on Bioethics: What's wrong with enhancement? (n.d.). Retrieved October 22, 2022, from https://bioethicsarchive.georgetown.edu/pcbe/background/sandelpaper.html 

16. Kass, L. R. (2003). Ageless bodies, happy souls: biotechnology and the pursuit of perfection. The New Atlantis, (1), 9-28.

Cryonics: The Cure for Death?

Zombies have been a popular science-fiction creation for decades, and the idea of resurrection goes back even further. How can a person be revived from death? Is it morally correct for such a thing to happen? These questions are relevant yet again due to recent interest in cryonics.

Cryonics is the technique of deep-freezing a dead body with the hopes that future scientists will be able to revive and restore it to full health. The process starts while the patient is still alive. They can sign up for the procedure through a cryonics facility, paying anywhere from tens to hundreds of thousands of dollars for a second shot at life. With this contract in place, a standby team will spring into action once a patient is pronounced legally dead, usually waiting in the hospital with the patient until it’s time. The team keeps the body stable while it is transported to the facility: supplying enough oxygen and blood to maintain minimal brain function, circulating the anticoagulant heparin to prevent blood clotting, and packing the body in ice while it is en route. A medical team awaits upon arrival [1]. 

The long-term preservation takes place on-site. Blood is drained from the patient and replaced with a mix of medical-grade antifreeze and organ-preserving chemicals, known as cryoprotective agents. If the body were to be placed directly in vats of liquid nitrogen the water in cells would expand to form ice crystals and the cells would be destroyed. With the added chemicals, organs and tissues are protected because the chemicals clump together in cryogenic temperatures. They form a solid that is molecularly similar to glass, and this new “glass” prevents the cells from bursting. Next, the body is cooled on a bed of dry ice until it reaches -130ºC (-202ºF). This completes the vitrification process, or the process of deep cooling without freezing, and allows cells to enter a state of suspended animation [2]. The body is finally inserted into an individual container and then placed into a large metal tank filled with liquid nitrogen at around -196ºC (-320ºF). It is stored head-down in these vats so that the brain will be most protected if there is ever a leak [3]. 

Currently, there are around 500 human bodies stored in vats around the world because of cryonics, with the majority being in the U.S. Major companies include the Cryonics Institute, KrioRus, Shandong Yinfeng Life Science Research Institute, and Alcor Life Extension Foundation. Alcor is the most expensive and best-known cryonics company in the U.S., charging $200,000 to handle a full human body and $80,000 to just preserve a brain (called “neuro” preservation) [3]. 

During the COVID-19 pandemic, these companies were forced to adopt new operating room rules. At Alcor, this looked like restricting the application of its medical-grade antifreeze solution to only the brain and leaving everything below the neck unprotected. It was also harder to reach clients quickly because of travel restrictions and limitations on hospital access [3]. 

Despite these more challenging circumstances, business was thriving. KrioRus and Alcor reported receiving a record number of inquiries during Covid, likely because the pandemic brought death to the forefront of people’s minds. Valeriya Udalova, chief executive of KrioRus, noted that “perhaps the coronavirus made them realize their life is the most important thing they have and made them want to invest in their own future” [3]. Jim Yount, a member of the American Cryonics Society, also commented that “something like covid brings home the fact that they are not immortal.” [3]

But how likely is it that people who “invest in their own future” by signing up for cryonics will see their money well spent? Can this process really add decades, or even centuries, to a person’s life? The quick answer is probably not. It hasn’t been proven that complex human systems can be “stored” with the help of these facilities. All we know for sure is the technology available to us right now, none of which can revive these dead bodies. In this way, the cryonics industry is built entirely on optimism since companies place the tall order of revival in the hands of future scientists.

Supporters believe death is not just the moment when the heart stops; it is a process of deterioration that humans are capable of intervening in. They generally concede there isn’t any guarantee that future science will be able to reanimate these people. Nonetheless, the odds of revival with cryonics are still better than without it. This much is certainly true: scientists can’t resuscitate a pile of ashes or bones, but at least cryonics provides a body to work with. Plus, “if you’re starting out dead, they say, you have nothing to lose.” [3]

At the same time, cryonics company websites hardly drive home the uncertainty involved in these procedures. The Alcor website advertises cryonics as “an ambulance into the future” and states that “cryonics is currently the best-known method for pausing the dying process in a way that allows for potentially restoring good health with medical technology in the future.” It also says that “cryonics sounds like science fiction, but it’s based on modern science.” [4] While the website is transparent about the procedure’s reliance on technology that doesn’t yet exist, it also advertises the success of cryonics as being only a matter of time. There are no disclaimers about the uncertainty involved or the industry’s foundations of sheer optimism. Is it misleading for websites to lack precautionary messaging? Perhaps it is within their right as private companies to advertise themselves as they wish, but it could also be considered immoral to require prospective clients to read between the lines on such important subject matter.

There are also a plethora of questions that arise when thinking about the fact that at the end of the day, these are private companies working for profit. Cryonics companies are quite literally in the business of death. Who can determine if they are acting in their client's best interest, and do they even have the incentive to do so given that the bulk of their work happens once their clients are dead? The image of these companies has already begun to tarnish, since in 2009 there were allegations that Alcor was mishandling bodies and even hastening clients’ deaths [5]. Who will hold these companies accountable in such a delicate industry?

A unique set of questions arises from assuming cryonics will be successful. Given the prohibitive pricing of these procedures, society could reach a place where wealthy people are immortal. Would this be a fair change? Wealthy people already have better access to medical care and longer life expectancies. Perhaps immortality as a result of wealth is a natural progression for society, or perhaps there is some line to be drawn as to just how much money should be able to buy.

There’s also the question of sustainability. We already struggle with overpopulation. Is it ethical to exacerbate this for our descendants by sending people from our century into the future? 

On a different note, we must examine how society as a whole would be affected by mass cryopreservation. New and old generations would eventually be living together- would society be able to progress or would it be held stagnant by the continued presence of old ideas? As USC student Anu Rajendran put it, the “advancement of culture could slow down,”making cryonics detrimental to the larger society [6].

Although it is impossible to answer these ethical questions without lived experience, they are still important to consider as the cryonics industry grows. The procedure’s allure is undisputed. If successful, patients could be treated with new cures to mend an untimely death or have decades more with loved ones (if they also partake). Most ethical dilemmas wouldn’t be realized unless millions of people were choosing to be cryopreserved, but if the process were successful and affordable that could very well be the case. Thus, it is critical to consider all possible effects of the procedure as it gains popularity.

References

1. How Cryonics Works. (2005, January 5). HowStuffWorks. https://science.howstuffworks.com/life/genetic/cryonics.htm 

2. Cryosleep - An Overview of Cryonics, Cryosleep and Cryotherapy. (2018, October 17). The Medical Futurist. https://medicalfuturist.com/are-you-going-to-wake-up-from-cryosleep/ 

3. Wilson, P. (2021, June 26). The Cryonics Industry Would Like to Give You the Past Year, and Many More, Back. The New York Times. https://www.nytimes.com/2021/06/26/style/cryonics-freezing-bodies.html 

4.  What is Cryonics? (n.d.). Alcor. Retrieved November 24, 2022, from https://www.alcor.org/what-is-cryonics/ 

5. News, A. B. C. (n.d.). Former Alcor Employee Makes Harsh Allegations Against Cryonics Foundation. ABC News. Retrieved November 24, 2022, from https://abcnews.go.com/Nightline/alcor-employee-makes-harsh-allegations-cryonics-foundation/story?id=8764331 

6. Rajendran, A. (2017, December 13). The Frozen-Undead: Ethical Implications of Suspended Animation and Cryonics. Viterbi Conversations in Ethics. https://vce.usc.edu/volume-1-issue-1/the-frozen-undead-ethical-implications-of-suspended-animation-and-cryonics/ 

Painful Justice: Botched Executions and Capital Punishment

The death penalty has been practiced as a fundamental tool in criminal and judicial systems for thousands of years and has played an integral role, both socially and punitively, in many ancient and modern societies. The practice of capital punishment in the United States began in the colony of Jamestown with the first reported execution occurring in 1608 [1]. This practice has withstood the test of time, remaining a possible sentence in twenty four states [2]. Many states, most recently, Virginia, which outlawed the practice of the death penalty in 2021, have stopped carrying out executions altogether as a form of criminal punishment. Currently in the states where the death penalty is still practiced, the most common and widely used method of execution is lethal injection, in which various medications are administered through intravenous injections resulting in the death of the prisoner. This method of execution is regarded, generally, as the most humane and is not meant to cause any pain to the person being executed [3]. 

In striving for this aversion to pain in the practice of lethal injection, legislators and advocates aim to parallel the philosophies of the medical field. In medicine, practitioners attempt to reduce the pain of patients undergoing procedures through anesthesia and control for pain in post-op recovery with pain medications as strong as morphine or fentanyl. When all goes well, lethal injection is similar to any other medical procedure where pain is managed or even completely absent for the patient. However, this is not always reality. Lethal injection has the highest rate of failure among other contemporary methods of execution sitting at 7.12%, while other methods such as electric chair or firing squad have failure rates of 1.92% and 0% respectively [4]. 

These so-called botched executions subject the person being executed to visible extreme pain, discomfort, and distress. One such execution made national news when an Oklahoma man was seen convulsing and throwing up during his execution [5]. In multiple cases, executions have failed due to prisoners who have compromised veins as a result of drug use that make it harder to insert an IV through which to inject the drugs. In these circumstances, a decision must be made to continue with the execution by finding other ways to insert IVs, such as in hands, necks, and other places on the body, causing extreme discomfort for the prisoner involved [4]. In these cases, physicians often aid technicians in establishing an IV through which to administer the drugs. And in this way, physicians play a central role in the medical killing of another human being. If the consistency of lethal injection as a mode of capital punishment requires physicians to play a role in carrying out this work, physicians must face various ethical dilemmas in weighing the benefits of both “justice” and medical ethics, similar to the ethical dilemmas of euthanasia or assisted suicide. 

 Lethal injection, the most “humane” method of execution, comes with complications not seen with other methods of executions that put into question the efficacy of lethal injection. The use of firing squads has dwindled over the years due to the sheer carnage it endows the body of the prisoner with, and execution by electric chair has similarly dwindled due to concerns over  pain and suffering during the procedure [6]. So now, we have been left with lethal injection. If the most “humane” method of execution is still having unforeseen consequences for the prisoners who are being executed, perhaps capital punishment as a whole needs to be reevaluated as a practice. 

References 

1.  “History of the Death Penalty.” Death Penalty Information Center. https://deathpenaltyinfo.org/facts-and-research/history-of-the-death-penalty/early-history-of-the-death-penalty. 

2.  “State by State,” Death Penalty Information Center. https://deathpenaltyinfo.org/state-and-federal-info/state-by-state. 

3.  “So Long as They Die: Lethal Injection in the United States,” Human Rights Watch. https://www.hrw.org/report/2006/04/23/so-long-they-die/lethal-injections-united-states#:~:text=Compared%20to%20electrocution%2C%20lethal%20gas,it%20mimics%20a%20medical%20procedure. 

4.  “Botched Executions,” Death Penalty Information Center. https://deathpenaltyinfo.org/executions/botched-executions. 

5.  “Oklahoma executes inmate who dies vomiting and convulsing,” AP, October 28, 2021. https://apnews.com/article/us-supreme-court-prisons-executions-oklahoma-oklahoma-attorney-generals-office-6e5eedd1956a38f83db96187651f145c. 

6. “South Carolina judge halts the use of firing squad, electric chair,” Washington Post, September 7, 2022. https://www.washingtonpost.com/nation/2022/09/07/south-carolina-firing-squad-electric-chair/. 

Inequitable Effects of Urban Heat Islands

It is no surprise that highly urbanized areas with little vegetation cause negative effects on their inhabitants and the local climate. These areas are called heat islands, and can be 1–7°F hotter during the daytime and 2-5°F hotter at night in comparison to more natural, vegetated land. There are two main factors that contribute to heat islands: the loss of vegetation that naturally provides cooling and the man-made structures that lead to retention of heat. 

Natural growth provides shade, which cools the land in its shadow. Trees also cool the air as the water in their leaves transpires. Bodies of water which may be covered or diverted in urban areas would also cool the air if left untouched. 

The building materials themselves in urban areas retain more heat than plants do, contributing to the rise in temperature within heat islands. Large man-made structures such as several-story buildings can also block the flow of wind, which would normally have a cooling effect in the city. These temperature differences are also greater in areas of denser populations. Increased human activity leads to increased use of all sorts of machinery, electronics, vehicles, and other industrial innovations, which all release thermal energy into the environment [1]. 

Not only are heat islands associated with increases in temperature, they can also be costly—in terms of energy, household electricity cost, and government aid. When the temperature rises in an urban area, it can cause a strain on power grids as more people use electricity to cool their homes. This leads to an energy loop, where people use electricity to cool their homes, which releases thermal energy out into the environment, which thereby makes the heat island even worse [2].

The environment also suffers because of these heat islands, because all parts of an ecosystem are interconnected, both biotic and abiotic. If the bodies of water in a heat island are heated and then flow into local rivers or lakes, it can cause harm to animals living there that have adapted to live in a cooler environment. Pollutants in heat island cities also have more severe effects, as they cannot easily be dispersed; air pollutants cannot be blown away due to disrupted air flow by tall buildings, and ground-level pollutants do not go down into the earth due to man-made non-permeable materials like roads and sidewalks [2,3]. 

These heat islands can also affect human health. “[Urban heat islands] intensify health problems in cities,” writes Professor Mattheos Santamouris, author of several books on heat islands and energy conservation, “During the 2003 heat wave in France, the excess mortality in Paris surpassed 140%, while in smaller cities it was much lower at close to 40%” [3]. Heat related illnesses like heat stroke and respiratory difficulties can be severe, and even fatal, especially in certain populations. Those who are very old or very young, those who have preexisting health issues, and those who work outside can be susceptible to increased effects from heat waves. 

Two final demographics of people who are more severely affected by heat islands stress the lack of equity in this environmental issue. Those who are low-income, and people of color. 

Per a 2021 research study on disproportionate heat island intensities, “​​We find that the average person of color lives in a census tract with higher [Surface Urban Heat Island] intensity than non-Hispanic whites in all but 6 of the 175 largest urbanized areas in the continental United States,” [4]. This disparity is theorized to be partially due to historical redlining—the denying of home sales or loans based on the area’s racial makeup. The data shows that these redlined, historically POC neighborhoods have a higher temperature makeup than other neighborhoods within the same city [4]. This racial segregation can lead to lack of funding and neglect by the local government, and “leads to people of color incurring more environmental health risks, including higher levels of exposure to pollution, hazardous waste, and urban heat” [5].

Low income households also face inequitable consequences from heat islands. The effects are dissimilar to the experiences of POC—“In nearly half the urbanized areas, the average person of color faces a higher summer daytime [Surface Urban Heat Island] intensity than the average person living below poverty”—but are still very significant [4]. Low income households are more likely to have a lack of air conditioning and shelter, and thus are more susceptible to inequitable heat related illness and death during hotter months [6]. 

Systems must be implemented in order to decrease the amount and severity of heat islands, as well as give additional help to demographics most affected by heat islands. Planting vegetation in the ground or on rooftops, as well as using lighter colored materials on buildings are two simple ways to help improve heat island intensity, but there are many more solutions out there that researchers are studying and implementing [2]. As this is a form of local climate change, it is up to local governments to notice and take charge when their communities begin to experience severe heat island effects. It is also important for governments to understand and recognize the inequitable effects of heat islands and to make sure all of their citizens are given aid and funding to help heal these local climate issues. 

References:

1: Learn About Heat Islands. (2022, September 2). US EPA. Retrieved October 9, 2022, from https://www.epa.gov/heatislands/learn-about-heat-islands

2: Urban Heat Island | National Geographic Society. (n.d.). Retrieved October 9, 2022, from https://education.nationalgeographic.org/resource/urban-heat-island/

3: Santamouris, M. (2019). Urban Heat Island and Local Climate Change. In Minimizing Energy Consumption, Energy Poverty and Global and Local Climate Change in the Built Environment: Innovating to Zero. Elsevier. https://doi.org/10.1016/B978-0-12-811417-9.00003-9

4: Hsu, A., Sheriff, G., Chakraborty, T. et al. Disproportionate exposure to urban heat island intensity across major US cities. Nat Commun 12, 2721 (2021). https://doi.org/10.1038/s41467-021-22799-5

5: Ndugga, N., & Artiga, S. (2021, September 8). Extreme Heat and Racial Health Equity. KFF. Retrieved October 9, 2022, from https://www.kff.org/policy-watch/extreme-heat-racial-health-equity/

6: Heat Island Impacts. (2022, September 2). US EPA. Retrieved October 9, 2022, from https://www.epa.gov/heatislands/heat-island-impacts

Biohacking

In 2017, an eccentric biotech CEO injected himself with a homemade herpes cure at a biohacking convention, the whole thing live streamed for the world to see. [1] What was perhaps previously only a fringe subculture in the science community immediately shot into the public eye. But what is biohacking, and how can it be treated lawfully?

Biohacking is traditionally defined as “the attempt to manipulate your brain and body in order to optimize performance, outside the realm of traditional medicine.”[2] This subculture encompasses a wide variety of people and aims: from the extremely health-conscious who wish to live to the age of 180 to those afflicted with a rare genetic condition and have become disillusioned with standard medical treatment. In its practice, biohacking can range from taking daily vitamin supplements, intermittent fasting, or meditating to completely changing the microbiome of one’s gut, implanting microchips in one’s body, and even selectively, artificially modifying one’s genome. While certainly overshadowed by events like the one that made the name famous, biohacking has provided incredible tools to increase the enjoyment of human life. For example, in 2018 a quadruple amputee had a microchip inserted under his skin in order to more easily perform daily tasks like opening doors. [3]

Arguably the most intriguing form of biohacking are procedures that involve the selective manipulation of the human genome. And while human genetic modification is still in its infancy – with examples of which, successful or unsuccessful, being few and far between – its future as a powerful technology should not be dismissed. As genetic modification technology is becoming a reality, its legality must be considered from an ethical perspective. Although home genetic editing kits may have the potential to cause harm and regulatory bodies should respect the principle of nonmaleficence (not doing harm), the adherence to the principle of autonomy, as described by the Principlist philosophy of Beauchamp and Childress, outweighs nonmaleficence and most prominently shapes the nature of the legality of genetic modification kits so as to fit an ethical criterion. 

Autonomy, as defined as “self decision that is free from the controlling interference by others and from limitations that prevent meaningful choice”[4] is a fundamental principle of not only the American bioethical philosophy, but also of our national culture. Autonomy can be further broken down into three qualities: intentionality, understanding, and non-control. For genetic modification kits to be ethically made legal, they must support these aspects of autonomy in their consumers.

Acting with intentionality refers not so much to an action as much as it does the series of events and planning leading up to said action. For an action to be intentional, there must have been some thought or planning that led up to the decision to partake in the action. However, intentionality does not prevent undesired outcomes. An act can still be intentional even if its outcome was not what the agent wanted. This detail is significant, as it separates the principles of autonomy from nonmaleficence. Whereas the principle of nonmaleficence would primarily seek to minimize any and all harm, just because an act causes harm to an agent does not mean that the action has violated the principle of autonomy. Only if the agent had not been made aware of the possibility of harm when forming their plan of action could an act be considered unintentional and not respecting autonomy. Because of this, understanding could be considered a prerequisite for intentionality.

Understanding is simply the state of having adequate knowledge of an action they are going to undertake. This is obviously a vague and subjective criteria, and it can be difficult to determine where the threshold of understanding begins. However, we as a society have decided on actual thresholds of understanding that an individual is required before we can trust that they are acting autonomously in their actions. For example, passing a driver’s test is required before we grant driver’s licenses. Yes, an understanding of road laws is essential to driving safely and preventing harm to others (driver’s test also adheres to the principle of nonmaleficence), but driver’s tests also function to ensure that a potential driver is properly informed of the action in which they are going to participate. It would not be ethical to allow for a person to get behind the wheel of a car without properly understanding both the social contract they are agreeing to between themselves and other drivers and also the dangers of driving.

Lastly, non-control refers to the lack of controlling external influences on decision making. An act can only be autonomous, and an agent can only act autonomously, if their decisions are truly self-directed. Not all forms of external influence violate the principle of non-control (ensuring understanding could be considered an external influence), rather only influences that coerce or manipulate can strip an agent of autonomy. As it regards biohacking, the decision to genetically modify oneself must be sourced internally to the agent, and biohacking must not be used as a method of violating non-control, and therefore the autonomy, in others. 

The criteria by which an action or an agent can be considered autonomous might be considered rigorous, and possibly even infringing on what some believe to be their freedom. However, ensuring people’s right to autonomy is not just allowing people to do whatever they want. Restrictions on “freedom” are in place to limit the influence of others on an individual’s decision and to ensure that an individual has a proper understanding of the action in which they are going to partake. Completely restricting access to genetic modification kits would completely violate the principle of autonomy, as it would deny people their right to self-directed actions and meaningful choice. However, legalizing genetic modification kits without any regulations or guidelines would also violate the principle of autonomy by not ensuring that intentionality, understanding, and non-control are respected. 

One way that bioethicists have succinctly ensured autonomy in medical or regulatory settings is by emphasizing the notion of informed consent. If an agent is not given adequate information about a procedure or an act they are going to perform  (i.e. the agent lacks understanding and/or intentionality), they cannot be considered as acting as autonomous agents (i.e. they are being unethically influenced and cannot give consent). Moreover, if an agent lacks the ability to develop understanding, intentionality, or resist control, they can be considered unable to give consent. An inability to give consent can be due to mental deficiencies, a vegetative state, or simply age. Children cannot be considered autonomous individuals because they can not be trusted to act with intentionality, understanding, and non-control. Buying alcohol for minors is illegal because we acknowledge that children are not developed enough to make autonomous decisions for themselves, and only a truly autonomous agent can understand the risks involved with and engage in a potentially harmful activity like alcohol consumption.

The concept of informed consent underlies the role of a regulatory agency like the FDA. Requiring clear labeling of nutritional information, side-effects of pharmaceuticals, and cancer warnings on cigarette packaging all aid in informing consumers of what exactly they are going to put in their bodies. Not only is this information essential to ensure intentionality and understanding, but it also helps prevent non-control; unequal access to information can create unhealthy, predatory relationships between those that have knowledge and those that don’t. A kit that could be used to edit one's genome must be held to the same standard of transparency. Not everyone has a Phd in molecular biology, and therefore the legality of the sale of technology that can edit human DNA for the masses is contingent on ensuring that the masses have the resources to act with intention, understanding, and non-control. 

While an agency like the FDA is trying to respect the autonomy of the people it influences, it also has a moral obligation to prevent harm, or non-maleficence as it's called. While non-maleficence is generally used in the context of a medical professional preventing the harm that a treatment or experiment could cause to their patient, regulatory bodies should also be held to a similar standard of preventing the harm that genetic modification kits could produce. However, the difference between a doctor’s and a regulatory body’s obligation to non-maleficence is distinct. Whereas doctor’s must be required to not cause harm to their patients, regulatory bodies are not necessarily obligated to keep a consumer of a genetic modification kit from harming themselves. A regulatory body does have an obligation to non-maleficence when a consumer of the product they regulate is not acting as a truly autonomous agent. Like mentioned previously, this can be due to mental deficiencies, a vegetative state, and also ignorance. The role of a regulatory body, as it regards non-maleficence, is to ensure that individuals are not harming themselves because they lacked intentionality or understanding. If an individual is truly informed and able to consent to an action, which would mean they understand the risks involved, and the individual somehow harms themselves, then the regulatory body would not be morally responsible for this harm. Ensuring informed consent is not only vital to protecting consumers’ right to autonomy, but it also underlines a regulatory body’s responsibility to non-maleficence.

One could argue that a regulatory body’s responsibility to non-maleficence extends beyond just ensuring non-maleficence in non-autonomous individuals, and that the responsibility to non-maleficence of regulatory bodies should be held to the same standard as medical professionals (i.e. preventing all harm that a treatment could cause to a patient). Overarchingly, the difference between these two takes is deciding which bioethical principles takes precedence over the other: autonomy over non-maleficence or vice versa. In a case like this, where adhering to two bioethical principles might be contradictory, one should weigh and balance the weight of these two principles in the face of each other.

Instances where the responsibility to non-maleficence outweighs the responsibility to autonomy are referred to as paternalistic. In cases like these, a regulatory body would have the moral responsibility to intervene to prevent harm, even if it meant infringing on one’s right to autonomy. However, for intervention to occur, the following conditions must be met:

1. A patient is at risk of a significant, preventable harm or failure to receive a benefit.

2. The paternalistic action will probably prevent the harm or secure the benefit.

3. The intervention to prevent harm to or to secure a benefit for the patient probably outweighs the risks to the patient of the action taken.

4. There is no morally better alternative to the limitation of autonomy that will occur.

5. The least autonomy-restrictive alternative that will prevent the harm or secure the benefit is adopted. [4]

Regulatory bodies have a more difficult time in adhering to all of these conditions because they cannot act casuistically in their decision making. Regulatory bodies and lawmakers are making broad, generalized rules that should govern all consumers of a product objectively. While a physician might be able to determine that their patient “is at risk of a significant, preventable harm or failure to receive a benefit”, regulatory bodies can not say the same about a whole population. Since regulatory bodies can not as easily meet the conditions of justifying paternalism given the magnitude of their “patients,” it is only ethical for them to favor autonomy over non-maleficence and not justify acting paternalistically.

The potential for harm that genetic modification kits can yield does not necessarily necessitate their restriction. Yes, it is absolutely possible that rational, adult human beings could use genetic editing kits to harm themselves. However, rational, adult human beings drink alcohol, don’t wear sunscreen, and eat junk food all the time. All of these acts cause a great amount of harm to both the individual and society, yet the legality of these products and its respect for autonomy is weighed over the harm that they cause. That being said, it is also the responsibility of a regulatory body to mitigate as much harm as possible without violating autonomy. In the end though, autonomous agents ought to have the right to engage in the use of genetic modification technology, even with the potential for harm present. However, to actually meet the standard of autonomy that predicates their legality, strict rules must be in place that restrict genetic modification kits solely to individuals who act with intentionality, understanding, and non-control. 

Sources: 

1. Chen, Angela. “A Biohacker Injected Himself with a DIY Herpes Treatment in Front of a Live Audience.” The Verge. The Verge, February 5, 2018. https://www.theverge.com/2018/2/5/16973432/biohacking-aaron-traywick-ascendance-biomedical-health-diy-gene-therapy. 

2. Samuel, Sigal. “How Biohackers Are Trying to Upgrade Their Brains, Their Bodies - and Human Nature.” Vox. Vox, June 25, 2019. https://www.vox.com/future-perfect/2019/6/25/18682583/biohacking-transhumanism-human-augmentation-genetic-engineering-crispr. 

3. “Quadruple Amputee Has Microchip Implant to Unlock Doors.” BBC News. BBC, January 18, 2018. https://www.bbc.com/news/av/uk-england-dorset-42725099. 

4. Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford university press, 2019.

Management of Medical Waste: A Threat to Human and Environmental Health in Developing Countries

Medical waste or healthcare waste can be interpreted as waste generated by healthcare facilities like hospitals, blood banks, clinics, research facilities, laboratories, etc. Medical waste has always been an issue under the larger umbrella of waste management, but the ongoing COVID-19 pandemic has placed a substantial strain on how developing countries are responding to increasing threats of human and environmental health.

Although the classification of healthcare waste varies widely, according to the World Health Organization (WHO), there are  eight broad categories:

1. Infectious (waste contaminated with blood and other bodily fluids, or waste from infectious patients)

2. Pathological (tissues, organs, or fluids), Sharps (syringes, needles, scalpels, blades)

3. Chemical (solvents, reagents, disinfectants, or sterilants)

4. Pharmaceutical (expired, used, or contaminated drugs)

5. Cytotoxic (waste with genotoxic properties)

6. Radioactive (waste contaminated by radionuclides)

7. Non-hazardous or General waste (waste that does not have a particular biological, radioactive, chemical, physical hazard)

As of February 2022, there have been 10.7B COVID-19 doses administered worldwide, producing over 192,000 tonnes of waste in the form of syringes, needles, and safety boxes according to the WHO. Additionally, over 140 million rapid testing kits have been shipped worldwide, generating over 2600 tonnes of non-infectious waste and 731,000 liters of chemical waste. Other major contributors to medical waste include personal protective equipment (PPE) in the form of disposable masks, gloves, and gowns. Furthermore, more than 87,000 tonnes of PPE were shipped to countries who need support in responding to the pandemic. Last, in developing countries in particular, millions of unused vaccines are being destroyed and thrown away, which further contributes to the medical waste issue.

These numbers are of enormous concern because they not only reveal how our increasing wastefulness threatens both human and environmental health, but also emphasize the urgency of improving our current waste management systems before it gets too late. For example, the WHO has stated that health workers should be fitted with the correct PPE, but it is essential for individuals to pay more attention to how they can use PPE in a safe and environmentally sustainable manner. Although it is not recommended to wear gloves for COVID-19 vaccine administration, data reveals that each healthcare employee discards an average estimate of 50 pairs of disposable gloves per week. The WHO has reported that 30% of healthcare facilities, and up to 60% of developing countries, are not properly equipped to handle our current waste loads, thus posing a health hazard.

So how can healthcare professionals ethically follow their obligations to avoid causing harm to patients while also following the ethics of public health and management to thwart medical waste production? What makes up healthcare ethics, and what explains the issues that developing nations are facing in terms of waste management systems?

In developing nations in Africa and Asia, research has estimated that Asia will generate the highest quantity of discarded facemasks per capita per day (1.8B) followed by Europe (445M) and Africa (411M). Because of existing COVID-19 policies and pandemic protocols, PPE waste (medical waste) is potentially boosted by single-use masks, gloves, and face-shields. Two main problems with this is that 1) discarded PPE may form a bulk of mismanaged waste which would end up as litter in terrestrial environments or coastal shorelines, and 2) developing countries may find it more difficult to handle excess waste given that have already been an ongoing issue of waste mismanagement.

What is contributing to waste mismanagement in developing countries? African countries such as Ethiopia, Botswana, Ghana, and South Africa have not separated the way they manage medical waste compared to regular waste, which is problematic because contamination of regular waste could create unexpected secondary chemical reactions that may result in unprecedented reactions when chemicals are oxidized and react with other substances. Similarly, many healthcare facilities and pharmacies are unaware of where their medical waste is disposed of because of limited funding, thus hindering many developing countries from hiring private contractors services to dispose of and transport medical waste. Unlike other continents and countries around the world that implement a wide variety of practices for disposing and classifying waste according to their country/state legislation, developing countries in Africa and Asia are having difficulties doing the same, as they are stricken by severe poverty, limited resources, and natural disasters.

Studies and publications on sustainable waste management of medical waste in developing countries in particular have suggested that a substantial waste management model should be implemented for countries to take more control over their waste. For example, instead of open-dumping or incineration, solid waste can be disposed of at a management facility or at an available DUMP (Disposal of Unused Medicines) programme for pharmaceutical waste. For countries and healthcare professionals to ethically follow their obligations to not cause harm while also aligning themselves with the ethics of public health and management, pushing towards socio-economic change and finding approaches to overcoming challenges within existing government guidelines and policies for proper waste handling should be addressed first. After establishing proper waste handling policies and guidelines, a call for reform and additional public support towards a reduction of medical waste among the common and professional world will successfully prevent tonnes of medical waste from being generated.

References:

Aljazeera. “Huge volumes of COVID medical waste posing health hazard: WHO.” Al Jazeera, 1 February 2022, https://www.aljazeera.com/news/2022/2/1/huge-volumes-of-covid-medical-waste-posing-health-hazard-who. Accessed 19 March 2022.

Benson, Nsikak U., et al. “COVID pollution: impact of COVID-19 pandemic on global plastic waste footprint.” Heliyon, vol. 7, no. 2, 2021, p. 9. ScienceDirect, https://www.sciencedirect.com/science/article/pii/S2405844021004485.

Chisholm, Jade Megan et al. “Sustainable waste management of medical waste in African developing countries: A narrative review.” Waste management & research : the journal of the International Solid Wastes and Public Cleansing Association, ISWA vol. 39,9 (2021): 1149-1163. doi:10.1177/0734242X211029175

Hassan, Adeel. “A Deluge of Medical Waste Is Swamping the Globe, a UN Report Says.” The New York Times, 3 February 2022, https://www.nytimes.com/2022/02/03/world/medical-waste-environment-covid.html. Accessed 19 March 2022.

Khan, Bilal Ahmed et al. “Healthcare waste management in Asian developing countries: A mini review.” Waste management & research : the journal of the International Solid Wastes and Public Cleansing Association, ISWA vol. 37,9 (2019): 863-875. doi:10.1177/0734242X19857470

Washington State Department of Health. Glove and Other PPE Guidance for COVID-19 Vaccine Administration. 2021. Department of Health, https://doh.wa.gov/sites/default/files/legacy/Documents/1600/coronavirus//COVID-19VaccineGloveGuidance.pdf.

World Health Organization. Tonnes of COVID-19 health care waste expose urgent need to improve waste management systems. 2022. World Health Organization, https://www.who.int/news/item/01-02-2022-tonnes-of-covid-19-health-care-waste-expose-urgent-need-to-improve-waste-management-systems.

Personalized Genomics - Entertainment or Ethical Conundrum?

If you were on the internet around 2018, you could not miss it: seemingly everyone was ordering their own set of 23andMe or AncestryDNA – two popular brands of home genetic testing kits – and finding out their genetic ancestry. All over YouTube, people were amazed to discover where in the world their ancestors came from, and millions watched them do it. The tests did not only look at ancestry, but also offered a health screening, which would tell you if you were predisposed to certain diseases. However, with all the attention focused on its entertainment value, the implications of bringing this technology directly to consumers went unnoticed and undiscussed.

Genetics, in popular culture, is a topic that is often misunderstood. Of course, not everyone can be an expert on genetics. Yet, this particular field of the biological sciences is one that can have significant impacts if misapplied. The recent advent of direct-to-consumer (DTC) genetic testing has led to many people interacting with genomics - the study of an organism’s complete set of genes - without really understanding what they are seeing.

First of all, it is important to recognize that these DTC tests do not sequence your genome - they detect single-nucleotide polymorphisms (SNPs, pronounced “snips”), i.e. the variation at a particular location in your DNA. Furthermore, most DTC tests only look at a very small number of SNPs for a given gene. In the case of genes such as BRCA1 and BRCA2, for which some variations have been linked to breast cancer, only a few SNPs are screened for, despite there being over 1000.[1] Furthermore, having a SNP that correlates with a higher risk for a certain phenotype that may be linked to a particular disease, does not mean you are destined to have it - it is just a correlation. Without an understanding of these limitations, consumers may be misled by the results of the tests. They might take the SNP results to be an absolute biological truth, telling them everything they need to know about themselves and what diseases they will get. Although DTC tests inform consumers of these limitations, it is easy to overlook such a disclaimer should a test tell you that you are predisposed to cancer.

It also begs the question: what is truly the point of giving consumers this health information? They should not see it as a replacement for a clinical diagnosis. DTC genetic health screenings create the risk of people seeking unnecessary clinical procedures and adds stress to their lives, making the tests seem like more trouble than they’re worth.

As more and more people jumped aboard the personalized genomics train, privacy concerns took a backseat, all the while being exacerbated as more people’s DNA was analyzed. Of course, these companies have privacy policies in place. The genomic data is encrypted to ensure restricted access, and you can choose to have your data destroyed after testing is completed. 23andMe’s privacy policy states that data will not be shared with any public databases, employers, or insurance companies – but may be shared with “service providers”.[2] 

Data breaches are rare, but a possibility – in 2020, the genealogy service GEDmatch’s database was hacked.[3] Perhaps the most glaring and surprising privacy concern is the fact that genomic data from DTC tests has been used to trace and identify people who have never used these services. One such case occurred in 2005, before DTC genetic tests were widely available. Using genomic data from relatives in combination with some other identifying information, a fifteen year old managed to track down his anonymous sperm donor father4. Furthermore, nine years ago, a paper was published in which researchers had been able to identify surnames from personal genomes, all of it while using only free internet resources [5]. Although these companies appear to be making it a priority to protect genetic information, with the advancement of technology and the availability of information, it is seemingly impossible to ensure complete privacy of genomic data.

You might shrug at this information and think, ‘so what, what would anyone want to do with my genetic information anyway?’ Well, the boom in genetic technologies occurred relatively recently, and is still evolving at such a rapid pace that legislation may not be able to keep up. In that case, we could be dealing with potential issues of genetic discrimination, such as people being denied insurance or employment due to their genetic predisposition to a disease, and bad faith actors may be able to use your genomic data against you.

So while DTC genetic tests may have exploded in popularity as a fun way of learning more about yourself, their potential in a broader health context and the ethical concerns surrounding them result in a more muddled view of their benefits when weighed up against their drawbacks. The wave of DTC popularity is a major foray into popular genomics, but there is certainly more to come, and it is important to avoid misconceptions about what a piece of genetic information actually means, and to be aware of novel privacy concerns that DTC genetic tests raise.

References

1. Horton, R. (2020, January 17). Direct-to-consumer testing: a clinician’s guide. Genomics Education. Retrieved March 10, 2022, from https://www.genomicseducation.hee.nhs.uk/blog/direct-to-consumer-testing-a-clinicians-guide/ 

2. Privacy Highlights. 23andMe. (2022, February 3). Retrieved March 10, 2022, from https://www.23andme.com/about/privacy/ 

3. Murphy, H. (2020, August 1). Why a data breach at a genealogy site has privacy experts worried. The New York Times. Retrieved March 10, 2022, from https://www.nytimes.com/2020/08/01/technology/gedmatch-breach-privacy.html 

4. Sample, I. (2005, November 3). Teenager finds sperm donor dad on internet. The Guardian. Retrieved March 10, 2022, from https://www.theguardian.com/science/2005/nov/03/genetics.news 

5. Gymrek, M., McGuire, A. L., Golan, D., Halperin, E., & Erlich, Y. (2013). Identifying personal genomes by surname inference. Science, 339(6117), 321–324. https://doi.org/10.1126/science.1229566 

Opinion: N.Y. Nursing Homes' Immunity During the Pandemic Was Reasonable Due to the Challenges They Faced

The outbreak of the COVID-19 pandemic in the United States drastically changed our lives. College students were sent home, clothing stores closed their doors, and weddings were canceled. One industry that was impacted particularly hard was the healthcare industry.  The healthcare industry was faced with the formidable challenge of battling a novel virus it knew little about. For an industry which traditionally follows evidence-based medicine for patient management, the absence of any evidence-based approaches to this specific virus presented a daunting task.

 On January 31, 2020, the United States declared COVID-19 as a public health emergency [1].  On March 1, 2020, New York confirmed its first case of COVID-19 in the state [2].  Not too long after the first New York case, nursing homes became the center of COVID-19 outbreaks. This was not surprising, given that nursing home residents live in shared close spaces and many of them are elderly and immunocompromised, making them vulnerable to contracting the virus and to serious complications from the virus.  Advanced age and underlying medical conditions came to be known as primary risk factors for poor outcomes.  

It is admittedly hard to forget the news story with video footage of two large refrigerator trucks parked outside a New York City nursing home storing the bodies of patients who had died from COVID-19 [3].  With so many patients dying from the virus and back-ups at funeral homes, the nursing home had to resort to storing those bodies in trucks. The nursing home lost 98 patients to COVID-19 by May 1, 2020, which represented a startling 15% of its total patient population [3].    

About 20 states enacted legislation granting some level of immunity to protect healthcare professionals and facilities who worked amidst the peak of the COVID-19 pandemic from malpractice lawsuits [4]. New York was the first state to offer COVID-19 specific immunity to the healthcare industry. On April 6, 2020, New York’s then Governor Cuomo passed emergency legislation titled the New York Emergency or Disaster Treatment Protection Act (“EDTPA”).  This law provided civil and criminal liability immunity to all health care professionals and facilities for any injuries or death alleged to have been sustained in the course of providing health care services during the COVID-19 outbreak [5].  The stated purpose was sound: to promote the public health and safety of all citizens by protecting health care professionals and facilities from liability that may result from treatment of individuals under conditions created by the COVID-19 emergency [6].

However, on April 6, 2021, New York entirely repealed the immunity [7].  With New York as the first state to repeal the immunity, this raises the question of whether granting immunity was ethical in the first place. After examining the challenges that nursing homes in New York specifically faced during the COVID-19 pandemic, granting them immunity was the ethical and reasonable way to protect an industry that struggled with devastation and death for reasons outside their control.  

When COVID-19 was first introduced into the United States, there was no vaccine and there was no established effective treatment.  Further, nursing homes, along with all healthcare facilities, were short on testing kits and personal protective equipment (“PPE”).  At the start of the COVID-19 pandemic, the CDC only distributed limited numbers of testing kits to keep testing centralized, which in hindsight was a problematic plan given the explosion in cases [8].  Moreover, the New York State Department of Health fully expected and warned all healthcare facilities that there would be a shortage of PPE [9]. This expected shortage was probably the reason behind the CDC head-scratching guideline that facemasks should only be worn by sick people [10].  As we came to learn, this guideline sharply conflicted with all subsequent guidelines recommending or even mandating masks for everyone, sick or healthy, to limit transmission.  

Perhaps the most devastating blow to the New York nursing homes was Governor Cuomo’s March 25, 2020 Advisory, which required all nursing homes to admit hospital patients recovering from COVID-19 on an “expedited basis” [11].  So not only did nursing homes have to deal with a novel virus without established treatment, but they were put into the impossible position of having to accept COVID-19 recovering patients into a patient population already compromised and vulnerable due to advanced age and chronic medical conditions.  According to the Associated Press, an independent global news organization, the NYSDOH reported a total of 6,327 recovering COVID-19 patients were admitted from hospitals into New York nursing homes in the two months following this Advisory [12].  

The Journal of American Medical Directors Association conducted a study on the challenges that nursing homes faced from May 11, 2020 to June 4, 2020 which was at the height of the COVID-19 pandemic and during the period of New York State’s immunity. The study involved 152 nursing homes across 32 states and went through the universal problems experienced by nursing homes across the nation. The study revealed challenges of constraints on testing due to inadequate testing; reuse of PPE due to PPE shortages; burdens in tracking the inconsistent guidelines from regulator agencies; staff shortages due to staff illness; concern over caring for very ill and compromised patients; and concern over their health [13].  One nursing home CNA revealed “[we are] reusing…gowns and going in and out of rooms with the same gown.  The face masks [are] being reused for a week.”  [13]  One nursing home administrator expressed frustration at the “constant changing regulations” and one nursing home physician characterized the guidance as “spotty and unrealistic.”  [13] 

These were the challenges that nursing home workers faced each and every day, and this was the reason why New Yorkers applauded healthcare workers daily at shift changes [14].  The repeal suggests that we have forgotten the incredible sacrifices nursing home workers and all other healthcare workers made in caring for COVID-19 under the most trying of times. Those in favor of the repeal argued that healthcare administrators need to be held accountable for COVID-19 deaths, but this argument ignores that the law still allowed lawsuits of gross negligence [7].  It also ignores the fact that the immunity was given for a short period of time, from March 7, 2020 to August 4, 2020, which was the height of the COVID-19 outbreak and the immunity period ended once the country was able to better manage COVID-19.  Michael Balboni, executive director of Greater New York Health Care Facilities, strongly opposed the repeal: “To do this now seems to be piling on an industry that has already had so much death and devastation.  And I don’t really see how this is going to help anybody. . . This is an opportunity to rebuild better.  And we’re not doing that.” [7] The repeal of the immunity will open the floodgates to unjustified litigation against nursing homes as well as other healthcare professionals to hold them accountable for things that were beyond their control. Shortages of resources, beds, rooms, testing, and staff were endemic to the entire healthcare industry and occurred as results of the enormous burdens created by COVID-19.  

The height of the COVID-19 pandemic brought serious challenges to nursing homes and nursing home workers confronted significant dilemmas daily.  New York’s legal immunity law was an ethical and reasonable choice to protect the nursing home industry managing vulnerable patients in an unprecedented global health problem.   New York’s legal immunity sufficiently protected a patient’s rights to proper care because the immunity was only effective for a limited time and it always allowed for lawsuits of gross negligence.  The repeal of legal immunity unfairly exposes nursing homes to lawsuits for resource shortages and other treatment difficulties that arose in the entire healthcare industry because of the COVID-19 pandemic and were beyond their control. 

References

1. David Sencer, “CDC Museum COVID 19 Timeline”, Retrieved from  https://www.cdc.gov/museum/timeline/covid19.html

2. Manhattan Woman, 39, Is NYC’s First COVID-19 Case; Husband’s Test Results are Pending”, NBC, March 1, 2020.  Retrieved from    https://www.nbcnewyork.com/news/coronavirus/person-in-nyc-tests-positive-for-covid-19-officials/2308155/

3. Jim Mustian, “NY Nursing Home Reports 98 Deaths Linked to Coronavirus”, NBC, May 1, 2020.  Retrieved from    https://www.nbcnewyork.com/news/local/ny-nursing-home-reports-98-deaths-linked-coronavirus/2399097/

4. Recently enacted medical liability immunity statutes related to COVID-19”, American Medical Association, November 20, 2020.  Retrieved from    https://www.ama-assn.org/system/files/2020-12/medical-liability-immunity-statutes-chart.pdf.

5. Emergency or Disaster Treatment Protection Act”, New York Public Health Law, Article 30 D,  3082, (2020).   

6. Emergency or Disaster Treatment Protection Act”, New York Public Health Law, Article 30 D, 3080, (2020).  

7. Marlene Lenthang, “Cuomo repeals nursing home and hospital COVID-19 liability protections”, ABC, April 7, 2021. Retrieved from https://abcnews.go.com/US/cuomo-repeals-nursing-home-hospital-covid-19-lia bility/story?id=76921804

8. CDC, “Distribution of CDC Diagnostic Test Kits Will Expand Laboratory Capacity to Detect 2019-nCoV”, [Press Release], February 6, 2020.  Retrieved from    https://www.cdc.gov/media/releases/2020/p0206-coronavirus-diagnostic-test-kits.html

9. New York State Department of Health, “PPE Shortage” [Letter], February 6, 2020. Retrieved from  https://coronavirus.health.ny.gov/system/files/documents/2020/03/2020-02-06_ppe_shortage_dal.pdf

10. CDC, “Prevent Getting Sick”, March 2019. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html

11. New York State Department of Health, “Hospital Discharges and Admissions to Nursing Homes” [Advisory], March 25, 2020.  Retrieved from https://dmna.ny.gov/covid19/docs/all/DOH_COVID19%20_NHAdmissionsReadmissions_%20032520.pdf

12. Siladitya Ray, “New York Underreported COVID-19 Patients Sent from Hospitals to Nursing Homes By 40%”, Forbes, February 12, 2021. 

13. Elizabeth White et. al, “Front-line Nursing Home Staff Experiences During the COVID-19 Pandemic”, J. Am Med Dir Assoc., January 2021.

14. Every Night, New York City Salutes Its Health Care Workers”, NPR, April 10, 2020.  Retrieved from https://www.npr.org/2020/04/10/832131816/every-night-new-york-city-salutes-its-health-care-workers

The Social Equity Implications of Uterine Transplant Surgery

According to Penn Medicine, over 70 uterine transplants have been performed globally, providing new hope for women with Uterine Factor Infertility (UFI). Since 2017, institutions like the Penn Transplant Institute and Baylor University Medical Center have pioneered this procedure to provide women struggling with infertility a chance to have biological children. 

Penn Medicine describes UFI as a condition for being born without a uterus, not having a functioning uterus, or having had their uterus removed. According to the NHS, a hysterectomy or the removal of a uterus is often considered for those with heavy periods, endometriosis, pelvic inflammatory disease (PID) or cancer of the uterus or ovaries. Baylor Scott & White Health, outlines that candidates for the transplant must have UFI, be a non-smoker, non-diabetic, cancer-free for at least five years, negative for HIV and hepatitis, and be within child-bearing age, 21-40. The donor – either living or deceased – must be HIV, STD free, be aged 30-50 of a healthy weight, cancer-free for at least five years and have no history of diabetes. 

Penn Medicine describes a uterine transplant as a lengthy procedure which begins with in vitro fertilization (IVF) treatments to harvest and fertilize the patient’s eggs. The uterus is then transplanted and the patient begins to take immunosuppressants, followed by an embryo transfer, and eventually a hysterectomy to remove the transplanted uterus. The entire process takes between two to five years, and women can have up to two children under clinical trials.

UFI affects 5% of all women worldwide. Addressing it is a monumental step towards providing women with more opportunities to have biological children, according to Baylor Scott & White Health. In addition to cis-gendered women, future uterine transplants may provided more reproductive freedom for transgender women who have undergone gender confirmation surgery, according to a recent 2019 study in the U.K. published by the JAMA Network. 

In the same 2019 study surveying transgender women in transgender support groups, over 90% indicated that a uteran transplant would increase their happiness, feelings of femininity, and address gender dysphoria. Access to new technologies for non cis-gendered individuals can break down barriers in healthcare that traditionally cater to cis-gendered people. Transgender individuals are often deprived of fertility preservation counseling and limited in their access to IVF – leaving countless uninformed about assisted reproductive technologies. 

Not surprisingly, social issues come into play.  Although the movement towards more innovative technologies improves the wellbeing of those who are non cis-gendered or those who may be infertile, uterine transplants highlight existing societal and racial inequalies. 

As a white woman, I have an inherent bias towards favoring uterine transplants in those who share both my race and socioeconomic status. Therefore, it is important that I take ample time to realize how reproductive technology may disproportionately impact certain women of color. 

The highest rates of U.S. poverty are experienced by African American, Native American, Alaska Native and Latina women, according to the Center for American Progress. The wealth gap that places women of color in lower socioeconomic environments, prevents access to quality education, healthcare and job opportunities. This often prevents them from accessing invasive, expensive, and new technologies that expand their reproductive choices.

On average, IVF costs between $8,000 to $13,000 per round without medication– effectively limiting low income women from accessing reproductive technologies, according to the Pacific Fertility Center in Los Angeles. Additionally, the use of immunosuppressants – which according to the Cancer Research Institute, causes nausea, increased risk of infection, loss of appetite, vomiting, etc. – may deter women who work full time, work multiple jobs, or have limited opportunities for leave from participating. During the recent pandemic, the increased risk for infection and potential for dangerous exposure to COVID-19 may be a risk many working women of color facing poverty are unwilling to take.

In her novel Intimate Justice: The Black Female Body and the Body Politic, Shatema Threadcraft discusses how women of color have often historically been targeted by coerced sterilization, encouraged to take birth control to reduce their fertility, and have deemed ‘welfare queens’ who through motherhood take advantage of welfare programs. This has culminated in an ingrained pattern in American healthcare to effectively maintain white reproduction. New expensive procedures like uterine transplants are institutionally marketed towards upper-middle class white families which in turn prevents reproduction for women of color who struggle with infertility. 

The inaccessibility of many treatments can also raise the question of if uterine transplants should be covered by subsidized healthcare. For example, in states like California, Medicaid explicitly covers transgender services, which according to the State of California Health and Human Services Agency includes, “psychotherapy, continuous hormonal therapy, labratory testing to monitor hormone therapy and gender reassignment surgery that is not cosmetic in nature.” Within this definition, uterine transplants to aid gender dysphoria should be made more accessible through government-funded programs like Medicaid in states like Colorado, California, Connecticut, Delaware etc. If these services are not provided through federal funding, this highlights the broader issue of a lack of bodily autonomy for people of color, those below the poverty line, and LGBTQ+ members.  

Overall, uterine transplants present unmatched opportunity for transgender or infertile women to participate in expansive fertility options. However, the inaccessibility of these technologies consistently put women of color or those in poverty at a disadvantage when taking control of their reproductive autonomy. Uterine transplants are just one example of modern biomedicine highlighting social inequity. This can beg the question if novel assistive technologies perpetuate modern day eugenics by encouraging white reproductive choice, whilst alienating the conception of Black, LatinX or Native children.             

References

Healthcare Laws and Policies: Medicaid Coverage for Transition-Related Care. 10 Dec. 2021, https://www.lgbtmap.org/img/maps/citations-medicaid.pdf.

Hysterectomy - Why it’s necessary  - NHS. (2019, February 9). NHS. https://www.nhs.uk/conditions/hysterectomy/why-its-done/

Immunotherapy Side Effects - Cancer Research Institute (CRI). (n.d.). Cancer Research Institute. Retrieved March 13, 2022, from https://www.cancerresearch.org/en-us/immunotherapy-side-effects

Penn Uterus Transplant Program. (n.d.). Penn Medicine. Retrieved March 13, 2022, from https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/penn-fertility-care/uterus-transplant 

Perceptions and Motivations for Uterus Transplant in Transgender Women | Pediatrics | JAMA Network Open | JAMA Network. (2021, January 20). JAMA Network | Home of JAMA and the Specialty Journals of the American Medical Association; JAMA Network. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775302

Ross, L., & Solinger, R. (2017). Reproductive Justice. Univ of California Press.

Sahakian, V. (n.d.). The Cost of IVF in California. Pacific Fertility Center of Los Angeles | Top-Rated IVF Clinic. Retrieved March 13, 2022, from https://www.pfcla.com/blog/ivf-costs-california

The Basic Facts About Women in Poverty - Center for American Progress. (n.d.). Center for American Progress; https://www.facebook.com/americanprogress. Retrieved March 13, 2022, from https://www.americanprogress.org/article/basic-facts-women-poverty/

Threadcraft, S. (2016). Intimate Justice: The Black Female Body and the Body Politic. Oxford University Press.

Uterus Transplant | Baylor Scott & White Health. (n.d.). Welcome to Baylor Scott & White Health. Retrieved March 13, 2022, from https://www.bswhealth.com/uterus-transplant/

Embryonic Selection of Genes Associated with Intelligence: A Dangerous Parallel To Eugenics

In the early twentieth century, racism, ableism, and social Darwinism found an abhorrent intersection in the practice of eugenics. Eugenics was a scientific movement to “improve” the human genome through horrific methods such as euthanasia and forced sterilization [1]. In Nazi Germany, these practices were used as a tool of the Holocaust. In the United States, they were used against marginalized groups such as those with disabilities or people of color [1]. These practices were based not only on the terrible devaluation of human lives, but also the incorrect belief that all human characteristics were easily attributed to genetics [1]. This “science” was claimed to be the justification for eugenics. The quantification of this was often through IQ tests, which eugenicists used to claim “feeblemindedness” if the scores were low enough [2]. Thus, using genetics to select against lower IQ scores was one of the facilitators of an incredible injustice – one that is, unfortunately, newly pervasive in the ever-growing field of genetic engineering. 

Today’s era of biotechnology poses an eerily familiar ethical dilemma. It has been almost twenty years since we first sequenced the entire human genome [3]. We know countless associations between genes and disease. And, to some extent, we can predict the chances of outcomes for embryos based on these associations [4]. The subjects of these genomic predictions range from health to intelligence, although the predictive power is far from one hundred percent [4]. Nevertheless, some companies have already begun to use these predictions for in vitro fertilization (IVF) through embryo selection based on polygenic scores, or ESPS [4]. But assigning value to certain traits over others – such as intelligence – and then proceeding to artificially select for them begins to sound analogous to a very dark part of our nation’s history.

ESPS is a new, underdeveloped technology, and has had several concerns surrounding both its biological and ethical consequences. These concerns were brought up in a study recently published in the New England Journal of Medicine. The study, “Problems with Using Polygenic Scores to Select Embryos,” claims that selecting against one gene could have inadvertent, deleterious repercussions on many other traits [4]. Conversely, in selecting for one trait, scientists might also unwittingly select for unfavorable ones [5]. This study also points out that much of the research for ESPS has been done on the genetics of adults with European ancestry, meaning that the predictive power will be far lower for anyone who doesn’t fit that description [4].

ESPS does have some beneficial purposes, as do many ethically-charged biotechnologies. For instance, it can help screen against Tay-Sachs Disease [4], which is an incurable disorder that leads to fatality around age five [6]. Yet, the aforementioned article published by the New England Journal of Medicine says that even “ethically appropriate” selection (against traits associated with mortality, for example) brings into question issues of unequal access. The article claims that even this “would probably exacerbate existing disparities in health owing to factors such as economic inequality [and] racism,” [4]. However, it is a different matter in instances of terminal illness that have been empirically proven to be linked with a specific genetic mutation, such as Tay-Sachs Disease. This is certainly a fine line on which to ethically balance. But, in avoiding the use of this technology, would we really condemn a child to death on the basis of the previous argument? 

Nonetheless, ESPS has developed outside of being used as a determinant for fatal genetic disorders. In particular, Steve Hsu, founder of the company Genomic Prediction, is a proponent of selecting against intellectual disability, which is associated with low IQ scores [7]. He argues that of the embryos created during IVF, the majority will be selected against anyway, based on something as simple as the embryo’s shape – so why leave this selection partially up to chance [7]? Why should parents not want to lower the likelihood of disease for their child? This is arguably ethical for cases of serious illness. However, selective reproduction based on something like IQ scores is essentially comparable to eugenics. Furthermore, it is well established today that IQ tests are poor markers of intelligence anyway because of their inherently complex, biased nature [2]. Yet the most important concept to consider is that intelligence, regardless of how measurable, is hardly a determinant of one’s quality of life [7]. Selecting against intellectual disability reinforces an idea that disability rights activists have been fighting for decades: that traits which lead to disabilities are somehow “less valuable” than others – that the life of someone with a disability will be less valuable than others [8]. 

Eugenics constitutes a dark time in the history of biomedicine. As our society moves away from this period into one of biomedical beneficence, we are obligated to pay special attention to anything that is reminiscent of this past. And while Genomic Prediction seems to have yet to provide this kind of intelligence reporting as a service on their website, we must be extra cautious in navigating this technology which intersects so dangerously with the tragic history of eugenics.

References 

1. National Human Genome Research Institute. (2021, December 1). Eugenics and scientific racism. Retrieved March 4, 2022, from https://www.genome.gov/about-genomics/fact-sheets/Eugenics-and-Scientific-Racism

2. Martschenko, D. (2017, October 11). IQ tests have a dark, controversial history - but they're finally being used for good. Business Insider. Retrieved March 4, 2022, from https://www.businessinsider.com/iq-tests-dark-history-finally-being-used-for-good-2017- 10 

3. National Human Genome Research Institute. (2020, December 22). The Human Genome Project. Retrieved March 4, 2022, from https://www.genome.gov/human-genome-project

4. Turley, P., Meyer, M.N., Wang, N., Cesarini, D., Hammonds, E., Martin, A.R., Neale, B.M., Rehm, H.L., Wilkins-Haug, L., Benjamin, D.J., Hyman, S., Laibson, D., Visscher, P.M. (2021, July 1). Problems with using polygenic scores to select embryos. New England Journal of Medicine; 385 (1), 78. Retrieved March 4, 2022 from DOI: 10.1056/NEJMsr2105065 

5. University of Southern California. (2021, June 30). Report sounds alarm on efficacy, safety, ethics of embryo selection with polygenic scores: A multinational team of researchers describes the limitations and risks of the new service. ScienceDaily. Retrieved March 4, 2022 from www.sciencedaily.com/releases/2021/06/210630173622.htm 

6. National Organization for Rare Disorders, Inc. (2021). Tay sachs disease. Retrieved March 4, 2022 from https://rarediseases.org/rare-diseases/tay-sachs-disease/

7. Adler, S., Cusick, R., & Walters, P. (2019, July 25). G: Unnatural Selection | Radiolab. WNYC Studios. Retrieved March 4, 2022 from https://www.wnycstudios.org/podcasts/radiolab/articles/g-unnatural-selection

8. Ouellette, A. (2011). The Struggle: Disability Rights versus Bioethics. In Bioethics and Disability: Toward a Disability-Conscious Bioethics (Cambridge Disability Law and Policy Series, pp. 12-46). Cambridge: Cambridge University Press. Retrieved March 4, 2022 from doi:10.1017/CBO9780511978463.003

In-Vitro Gametogenesis Opens New Doors for Same-Sex & Infertile, Hopeful Parents

For same-sex or infertile couples looking to have a child, there are several options; adoption, surrogacy, and in-vitro fertilization (IVF) have come a long way since their origins. However, there is one possibility that scientists hope to develop—the ability for these types of couples to conceive biological children. The most promising method is in-vitro gametogenesis (IVG). Both IVF and IVG are the implantation of an embryo fertilized in vitro (meaning outside the body) into a womb. However, unlike IVF, IVG is the creation of sperm or egg cells from adult somatic cells, rather than the use of pre-existing gametic cells. With IVG technology ethical concerns have arisen, many of which are similar to those surrounding IVF when it was first developed. 

The event that spurred this on was a discovery in 2006 by scientist Shinya Yamanaka. Yamanaka was able to create induced pluripotent stem cells (iPSC) from the adult somatic cells of mice. Pluripotency is the ability of a cell to change into any type of cell. In nature, once a cell develops into, for example, a muscle cell, it is unable to change into another cell type. The only cells that can naturally differentiate into multiple types of cells are stem cells. [1] The development of iPS cells is so important because, before this discovery, to work with human stem cells, a scientist would have to extract them from human embryos. iPSC offers a close imitation of embryonic stem cells without any need for an actual embryo. The creation of iPS cells not only changed the future of fertility but other fields such as organ transplantation and drug development. 

This may sound like the perfect solution, but it is not so simple. One main issue is that it is more difficult to have an iPS cell develop into an egg than other cell types. From MIT Technology Review, “Certain cell types are very easy to make in the lab: leave pluripotent stem cells in a dish for a few days, and some will spontaneously start to beat like heart muscle. Others will become fat cells. But an egg might be the hardest cell to produce. It’s huge—one of the largest cells in the body. And its biology is unique, too. A woman is born with her full complement of eggs and never makes any more.” [2] However, there is hope for the future. Per Professor Sonia M. Suter of George Washington University Law School, “So far scientists have not achieved similar success in creating human oocytes, although they have derived egg-like cells. Given that research on mice has yielded both sperm and oocytes, however, it is probably merely a matter of time before human oocytes can be derived in vitro.” [3]

The other major issue when utilizing IVG for same-sex couples is the issue of X and Y chromosomes. For two biological females to have a biological child together, a cell from one female would need to be changed into a sperm cell with an X and a Y chromosome. Similarly, for two biological males to have a biological child together, one of their cells would need to be changed into an egg cell with two X chromosomes. The male couple would also need to have someone else with a womb carry the child until its birth. [4] The matter of X and Y chromosomes, however, is not an issue for opposite-sex infertile couples. 

There are a variety of difficulties making scientists hesitant about pursuing in vitro gametogenesis. Firstly, we must address one significant problem: the stigma surrounding same-sex couples having children together. Same-sex couples in many countries are still unable to marry or have joint custody of children. Only 33 countries recognize joint same-sex adoption, which is only 17% of the world’s nations. [5] As many places do not allow same-sex adoption, even if IVG advances it is possible that same-sex couples will not be able to use it. Prejudice towards same-sex couples is stinting the study of this form of childbearing, as funding for scientific research is allocated towards what is seen as most beneficial for a country’s citizens, and thus the majority of countries will not allocate funding for this type of research. However, as IVG would also help infertile heterosexual couples, and as sentiment towards same-sex couples generally improves, hopefully this is a problem that will become less glaring in the future. 

Another issue is how we approach the research of IVG. The fear is that in order to pursue the research of IVG for commercial use, we will have to create and destroy artificial embryos. This is an ethical issue for many scientists and researchers. Additionally, research into IVG would likely further the genetic editing field as a whole, and many may ask: if we are creating embryos artificially and can edit them, why not make our children the best they can possibly be? This leads to the slippery slope of ‘designer babies’ and eugenics. Professor Sonia M. Suter writes, “Given the breadth of genetic information that would potentially be available with such technological advances, future parents would have the potential to select embryos or gametes not only based on genetic factors associated with illness, but also based on certain traits. This development might motivate ever more fine-tuning of the ‘quality’ of future offspring and potentially normalize the kinds of commodification attitudes that are troublesome under relational autonomy.” [3] Many are very worried about the future of genetically edited embryos because it can further strengthen disparities based on wealth, class, and access to cutting-edge medical technology. If only the top echelon of humanity can afford or access this technology, this can widen the divide between them and the rest of the population. However, this concern is not unique to IVG. It has been voiced about nearly every other genetic innovation, from CRISPR to IVF. This technology will not inherently lead to negative outcomes: it is all about how it is used and how lawmakers regulate it. 

Despite all these potential worries surrounding IVG, its development would truly change lives. The ability for infertile and same-sex couples to have biological children seems like science fiction, but it may be within our grasp. As long as IVG, similarly to many other scientific innovations, is developed, used, and regulated responsibly, this technology could truly change the ability of many families to grow.  

References:

1. Pontin, J. (2018, March 27). Science Is Getting Us Closer to the End of Infertility. Wired. https://www.wired.com/story/reverse-infertility/

2. Regalado, A. (2021, October 28). How Silicon Valley hatched a plan to turn blood into human eggs. MIT Technology Review. https://www.technologyreview.com/2021/10/28/1038172/conception-eggs-reproduction-vitro-gametogenesis/

3. Suter S. M. (2015). In vitro gametogenesis: just another way to have a baby? Journal of law and the biosciences, 3(1), 87–119. https://doi.org/10.1093/jlb/lsv057

4. Lehmann-Haupt, R. (2018, February 28). Get Ready for Same-Sex Reproduction. NEO.LIFE. https://neo.life/2018/02/get-ready-for-same-sex-reproduction/

5. Which countries allow adoption by same-sex couples? (n.d.). CoParents.Co.Uk. https://www.coparents.co.uk/blog/which-countries-allow-adoption-by-same-sex-couples/

Do Plants Have Rights?

Like most questions in the field of ethics, whether or not plants have rights is a complicated question with a not-so-straightforward answer. It entails having to establish the moral obligations, if any, that humans may have toward plants; to do that, we must define what rights are in the context of scientific research. 

Research has a long history, with clinical research dating as far back as 500 BC [1]. All good research requires experimentation and, thus, experimental subjects. When it comes to clinical research, where the primary goal is understanding the mechanisms of the human body, humans are the ideal experimental subjects. The Hippocratic Oath defined a physician’s duty as limiting the harm inflicted upon patients, but a researcher is not a physician, and such protections didn't apply to human experimentation practices. In the modern age, there are many rules, regulations, and committees dedicated to protecting the lives, privacy, and freedom of human research subjects because violating these rules would be a violation to humanity’s moral values [1]. These moral values are the foundations of human rights in the context of research. 

Humanity’s moral obligations also extend to animals, though not to the same extent as human rights. The use of animals as experimental subjects has numerous regulations, which is a result of public outcry against the cruel treatment of animals in research [7]. One of the main reasons for protecting animals is the argument of sentience. According to the Merriam-Webster Dictionary, sentience is defined as “responsive to or conscious of sense impression”; in other words, an entity must be able to act upon and be aware of its own emotions. There have been numerous studies on animal psychology, and it has been found that animals are capable of experiencing suffering [6]. Animals move and eat, and many have complex social behaviors. In this way, animals are naturally perceived as being alive .

The same reasonings often used to justify the need for animal rights, unfortunately, either don’t apply to plants or are highly contested. For example, do plants even have emotions for them to act upon? Plants might share many similarities to humans and animals on a cellular and micro scale, but looking at the macroscale, plants don’t move or eat (excluding the carnivorous plants) or vocalize or possess a brain. They just exist and grow and wait to be eaten by herbivores and omnivores. Those in support of plant sentience cite that plants are capable of chemical communication when in danger and some are even responsive to music or scents [5]. 

So, plants do have rights?

Perhaps this is enough to justify plant sentience, and, therefore, the validity of plant rights. There is, however, the subsequent issue of what those rights are and how they should be enforced. This is an issue that also plagues the debate with animal rights. Animals are traditionally regarded to be lower on the priority scale compared to humans; after all, animals have been a source of food and labor for much of human history [7]. Even so, at the very least, regulations can be set in place to ensure that animal testing is not cruel and inflict undue suffering, and people can choose to remove meat from their diet. Enforcing similar regulations on plants would pose contradictions to human morality. Plants have a plethora of uses, from making dyes to being nutritious foods. Many of these uses involve “killing” the plant. Unlike meat, plants cannot be removed from the human diet; there’s a lot of nutrients contained in plants that humans cannot make themselves. Plants also have no use for privacy, and it’s quite difficult to get their consent. 

If there isn’t anything for the law to enforce, then, even if humans possess moral obligation to plants, plants may as well not have any rights at all.

The only way for plants to receive any form of rights would be to not view them as individual entities but as a whole. Around the world, there have been instances in which people have assembled together to call for the protection of an ecosystem by way of granting that ecosystem legal rights [3].

The Amazon rainforest is one of the largest rainforests in the world, home to a diverse abundance of fauna and flora. As human civilization has continued to grow, requiring more land and resources, the Amazon has experienced many destructive changes in recent decades. In response to these changes, a group of young Colombians filed a lawsuit in 2018 against the Colombian government for depriving its citizens of the right to live in a healthy environment and future. The plaintiffs won the case, and the region of the Amazon within Colombian borders is now protected under the same rights as any human being [2]. 

In the United States, as a result of the people’s efforts to combat the increasingly worsening conditions the lake was facing as a result of pollution, Lake Erie also obtained legal rights. This decision was a stark contrast to the case of Sierra Club v. Morton in 1972, where the United States Supreme Court ruled that nature should not have legal rights [4]. It can be seen that times have changed, and the recent increased awareness of environmentalism has brought to public attention the need for protecting the world’s forests and ecosystems. 

The question of ethics and human morality has many layers and must be taken into consideration thoughtfully and carefully. Humans share a communal space with all of the living organisms on this Earth. Because of our tools and intelligence, we have been able to grow our civilizations and influence the world around us for better and for worse. The plants that grow outside should be able to grow and flourish and not be driven into extinction. As the human population continues to grow, we must be ever conscious of the consequences of our actions and acknowledge that our leafy neighbors have just as much right to live in this world as we do. Plant ethics, or rather, nature ethics may not currently be our most foremost priority, but it is plausible that given the state of our world and environment, this question will receive greater importance in the coming years. 

References

1. Bhatt A. (2010). Evolution of clinical research: a history before and beyond james lind. Perspectives in clinical research, 1(1), 6–10.

2. Moloney, A. (2018, April 6). Colombia's top court orders government to protect Amazon forest in landmark case. Reuters. Retrieved February 27, 2022, from https://www.reuters.com/article/us-colombia-deforestation-amazon/colombias-top-court-orders-government-to-protect-amazon-forest-in-landmark-case-idUSKCN1HD21Y 

3. Samuel, S. (2019, April 4). Should animals, plants, and robots have the same rights as you? Vox. Retrieved February 27, 2022, from https://www.vox.com/future-perfect/2019/4/4/18285986/robot-animal-nature-expanding-moral-circle-peter-singer 

4. Samuel, S. (2019, February 26). Lake Erie now has legal rights, just like you. Vox. Retrieved February 27, 2022, from https://www.vox.com/future-perfect/2019/2/26/18241904/lake-erie-legal-rights-personhood-nature-environment-toledo-ohio 

5. Weeks, L. (2012, October 26). Recognizing The Right of Plants to Evolve. NPR. Retrieved February 27, 2022, from https://www.npr.org/2012/10/26/160940869/recognizing-the-right-of-plants-to-evolve 

6. Psychology and Counseling News. (2019, October 22). Do Animals Have Feelings? Examining Empathy In Animals. UWA Online. Retrieved February 27, 2022, from https://online.uwa.edu/news/empathy-in-animals/#:~:text=Still%2C%20most%20scientists%20agree%20that,feelings%20much%20like%20we%20do. 

7. "What Are the Issues Surrounding "Animal Rights"?." Institute of Medicine. 1991. Science, Medicine, and Animals. Washington, DC: The National Academies Press. doi: 10.17226/10089.