BIOETHICS DIGEST: Volume 2

Welcome to the second 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.

After the Supreme Court Decision on Lethal Injection Drug, More Questions

The execution of William Kemmler, August 6, 1890

Last month, the U.S. Supreme Court ruled that Oklahoma’s substitution of midazolam for sodium thiopental as a sedative in lethal injections does not violate the Eighth Amendment prohibition against cruel and unusual punishment. Now, an important question is whether states will even be able to obtain drugs used in capital punishment. Increasing numbers of professional associations that are essential for providing and compounding lethal injection drugs are urging their members not to do so.

The American Pharmacists Association (APhA) recently issued a statement discouraging pharmacists from participating in capital punishment. The APhA joins the American Medical Association, American Nurses Association, and American Board of Anesthesiology in defining capital punishment as inimical to ethical practice for health care professionals. Following on the heels of the APhA resolution, the International Academy of Compounding Pharmacists (IACP) has also declared that active participation of their members in the administration of the death penalty is unethical.

These changes could not come at a better moment, write Lillian Ringel, the Associate Director of the Columbia University Bioethics program, and Stephanie Holmquist is a course facilitator in the Columbia University Bioethics program, in Bioethics Forum, the blog of the Hastings Center Report. The capital punishment landscape in the U.S. is increasingly baroque. Utah recently reinstated the firing squad for execution when lethal injection compounds are unavailable. Oklahoma has approved capital punishment by nitrogen gas asphyxiation as its second line method of execution, after lethal injection, and before electrocution and the firing squad.

Capital punishment in the U.S. is also mired in concerns about states’ data collection. States that have adopted the Common Rule and collect data on the effects of execution drugs on death row inmates (prisoners are members of a categorically vulnerable population and require additional protections when they are subjects of research) must arguably receive oversight from an IRB and comply with other stipulations of the Common Rule. Otherwise, states’ data collection about lethal injection may constitute illegal human subjects research.

Rats Have Empathy, But What About the Scientists Who Experiment on Them?

Lab rats on a scientists’ gloved hand.

Decades of experiments have shown that rats are smart individuals that feel pain and pleasure, care about one another, can read others’ emotions, and will help unfamiliar rats even at a cost to themselves. It’s time to apply what we’ve learned from these animals and stop conducting experiments on them in laboratories.

Recently, there was substantial media coverage of experiments at Japan’s Kwansei Gakuin University demonstrating that rats will help other rats in need and even prioritize helping others over receiving a tasty reward.

The experimenters placed one rat in a water-filled tank, a situation that terrifies rats and from which they try desperately to escape to avoid drowning. A second rat on a platform had to figure out how to push open a door to help the drowning rat reach a dry area. The experimenters observed that rats quickly learned to open the door to rescue their cagemates. When given the choice between opening one door to save a drowning rat and opening another door to secure a chocolate treat, the platform rats helped the distressed rat first – and then shared the treat with the rescued rat. Rats who had themselves previously been thrown into the water tank were faster at opening the door to help their panicked cohorts.

This study is only the latest in a string of experiments that demonstrate that rats show sympathy for pain and distress experienced by other rats and take action to help them.

Unfortunately, many experimenters miss the forest for the trees, writes Alka Chandna, a senior laboratory oversight specialist for People for the Ethical Treatment of Animals (PETA) in Bioethics Forum. Instead of following this evidence to its logical conclusion that millions of rats shouldn’t be confined, burned, shocked, infected, and crippled in laboratories – or should at least receive some basic protections under the law – many use it as the basis for even more experiments. At least one such experimenter recently acknowledged the inherent conflict: “The more we do experiments like this, the more we wonder if we should do experiments like this.”

When Words Matter: Medical Education and the Care of Transgender Patients

A recruiting poster for Australian nurses from World War I.

I was only there to learn how to place IV lines. But as my anesthesia attending and I gathered our needles, tourniquet, and gauze, I noticed that our patient, whom I’ll call Jamie, didn’t appear to fit into a narrowly defined version of gender, writes Colleen Farrell, a fourth year medical student at Harvard, in Bioethics Forum. I wasn’t sure whether to refer to Jamie as she, he, or some other alternative, but imagined it could be quite hurtful if I used the wrong pronoun. I wanted to eliminate that potential for harm.

When it comes to caring for patients like Jamie, in my experience, avenues for improving medical students’ communication skills seem to be lacking. While many communication skills are transferable from one scenario to another, there are also unique issues that arise in caring for transgender patients. My medical school had in fact attempted to teach me how to handle situations like my encounter with Jamie in a lecture on asking patients questions about sexual orientation and gender identity. But real life medical encounters are almost always more complex than the versions presented in a lecture hall.

To address the needs of transgender and gender nonconforming patients, we need physician-mentors experienced in transgender patient care who can help us work through our uncertainty. We need opportunities to gain experience and comfort, through elective rotations in specific LGBT health centers or through simulated encounters with patient-actors. And we need an institutional culture that says loudly and clearly: it’s important to do this well.

Next Steps in LGBT: Continuing Awareness

“The first step toward change is awareness. The second step is acceptance.” —Nathaniel Branden, American Psychologist

Photo credit: Flicker—Kyle Rush

Thank you, readers, for joining us on our month-long LGBT blog take-over. Together we turned a critical eye on the human rights and rhetoric surrounding the LGBT community. Expanding past the common belief that equality is purely a social issue, our guest editors and articles showed relevance in business, education, psychology, bioethics and more. To facilitate the continuation of our thoughts and communal work, we’re setting free more scholarly articles and book chapters focused on awareness as a crucial engine in social change. Take a look at our page to see the latest in research across the social sciences and humanities in awareness.

The engine for social change is a moving target; one that if we’re not reading and engaging with, it can stall out. LGBT Pride Month garnered significant momentum in 2015 and we encourage you to share this page, the blog, your comments, and this content with peers. Keep talking, thinking, and demanding human rights and advocacy because if we learned anything from this month, it’s that LGBT rights affect all of us.

Highlights:

From our top-read blog post, Queering Philosophy—How can queer theory inform and transform the practice of Philosophy?

“The goal then has to be not to establish queer theory as a recognized subfield in philosophy, but to elaborate how the questions and methods of queer thought can more generally inform and transform the practice of philosophy and its standards for knowledge production.” —Annika Thiem, Hypatia

Read more

Business and LGBTQ, LGBTs in the Workplace

“The purpose of this special issue is to take LGBT scholarship to the next stage by gathering new knowledge and extending theory on LGBT individuals in the workplace.” —Canadian Journal of Administrative Science

Read more

The Coming Out Story—YouTube Beauty Guru, Ingrid Nilsen, Comes Out in Emotional Video

“Ingrid’s story is unique in that it had by 900,000 hits in eight hours.” —Kathryn Coble

Read more

Reproduction and the LGBT Parent; a Changing Narrative

One historically important objection to gay and lesbians relationships is that they are inherently sterile and incapable of producing children. Many gay men, lesbians, and bisexual people have managed to have children anyway, through prior relationships, adoption and by relying on donated gametes and gestational surrogacy.  The prospect of synthetic gametes may lead to further options as well, if researchers can derive female gametes from men and male gametes from women.  With synthetic gametes, a same-sex couple would not need any third-party gamete donor in order to conceive a child. Inventive options are available for transgender people too. Some jurisdictions used to require evidence of sterility before re-categorizing people they treated as male to female, from female to male. Most jurisdictions no longer require sterilization that way, with the interesting result that some transgender men have gestated children.  Transgender women might in the future turn to uterus transplants in order to gestate children, if clinicians can replicate for them the 2014 success they had in securing a live birth for a woman who had a uterus transplant. Artificial gametes might also give transgender men and women the option of being genetic fathers and mothers to their children, respectively.  Nothing about being lesbian, gay, bisexual, or transgender by itself ‘turns off’ the interest in having children. In light of the options now available and of those on the horizon, the future for LGBT people is looking less and less ‘sterile’ all the time.

Timothy F. Murphy is a Professor of Philosophy in the Biomedical Sciences at the University of Illinois College of Medicine at Chicago.  He is also an author with the Hastings Center Report, a prominent journal in biomedical ethics.

Read the collection of articles from the Hastings Center Report and other journals free through July 15th! Read Free

Closing the Question about Trans-Identities

Was there ever a time in which a person could have argued for the moral acceptability of slavery without doing something gravely wrong in the very arguing? Maybe not, but it ever there were, it is now long, long, past; some questions are simply closed.

Questions about the validity of transpeople’s identities—of whether, e.g., transwomen are “really” women, eligible to apply to Smith College and to use women’s restroom, have been considered fair game since we emerged into public view. Whether expressed in academic prose, in political posturing, or in outright sneers, such questions are heard by many transpeople as profoundly disparaging, and sometimes menacing.

Yet if the tide of social attitudes and practices easing passages between genders keeps swelling, such debates might become as out of place as, say, a serious discussion about whether homosexuality is a mental illness. The sound you hear may be the closing of yet another question about how human beings may live together.

What I wonder about is this: in the time remaining before trans becomes just another way of having a gender, as, say, adoption is just another way of becoming a parent, is there anything that need not be disparaging, that might actually be helpful, to be said? Might it be good for transpeople to take a moment to think about whether their own understandings and practices might sometimes be politically retrograde, or to have some insight into the challenge their lives pose to how cisgender people now have to reimagine themselves?

Jamie Lindemann Nelson

The Hastings Center Report

Professor at Michigan State University

The End of Reparative Therapy

50 Great Myths of Human Sexuality

With the removal of homosexuality as a mental illness in the 1970’s came a change in how therapists treated gay, lesbian, and bisexual patients. Instead of attempting to change a patient’s sexual orientation, experts were told to help them understand it and learn to cope in what was still a very homophobic society.
When mental health professionals changed, however, religious organizations picked up the mantle and started ministries dedicated to “reparative” therapy. Their members—who were sometimes referred to as ex-gays—went through programs that varied from independent bible study to aversion therapy, which involved administering electric shocks every time a patient became aroused by gay pornography.
These groups were very vocal for a few decades and lent their support to efforts to discriminate against LGBTQ individuals; they argued against teaching about sexual orientation in schools, fought the formation of gay-straight alliances, opposed marriage equality, and worked to prevent LGBTQ individuals from adopting children.
Their arguments were all grounded in the idea that sexual orientation could change, that people didn’t have to be gay. Ex-gays were paraded around as success stories—such as in a 1998 ad that insisted men could “pray away the gay.”
And then the truth began to come out. Some leaders of this movement were caught having homosexual affairs, visiting gay bars, or meeting men online. Others stepped forward to admit they were wrong, that they are still gay, and that sexual orientation does not change. In 2013, Exodus International—one of the largest and at one point most powerful, ex-gay ministries—shut its doors.
Now, in the United States at least, it looks like the time of reparative therapy has passed. The courts have held up laws in two states banning the practice for minors. The White House came out against it. And two Democratic Senators recently introduced a resolution condemning it.
But probably the best sign that its days are numbered come in the apologies from those who once sang its praises. Like these words from Exodus’ last president Alan Chambers: “I am sorry that some of you spent years working through the shame and guilt you felt when your attractions didn’t change….  I am sorry that there were times I didn’t stand up to people publicly “on my side” who called you names like sodomite—or worse.”

Martha Kempner, 2015.
Martha Kempner is co-author with Pepper Schwartz of 50 Great Myths of Human Sexuality published 2015 by Wiley

Contextualizing the LGBT Patient in the Health Care System

The Institute of Medicine (IOM) in its report, The Health of Lesbian, Gay, Bisexual and Transgendered People: Building a Foundation for Better Understanding, recommends that data on sexual orientation and gender identify be collected and included among other demographic information  routinely stored in patients’ electronic health records. The intent of the IOM recommendation is to improve clinical care and to facilitate research that can address health inequalities among LGBT persons. The reality is that many LGBT persons remain reluctant to disclose their sexual orientation or gender identity, or have that information documented in the electronic health record – even when sexual orientation or gender identity is material to a medical  diagnosis or treatment. This reluctance should be contextualized within the backdrop of a health care system where many lesbian, gay, bisexual, and transgendered persons have had negative, invalidating or discriminatory experiences when attempting to access health care, during their care or treatment, or during the care and treatment of a same-sex partner. As the Institute of Medicine observed, it is necessary to create a care environment in which individuals who have historically been stigmatized and discriminated against feel safe providing this information.  What steps can health care organizations take to demonstrate trustworthiness with respect to the collection and use of information related to sexual orientation or gender identify? Should clinicians’ elicit this information as a routine part of clinical care?

Mary Beth Foglia PhD MA

Department of Bioethics and Humanities, School of Medicine

University of Washington – Seattle

Editor and author for The Hastings Center Report

Diane Sawyer’s Interview with Bruce Jenner: What Were Its Lessons?

Diane Sawyer’s April 24, 2015 ABC News interview with Bruce Jenner drew 16.9 million total viewers. The interview was deemed highly anticipated, as the American public, via media reports, expected to hear comments regarding Jenner’s gender identity. During the two-hour block of time, viewership increased as the interview unfolded. Jenner had been in the public eye for several decades, first as an Olympic champion in the 1970s and more recently as a reality television show regular on Keeping Up with the Kardashians. In a sense, Americans thought they knew much about Jenner leading up to this interview; however, they would learn more, such as the fact that Jenner considers himself Republican and Christian.

In reports following the event, CNBC described the two hours as “moving, touching, and affirming” and referred to Jenner as “humble, personable, and flawed.” LGBTQ advocates were generally pleased with the interview, noting that it represented an “accurate portrayal of what it means to be transgender” and did not cater to sensationalism (The Advocate). Trans woman and star of Orange is the New Black, Laverne Cox, offered caution in pointing out that Jenner’s story is “very specific” in that “most trans people don’t have that kind of privilege.” Indeed, violence against trans people, including murder, is endemic in the United States, especially for trans women of color.

Taking Cox’s point that much privilege is embedded within Jenner’s life and story (such that he is not like most trans people), and at the same time, the interview received an overall positive reception in casting Jenner as an everyday and relatable person (via descriptors such as “accurate,” “humble,” and “flawed”), what was the take-away from this interview for most American viewers? In particular, what were its lessons regarding trans experiences and identities?

Mary Bloodsworth-Lugo
Washington State University
Hypatia

We encourage you to share your thoughts and comments below. Please also read our free special collection of articles on LGBT studies now through July.