Doing Drugs for Science

 

There is a place in Chicago where you can be paid to take mind-altering drugs.

In the Human Behavioral Pharmacology Laboratory at the University of Chicago, psychiatry professor Harriet de Wit studies various licit and illicit mind-altering drugs, from caffeine to Ecstasy, by testing their effects on human volunteers. The purpose of the research is to find out how different people react to different drugs, in order to answer the central question of drug abuse research: Why do some people become addicted to drugs when most people who try them do not?

Study subjects must be between the ages of 18 and 35 and have no history of drug abuse, except those volunteers participating in the studies of Ecstasy, who must already have tried the drug.  After the studies are completed, there is no long-term follow-up of volunteers.

The story in which I first read of these studies was on the front page of the August 7th Sunday Chicago Tribune. The studies are approved by two review boards and the national advisory council of the National Institute on Drug Abuse; yet, reading about the research, I felt a bit uneasy. I believe that research done on human subjects is supposed to have at least a potential benefit to the subjects under study. Will the knowledge gained in these studies really have enough of a potential benefit to the subjects to outweigh the risk? According to the story, “studies have shown that experiments like these do not make subjects more likely to use illicit drugs.” But that does not rule out the possibility that someone who takes part in these studies could thus become exposed and addicted to an illegal drug they might otherwise never have encountered. I vividly recall patients describing to me the stories of how they became addicts the first time they took a drug (cocaine and meth are the two I remember in particular), and I can easily imagine that happening in a study such as those described; in fact the story tells of one subject who was given methamphetamine and liked the feeling of the drug: “I felt extra happy . . . I was cheerful and peppy.”

Am I overly cautious?  Am I too obstructionist?  Is the knowledge gained from these studies worth the chance that even one person might, through participation in the study, become addicted to an illegal drug?  In other words, is this ethical human-subject research?

 

Euthanasia, mercy, and the Good Samaritan

Lately I’ve been discussing infant euthanasia with some of my online students.  They are impacted very strongly by the argument from mercy.  When they consider an infant who appears to have “hopeless and unbearable suffering” as referred to in the Groningen protocol used in the Netherlands they are convinced that nonvoluntary euthanasia should be allowed if not required.  Mercy includes a desire to relieve suffering and the argument for euthanasia says that suffering should be relieved even if that means killing the sufferer.

One of the clearest expressions of mercy in the Bible is Jesus’ parable of the Good Samaritan.  In answering a question about how to love your neighbor Jesus tells a story about a man who would be rejected by those who were listening.  He finds a man who is beaten and half dead and who has been abandoned by his countrymen.  If he were a dog or a horse it would have been appropriate to put him out of his misery, but instead the man cares for his wounds and takes him to where he can receive further care.  The man who cared for the other’s wounds is identified as one who showed mercy.

The mercy that Jesus described in the story and provided for others involved hands on care for the needs of those who were injured or ill.  It sometimes involved bringing people back to life, but it never involved ending those lives.  Paul Ramsey captured Jesus’ attitude well in his ethic of “(only) caring for the dying,” and those who followed in his footsteps expressed it as “always to care, never to kill” (see First Things, Feb 1992

When we can see the importance of affirming the inherent value of every human life and search for the way to care for those who are suffering including optimal palliative care without violating the inherent dignity of that person we can be like the Samaritan that Jesus identified as a loving neighbor.

What’s so bad about making humans better? (Part 1)

In the previous two blogs, I’ve made transhumanism my focal point.  I concluded that transhumanism correctly highlights human imperfections, but incorrectly assumes that the essence of human nature is information.

Still, it may be fitting to question why it should be considered necessarily wrong to improve the human condition.  It is a fair question to raise; after all, Christians should not naïvely presume that all human enhancements are inherently evil.  Moreover, Christians must admit that Scripture does not specifically address the issues of human enhancement or transhumanism.   Thus, even if altering human nature is against God’s intentions for humans, it may not be possible to make a conclusive case from Scripture against it.  Furthermore, even if one could present a biblical case against transhumanism, transhumanists generally do not accept Scripture as an authority.

I continue my critical response with what I believe to be some of the negative consequences of transhumanism. Transhumanism, the philosophy that drives it, and its actual fulfillment, will negatively impact humanity in at least two areas:  1) the dehumanization of humans, and 2) the unavoidable but dangerous distinction between the “Naturals” and the “Enhanced.

First, a strong case can be made that, by forfeiting the negative traits that make us human (in our current form), we lose the potential positive qualities that result from difficult life experiences.  In the book Radical Evolution by Joel Garreau, one chapter underscores the negative impact of transhumanistic assumptions.  Political writer Francis Fukuyama observes that, “Human nature exists, is a meaningful concept, and has provided a stable continuity to our experience as species.”  It is, “with religion, what defines our most basic values.”  But in the transhumanist world, we “no longer struggle, aspire, love, feel pain, make difficult moral choices, have families, or do any of the things that we traditionally associate with being human.”  Consequently, we “no longer have the characteristics that give us human dignity.”  He continues:

“Even something like the elimination of pain and suffering… There’s something about the experience of pain and longing and anxiety and all of these things that our therapeutic society is trying to get rid of.  It is somehow necessary to our self-understanding of what we are as human beings.  I mean, you can’t have courage without risk.  You can’t have real compassion or sympathy with the personal experience of pain.

Human nature provides us with a sense of morality as well as the ability to make moral, social and creative choices.  It allows humans to dialog with each other about issues pertaining to justice, autonomy, human rights, politics and, ironically, whether transhumanism is a good idea.  Brent Waters continues this sentiment by summarizing Leon Kass’ perspective, “It is in coming to terms with their finite limits, and the inherent pain and suffering entailed in those limits, that humans embody the nobility of spirit that is supremely expressed in procreation.”

British neuroscientist Susan Greenfield adds that, in the end, humans will lose their individuality and personal identity.  They will lose the will to achieve because achievement will be built into the technology.  Perhaps the worst facet of the transhumanist scenario is that, if the successful transfer to machines occurs, then humans won’t know that they are dehumanized, nor with they care to know it.

In next week’s blog, I will discuss a second potential downside to transhumanism – a new form of class war!

In Response to “Of Machines and Men”

I think Joe hit the nail on the head.  One of the reasons I’ve focused on personhood during my short bioethics career is that American physicians are increasingly unable to distinguish between the human being and the biological system.  Some deny altogether the existence of anything beyond the physical body, but others only consider the spirit or the soul to be some sort of esoteric thing about which one might philosophize.  As a result most physicians believe that if they know the medical information, perform the procedure correctly, and achieve a good outcome then they have practiced good medicine.  Tips they can gain from Abraham Verghese about interacting with the patient are icing on the cake.  An inspirational insight from Atul Gawande allows them to be reflective in their spare time.   But really, those kinds of things are for humanities professors or hospital social workers.  In the medical curriculum, we see this value system in ethics teaching that amounts to not much more than instruction on managing emotional responses.   “Use this phrase when talking to a patient about cancer so they will feel this way.”  “When you enter the exam room, perceive the patient’s disposition by examining facial cues and posture.”  If the physician uses a stimulus-response framework for patient interaction, then he has fallen back into the same problem all over again.  That’s why mentorship is so important in medicine: a student “lives life” with the attending physician so as to acquire his way of looking at the world, not just his skills.  That’s why the oaths—Hippocrates, Maimonides, or others—are so important: they emphasize that medicine is a covenant between two people before it’s anything else.  And, most notably, that’s why a medical practice most consistent with Jesus’s healing ministry is one which would still have something to offer if the machine and the lab report were not even there.

 

Of Machines and Men (Part I)

 

As part of my job, I have the privilege of participating in the delivery of many babies.  I was at one such blessed event earlier this week.  There were several medical personnel and the father standing around the bed of the expectant mother. Due to the wonders of epidural anesthesia, she was quite comfortable, despite the fact that she was in the final stages of labor.

Suddenly I became aware of what all of us were doing — myself, my residents, the nurse, even the father: we were watching a machine. The mother was hooked up to a machine that monitored both the baby’s heart rate and her own contractions. The rest of us stood and stared at the machine. When the machine showed she was having a contraction, we would all turn towards her and encourage her to push, cheerleaders for her and the little life that she was bringing into the world.  But we kept one eye on the machine, and as soon as it indicated the contraction was over, we turned away from the mother and towards the machine again, waiting expectantly for it to tell us when the next contraction was coming.

With a sense of deja vu I realized that I had observed a similar phenomenon in the ICU: doctors, therapists, nurses, even family and visitors who had no idea what the little multi-colored squiggly lines on the monitor meant, nonetheless staring expectantly at the monitor on the wall instead of at the patient in the bed.  And in my training of resident physicians, I have watched videotaped patient encounters showing them sitting in the office with the patient, staring deeply into the computer screen instead of at the patient who has come to see them.  Similarly, in their inpatient work, the residents spend a few minutes on the hospital floor seeing their patients, and the remaining hours of the day (and night) staring into a computer screen, tending to the computerized chart — the “iPatient,” as Abraham Verghese called it here.

The practice of medicine has historically been founded on the physician-patient relationship;  on that foundation has been erected an edifice of techniques and technologies, tools for medical practitioners to use in serving their patients. However, it seems that in our time the tools are beginning to attack the foundation of medicine rather than just being used by it. For a variety of reasons, the tools and technologies increasingly become the center of the physician’s attention. Instead of medical practitioners defining how the tools are used, the tools begin to define what medicine is. We are becoming what Neil Postman called a Technoloply: our tools change and determine our practice’s purpose and meaning, our very way of knowing and thinking and relating to our patients.

 

Edmund Pellegrino once wrote, “Men have always sensed that the more they forged and the more machines they built, the more they were forced to know, to love, and to serve these devices.” (From Humanism and the Physician.)

 

Next week:  Some thoughts on what we can do about the ascendancy of the machine in medicine.

 

The limits of medicine and technology

 

In Too Much to Know, author Ann Blair notes that in our culture, which virtually deifies technology, we believe that we can find technological solutions to all problems, even those that are actually addressable only by attending to ourselves.*

Perhaps this confusion about the proper solution to a problem is part of the crisis in medicine and bioethics. The knee-jerk expectation of the public and the medical enterprise alike is that for every problem people bring before a doctor there can be found a solution, and that a technical solution will be the best. But what if that assumption is incorrect?

What if there are some patients for whom a technical solution is the worse option? Maybe there are some depressed patients for whom the best solution to their problem is not another pill, but the balm of human compassion and the encouragement to use the resources they have at hand to find comfort. Maybe there are some people with terminal diseases for whom the best solution is not every last possible intervention trying to sustain bodily function indefinitely, but rather help in strengthening faith and preparing for death.

Maybe instead of attempting to eliminate disabilities by trying to detect and eliminate fetuses that have them, we should be striving to be a people who can love and cherish those among us with worse disabilities than our own. Maybe instead of seeking absolute certainty (an illusion at best) by demanding that every technological test and scan be made available, we should be learning to live in the freedom of the inevitable uncertainty that comes with life on this planet.

Maybe there are types of human suffering that medicine was never meant to address. Maybe there are problems that we can only address by fixing not the problem, but our selves. And maybe part of the task of bioethics should be seeking the wisdom to discern between the two.

 

*This summary of Blair’s thought is from Alan Jacobs’s review in the May/June 2011 Books & Culture.

The Promise of Crossing Species Boundaries

 

Last week I discussed the Myth of Crossing Species Boundaries, which reflected on the fictional works of yesterday and today. So, as I promised, I wish to address now “the context that made these fictional fears, so real.”

Indeed, we are and have been capable of amazing scientific feats (well not me). Among many other skills, we are able to mess with tiny parts, and manipulate them to be and do things outside their normal function…

We are able to grow human parts in/on an animal, fuse human cells with animal eggs, create animals to have human blood running through their veins, attempt human organ growth in animals, implant a mostly human organ into an animal, and even transplant human-brain stem cells into an animal brain.

However, as Paige Cunningham wrote in a recent article: “When the great naturalist Joseph Kolreuter [pioneer in study of plant hybrids] painstakingly and methodically cross-pollinated hundreds of plants in the 18th century, he could not have foreseen the 21st century version of hybrids: human-animal (HA) hybrids.”

In its natural form (or traditional understanding), ‘hybriding’ takes place during mating or crossing, as in the case of a plant’s cross-pollination or a horse and a donkey being the last two animals on an island… The new understanding, armed with the unraveling of DNA and new reproductive technologies, involved a Doctor (Mad Scientist) wearing a lab coat in a clean room.

These new processes enabled a new world of possibility. A new world of promise. Promise of potential cures. Promise of a new life. Promise of replaceable parts. Promise of a better future. This is why we so quickly breeze past the concerns of science fiction and the warnings uttered by the skeptical.

But promise, in any form, is rarely without its ethical and theological concerns. As we are well on our way into HA hybrid research we would do well to reflect upon these critical questions:

 

Is there a qualitative difference between being human and being an animal?

Are there no boundaries to our research on animals?

Do any boundaries even exist? Boundaries between species, boundaries we ought not cross…

What of human dignity?

 

 

 

 

 

House calls and Hippocrates

Last week I was in the “piney woods” of northern Louisiana.  I had thought I would write a blog entry from there, but time and internet access were scarce, so I’m doing it this week. My wife and I were visiting her parents, Aaron and Betty.  I have always enjoyed being with them and this trip was no exception.  It was also a time to check on how they were doing.  They are both in their 80s and have some significant health problems.

On Tuesday Betty’s visiting nurse came to see her, and it made me think of the part of the Hippocratic Oath that says “Into whatever houses I enter, I will go into them for the benefit of the sick.”  Physicians don’t take care of their patients in their homes very much any more.  There are good reasons why things have changed, but there are things that have been lost.

The nurse who comes out to see Betty is becoming part of the family.  They offer her tea and cake and Aaron teases her like he does his daughter.

In the sterile environment of the hospital or office a patient can become a diabetic or an arthritic or a stroke victim.  In her home she is the person she really is and it is harder to miss that.  Those of us who care for the sick need to remember that what we are doing should be for the benefit of those we care for.  Those who receive our care are real people with homes and families who are welcoming the physicians and nurses and others who care for them into their lives just like they would welcome us into their homes.

We need to enter into their lives as respectfully as we would enter their homes and realize we are being accepted as a part of their family.

Rise of the Planet of the Transhumans

Futurist Ray Kurzweil predicts a future in which “the very nature of what it means to be human will be both enriched and challenged as our species breaks the shackles of its genetic legacy…” (from The Singularity is Near website).  Why would humans plot such a scheme?  They do it because transhumanists see the human body, in its current form, as limited and defective.  In his book From Human to Posthuman, Brent Waters observes that what unites the proponents of transhumanism is an “unwavering belief that the current state of the human condition is deplorable, and the only effective way to remedy this plight is for humans to use various technologies to radically enhance and transcend their innate and latent capabilities.”  Science journalist Brian Alexander concurs, “Transhumans regard our bodies as sadly inadequate… which restricts our brain power, our strength and, worst of all, our life span.”  Kurzweil believes that to accomplish the goals of transhumanism and overcome our imperfections, humans need to become “less biological” and more technologically enhanced, more “God-like.”  The emergence of transhumans is referred to as a ‘technological singularity,” a time when humans achieve “inconceivable heights of intelligence, material progress, and longevity.”  Indeed, in the mind of many futurists, this can be accomplished sooner than we think, perhaps as soon as 2030.

One basic presupposition of transhumanism is the view that human nature is not fixed but is malleable.  Waters observes that for transhumanists, “There are no given features, such as finitude and mortality, which define the quality and character of human life and lives.  Personal, social and political identities are subjected to continuous deconstruction and reconstruction.  In this respect, medicine (and I would add ‘technology’) can be used to deconstruct and reconstruct human bodies.”  Transhumanists think that the true essence of human nature is information, information that be downloaded onto something more durable such as a computer or a robot.  Theoretically the information could be backed up indefinitely resulting in a type of virtual immortality.  In the end, as described by Joel Garreau in Radical Evolution, we may have a world where there is a distinction between the “Naturals” and the “Enhanced.”  In this world, “Naturals,” i.e., those who have not received genetic enhancements, may be viewed as if they disabled because they simply cannot keep up with those who are genetically superior.  Others describe the next possible step – the Singularity – when machines begin to outperform the intelligence of humans to such an extent that they become “ultra-intelligent” and begin to replicate themselves.

Christians agree that the human body is defective and limited.  The doctrine of depravity, which includes the effects of sin on the human body, is one of the core doctrines of the Christian faith.  And in response to the question of whether human nature is fixed or malleable, one possible rejoinder is both.  In other words, could it be that some psychological and experiential features of human nature are subject to change while personal identity is kept intact?  Ted Peters writes, “…changes in the body, even if resulting in changes in the mind, do not risk a loss of identity.  Beyond the therapy and even beyond the enhancement, our transformed self will still be our self.”  The common sense understanding of human identity, the view that best fits human experience and Scripture, is one that posits the continuity of an individual’s identity i.e., an individual remains the same individual throughout his or her existence.  This continuity cannot be explained by simply reducing human nature to mere information.  In addition, a strong case could be made that the continuity of identity can only be explained by putting forward a robust description of human nature, one that accounts for the common experiences of self-awareness, memory, the ability to identify people, places, etc. and the capacity to engage in self-reflection.  Moreover, the psychological powers to think, be aware of, choose, reflect, experience (pleasure and pain, emotions), and the like, are consistent with the view that a personal agent, and not simply information, is involved.   If human nature consists merely of information, then how are we to account for these common experiences?  Actually, it is more natural and intuitive to make reference to “you” acting in such and such a way, rather than to suggest that information is responsible for your actions.  In sum, the view that human nature is merely information leaves too many phenomena unexplained

Then there is the matter of consciousness.  John Searle (Professor of philosophy at the University of California, Berkeley) is noted for having a deep appreciation for the complexities of consciousness.  He questions how “consciousness can be reduced to zeroes and ones, that there is not some deep mystery behind it.”  Indeed, human consciousness itself is difficult to explain if humans are reduced to transferable data.

For Christians, the human is more than a list of psychological functions.  J.P. Moreland reminds us that Scripture consistently presents humans as individuals who are the same and remain the same throughout their existence.  For example, in Psalm 139, David assumes the continuity of his identity when he reflects on God’s hand on his existence before his birth.  The reason that David could write about his early existence was because he was the same person before birth and in his present state of existence.

Concerning the question of whether humans are mere information and whether there is a distinction between humans and machines, the Christian response is rooted in the doctrine of the imago Dei, and, in my opinion, the notion of substance dualism.  Genesis 1:27 teaches that “God created man in his own image, in the image of God he created him; male and female he created them (NIV).”  Humans are not mere products of evolution that can be reduced to information.  On the contrary, humans are persons created by God in his image.

History Books and Modern Language

Current events sometimes collide with academic reading. I’m reading a book on the history of eugenics in Germany and how many eugenicists, as well as and Nietszchean philosophers and later the Nazi supporters used some of the language and ideas from Darwinism to promote a “science-based” ethic. I had just finished the chapters on the rise of moral relativism and ethics based on scientific language from Darwinian theory, when I turned to some current events in the bioethics world (For two good resources on current events in bioethics go to www.bioethics.com or Bioedge ). Two stories at the top of the list were on sex-selection. One was one multiple birth reduction. While the articles deal with very difficult topics, if you step back and read the articles, particularly the justifications given by the parents, the language is coated with medical and scientific justifications along with the notions of the healthiest or most fit or the ones that are more valued by societal norms as being worthy of survival.

 

The book I was reading is From Darwin to Hitler by Richard Weikart. Weikart is a historian and does not make the argument that Darwinism necessarily results in the atrocities of World War II. Rather, Weikart traces through the history of ideas in the German (and European) culture that lead up to the rise of Hitler. He does however note how many of the early eugenicists and the Nazis used Darwinian language of natural selection and survival of the fittest to justify deeming some members of society weaker and less valuable than others. I think one of the important take away points to this is how Darwinism as laid out in On the Origin of Species and in Descent of Man does not have the moral capacity to deem these actions wrong, or even deem them a mis-application of Darwinism, even though Darwin himself is reputed as being a gentle naturalist.

 

The problem is ethics drawn from Darwinism undercuts itself creating a morally devoid ethic of survival of the fittest and propagation of the species. In one sense this type of naturalistic ethic is relativistic because instincts are natural and therefore not morally wrong. This allows anything to be justifiable as long as it is instinctive. Darwin showed this in Descent of Man by looking at the animal kingdom and comparing animal instincts to human actions. In another sense, Darwinism removed the individual from a place of importance and elevated society or the good of the whole above the individual. In this second sense, death was deemed justifiable in instances where it would benefit society by weeding out the weaker. This was justified by using the language of natural selection and survival of the fittest.

 

So turning to the new technologies available in knowing the sex of your child early in pregnancy and technologies, such as those used by Microsort that allows a couple to select the sex of their child, the justification for this is either prevention of sex-linked disease or “family balancing.” Another article on sex selection was about China and how it was dealing with the inevitable ramifications of their population control policies (see here and here. Population control was one of justifications used by eugenicists in the late nineteenth and early twentieth century. The last article I read (in an oddly similar vein) was about multiple birth reduction.

 

I think in future blog posts it might be interesting to trace through some of language used to justify controlling reproduction. There are some differences. The eugenics movement both in the U.S. and in Germany involved some people taking control of others reproduction by deeming some not worthy to reproduce. Today, it is seen more subtly in the form of parents wanting a certain type of child or a certain sex or a certain number, all of which are dictated by what society values. In the case of the United States, we value having many choices and personal autonomy. It is less subtle in China and India where many people value boys over girls. One of the doctors mentioned in the article who was at one time against reducing twins and has since changed his position, is quoted as saying that “[h]e became convinced that everyone carrying twins, through reproductive technology or not, should at least know that reduction was an option. ‘Ethics,’ he said, ‘evolve with technology.’ It seems that the ethic has not changed as much as one would think; it is the means to carry out that ethic that evolve with technology.