Welcome to the first Bioethics Digest, brought to you in association with the editors of the Bioethics Forum. This digest aims to bring you commentary on today’s most topical bioethics issues. The opinions expressed are those of the authors and not The Hastings Center.
One of the long-term contributions of Earth Day, which occurred on April 22, is that it offers a regular, semi-official reminder that a sense of the sacred is a vital part of environmentalism. But in the era of biotechnology, the notion of sacredness can pull in other directions.
A recent public form on synthetic biology hosted by Friends of the Earth and some other civil society groups effectively brought out how the notion of sacredness is woven into objections to genetically modifying microorganisms to produce fuel, cosmetics, medicines, and other chemicals. The event was titled “Sacred versus Synthetic: Competing Visions for Life on Earth,” and what was especially remarkable and helpful about it was that the presentations continually brought concerns about the possible practical harms of GM microorganisms back down to concerns about the very idea of GM microorganisms. To the speakers, the genetic modification of an organism is by definition a harm to nature, and it is perhaps the most fundamental harm to nature.
The goal of protecting life and preserving nature is a good moral starting point, writes Gregory E. Kaebnick, a research scholar at The Hastings Center and editor of the Hastings Center Report and author of Humans in Nature: The World as We find It and the World as We Create It. But a concern to preserve the natural world still requires careful thinking about which ways of altering nature constitute fundamental harms to nature.
“When I first began reading and writing about the genetic modification of organisms, I, too, felt that there was something particularly unattractive about it, that a sense of life’s value should guide us away from all forms of it,” Kaebnick writes. “I now believe that the real friends of earth should look at the big picture–at ecosystems and biodiversity, at the land, at the earth–and that the modification of DNA, per se, is not really the issue. The real issues have to do with the overall human-caused damage to the planet. We should focus on the problems of global climate change, pollution, ecosystem destruction, and human-driven extirpation of species.”
The idea that we can get better grades at school and advance our careers by taking drugs that improve concentration and other brain functions is at once controversial and tempting. Is this cheating, or is it in the same realm as drinking coffee to increase alertness? Bioethicists, medical professionals, and the general public are divided on this question.
What’s not contested is that teenagers and adults in the United States are using prescription medications such as Ritalin for nonmedical purposes in an attempt to enhance normal cognitive functioning. People are getting the drugs from doctors, or from patients (such as classmates) with prescriptions for neurological conditions who are willing to sell or share their pills.
Against this Wild West backdrop, the Presidential Commission for the Study of Bioethical Issues (PCSBI) has taken a significant step by issuing recommendations on the ethical use of medications and other means of “neural modification,” which includes drugs and interventions such as deep brain stimulation that might either treat neurological disorders or augment normal brain function. The recommendations are part of its final report, Grey Matters: Topics at the Intersection of Neuroscience, Ethics and Society.
Those who firmly believe that college students without ADHD who take Ritalin before finals are cheaters or that people in hard-driving careers who use drugs to sustain a seemingly inhuman output of work are frauds (or victims of coercion in a hypercompetitive job market) are likely to be disappointed by the commission’s report, writes Susan Gilbert, editor of Bioethics Forum, the blog of the Hastings Center Report. It is guardedly optimistic about the prospects for neural modification for enhancement purposes, stating that “contemplating novel methods of improving such functions as learning and memory in school or performance in competitive professions is truly exciting.” The commission does not assume that cognitive enhancers will necessarily promote injustice (by benefiting mainly those who are able to afford them) or help level the playing field (by enabling people with below average but still normal memory and other brain functions to perform better). But it concludes that it’s worth finding out.
A 78-year‐old man in Iowa, Henry Rayhons, was charged with third‐degree felony sexual abuse for having sex with his wife, who had severe Alzheimer’s, in her nursing home last year. Though Rayhons was acquitted last month, the case raises questions about the capacity to consent in cases of severe dementia, an issue that is not limited to sexual relations, writes Bonnie Steinbock, a Hastings Center Fellow, who is professor emeritus of philosophy at the University at Albany, State University of New York and a professor of bioethics at Union Graduate College’s Center for Bioethics and Clinical Leadership. It also comes up also in cases where patients with dementia initially resist food and water, but can be coaxed to eat. Does opening one’s mouth and ultimately swallowing indicate consent?
The importance of consent in sexual relations is well recognized, but this case is clearly not a case of spousal rape. No one suggests that Mrs. Rayhons resisted sexual contact with her husband, nor were there any signs of abuse. Indeed, by all accounts, theirs was a loving and affectionate relationship, and Mrs. Rayhons was always pleased to see her husband, even in the final stages of her dementia.
In other contexts, the absence of affirmative consent to sexual relations may be the right criterion for rape or other sexual abuse. On many college campuses, the movement is away from “no means no” (absence of consent) to a standard of affirmative consent. That is, both partners must give affirmative consent, whether verbal or otherwise, for sex to be consensual.
However, using affirmative consent as the standard for patients with severe dementia would deprive them of sexual relationships, because few retain the capacity to articulate a desire for sex. That would be a shame, because of the importance for human beings—including those who have dementia — of physical intimacy.
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