Bioethics for Beginners

60 Cases and Cautions from the Moral Frontier of Healthcare

Glenn McGee

• Publisher: Wiley-Blackwell
• Year: 2012
• ISBN:
  9781118254639
• Edition: 1
• Topic: Medicine
• Subtopic: Ethics in Medicine

How far is too far? 60 cases illustrating modern bioethical dilemmas

Bioethics for Beginners maps the giant dilemmas posed by new technologies and medical choices, using 60 cases taken from our headlines, and from the worlds of medicine and science. This eminently readable book takes it one case at a time, shedding light on the social, economic and legal side of 21st century medicine while giving the reader an informed basis on which to answer personal, practical questions. Unlocking the debate behind the headlines, this book combines clear thinking with the very latest in science and medicine, enabling readers to decide for themselves exactly what the scientific future should hold.

Caution One

Tip-Toe When Walking on the Bleeding Edge

Case 1 The Dangers of Creating Life in the Lab

Synthetic biology is receiving much attention in the media and in churches, schools and offices around the world. The issue is the creation of life in the laboratory. And the reactions range from excitement to ethical outrage to horror at the new potential for bioterrorism.

First, the scientists at The Institute for Genomic Research (TIGR) in Rockville, Md., published the details of their effort to isolate the minimum number of genes an organism needs to survive in Science. They reported on a project in which they aim to create a kind of life form by building each bit of the genetic code for a type of simple bacterium called mycoplasma in the laboratory, then stacking the bits together like toy blocks. At the end of the effort, the scientists can prove not only that the bits of genetic information they stack together can be artificially “animated” into acting just like any other bacterium, but also that the most important parts of bacteria and viruses can be synthesized at will in a laboratory.

But to build a virus with a minimum complement of genes that would allow it to perform the same tasks is not the same as making a more complex organism, even an amoeba. Let alone one that can self-replicate. That is what Craig Venter did.

Craig Venter set the scientific, religious, and political worlds on fire when he announced that he had created a new organism by synthesizing DNA from one bacteria and inserting it into another. This time the organism included not only the minimal number of genes for survival, but also those required for self-replication. In doing so he created the first self-replicating synthetic bacteria.

And as a result of his research, even President Obama has been paid close attention to synthetic biology. Hijacking his own Presidential Commission's agenda, he asked that group to report within 6 months about the ethical, social, and legal implications of Craig Venter's research. That group concluded that “prudent vigilance” – a combination of Aristotelian notions of prudence combined with a eviscerated precautionary principle – is the approach that will allow science to flourish without running amok.

But in one sense there is a prior step: simply understanding what the current state of science can and cannot do. The creation of a self-replicating synthetic cell, while important scientifically, was not “playing God” or rearranging the natural order. Upon reflection, nearly every religious group – from the Vatican to Talmudic scholars – has come out in favor of the use of synthetic biology for its multitude of practical applications. In Venter's case, he has argued that this technology would allow for using synthetic cells to create biofuels, and ultimately mitigating the effects of climate change.

And while there are legitimate concerns about the more unseemly sides of synthetic biology, building in protections to prevent those misuses of the technology while allowing science to flourish has been the magic sweet spot that regulators and policy makers have been trying to find.

Outbreaks Via E-Mail?

The possible implications of synthetic biology can be downright terrifying. In little vials we see in movies like Outbreak, a few tiny bits of the most deadly viruses of our time are stored for research. Behind steel doors, frozen, with mighty ventilation and filtration systems, bits of anthrax, smallpox and countless biological variants of these viruses are kept for analysis at the US Centers for Disease Control and Prevention.

I'm really glad they sit there behind lock and key, and I bet you share my fear that the repository of viruses in the former Soviet Union is sometimes imperiled by fighting and political turmoil. Lots of folks would just as soon see our last bits of deadly virus eliminated.

Guess what? The synthetic biology research opens the door to a whole new problem: viral hacking. Who needs to find a tiny sample of smallpox, when you can synthesize it from scratch on a $1,000 iMac connected to a $10,000 gene synthesizer? If viruses can be manipulated and created, their genetic codes can also be e-mailed around the world and built from innocuous lab materials using the same technology.

For ethicists and society, the puzzle is to identify how scientists should proceed, and for what reasons they might have to slow down. But this is not always an easy proposition.

And in some cases, ethicists are not the right people to puzzle about the problem. The problems of dual-use, the problem that scientific advances and new technologies, like synthetic biology, can be used for both good and bad outcomes is a problem that must include public health experts, national security consultants, experts in international law, scientists, and others. Synthetic biology opens a whole new world of biological terrorism and environmental restoration. We will have to think fast to stay ahead of the power synthetic biology puts in the hands of scientists and terrorists. There is reason to be cautious indeed.

Case 2 Design: More Intelligent Every Day

Thanks to a 2005 court decision, children in Kansas now learn that the fossil record of our planet holds evidence of “irreducibly complex” traits, biological wonders that seem too sophisticated to be products of natural selection. Advocates of intelligent design argue that such complexity of biological life reveals evidence of a designer.

A different sort of designer is working in the nascent filed of synthetic biology. These scientists generate novel biological functions through the design and construction of living systems. Synthetic biologists manipulate the most complex biological interactions using the tools of engineering and computer science. It has borne fruit in the design of genomes, proteins, devices, integrated biological systems, and even cell-circuit hybrids. Synthetic biologists use evolution as a method. That seems pretty intelligent.

William Paley probably wasn't imagining such researchers when he expounded on the form of the intelligent design theory that children will be learning in Kansas. In his publication in 1800, Natural Theology, in which he was the first to suggest the idea, he wrote that just as a watch requires a watchmaker, the unexplainable complexities of nature can only be explained by the work of an intelligent creator. A small army of contemporary disciples has advanced the claim that for a variety of reasons intelligent design is a necessary antecedent to the teaching of evolution in schools.

Intelligent design theory might well be inspirational to those in synthetic biology, whose job it is to use their own brains to make imaginative sue of the raw materials and processes of creation. But the feeling would not be mutual. The Kansas school board spoke of its fear of evolutionists playing God. To an intelligent design proponent, synthetic biology is the blasphemous use of God's erector set. If biology is the story of the sacrosanct plan of an omniscient being, rather than the vicissitudes of natural selection, humans have a hard time explaining why they are tinkering with the works.

According to a February 2011 Gallup poll only 40 percent of the US population believes in evolution. Of the 25 percent who say they absolutely reject the theory, it is many of these citizens who have gone to court and to the polls to push the ideas that intelligent design is an important scientific theory.

They do so with religious zeal. A thousand miles away from Kansas in Dover, Pa., families who fired a school board that had insisted on teaching intelligent design are now in grave danger of incurring the wrath of God, according to televangelist Pat Robertson. “If you stick your finger in God's eye too many times, maybe you should try praying to Darwin when the next disaster strikes.”

Some people working in synthetic biology wouldn't mind sticking a finger in Pat Robertson's eye. A leading synthetic biologist once said to me that she is working so hard on building and animating an artificial bacterium primarily so that she can prove to advocates of intelligent design that it doesn't take a God to create life.

The real worry, though, is about the future of science. Children educated in a system in which untestable statements of faith are treated as privileged hypotheses are hardly prepared to face a world in which evolution is a fact of life. The next generation of scientists will face the rapid evolution of viruses and the implications of decreasing diversity in animals. We cannot afford to raise a generation of doctors who believe that drug-resistant bacteria are a punishment from God rather than an evolutionary process induced by the misuse of antibiotics. Whomever or whatever created the universe, let's hope they wanted us to be intelligent, too.

Case 3 “Shroom” Science: Safe and Effective?

In the August 2006 issue of Psychopharmacology, Johns Hopkins researchers published a study in which some subjects were given psilocybin and then asked to relate their experiences. Francisco Moreno of the University of Arizona published in the November 2006 issue of the Journal of Clinical Psychiatry his patients' reports that psilocybin helped them with migraine headaches. Harbor-UCLA Medical Center psychiatrist Charles Grob told the Chronicle of Higher Education that he is giving the compound to patients dying of cancer to see whether it eases pain by relieving anxiety.

The study of so-called magic mushrooms isn't new; it could be argued that it is celebrating its 55th anniversary this year. It began, as best anyone can tell, when Wall Street banker R. Gordon Wasson documented his trip to a healer in Oaxaca, Mexico, whose brew, he claimed, enabled him to see the reality of ideas and concepts. His 1957 essay in Life magazine excited the imaginations of scientists around the world. Sandoz patented the two active chemicals in the mushrooms, calling the compounds psilocin and psilocybin. Chaos ensued as researchers struggled to do excellent scientific work using a family of substances whose effects – to put it mildly – were not easily measurable using the tools of the time.

The scientists who used psilocybin in their research in the 1960s poked at the nature of consciousness, but this particular compound just refused to be caged by ordinary scientific conventions. Paper after paper stabbed at descriptions of the effects and utility of psilocybin, but scalar measures of transcendence just could not capture its effects, or side effects. A few of the leading scientists engaged in its study, most notoriously Harvard psychologist Timothy Leary, simply abandoned the strictures of scientific research as insufficient to grasp the power of psilocybin.

By the time the FDA banned hallucinogenic drugs in 1970, the majority of those experimenting with mushrooms were not in universities. Hallucinogens became part of a counterculture that aged quickly. By the 1980s, the next counterculture devoted to brain modification was moving in a completely different direction, experimenting with highly addictive stimulants, such as cocaine, which assist in thinking faster, concentrating harder, and intensifying ordinary experiences.

Time passes, and what's old becomes new again. In 2007 millions of people took legal stimulants and antidepressants. A decades-long quest for endless work capacity, unfettered concentration, and happiness on-demand has perhaps hastened the return of those who wonder whether the touch of transcendence could provide new insights into treating the maladies that have become rampant in our time. And indeed, new studies suggest that psilocybin may offer hope in treating a few of them, ranging from obsessive-compulsive disorder to rampant addiction.

With the dramatically enhanced ability of neural imaging to identify changes in brain state, and advances in the genetics of neuroscience, it is no wonder that some of those who researched psilocybin in the 1970s have begun to point again to the potential of that compound. Magic mushrooms are not addictive and have been around more than half a century. So should we really be worried about the potential that new research will lead a new generation to “turn on, tune in, and drop out”? Yes.

Ethics committees examining the research programs underway with hallucinogens need to be mindful that what sparked the widespread illegal use of psilocybin in the 1970s was not its mystical power but the reports of its safety and efficacy coming out of the leading institutions of higher learning in the United States. Scientists are acting with great care this time around, but let's avoid a bad trip.

Hallucinogens have not been scientifically demonstrated to be either safe or effective enough to be used in the treatment of any disease. Studies of them should be undertaken only when investigators avoid sending subtle messages about the safety or delight of chewing on backyard mushrooms. For example, in the Hopkins study subjects were given either Ritalin or psilocybin, sending the terribly premature message that the two substances are in any sense equivalent in terms of effect or safety. It would have been much better to compare psilocybin with, well, anything other than a compound prescribed to tens of millions and often abused by those seeking better cognition.

Thankfully that study was all but ignored by the media. When it comes to hallucinogens, if the research sends the wrong message, drop it. Or rather, don't.

Case 4 A Robot Code of Ethics

Should we require robot makers to program in a code of ethics?

The South Korean people really love robots. Industry in South Korea receives millions in government subsidies to develop them. Park Hye-Young, of the South Korean Ministry of Commerce, Industry, and Energy's robot team, said in a statement to the French Press Agency that the Ministry hoped “to have a robot in every South Korean household between 2015 and 2020,” and predicted that these robots would develop “strong intelligence.” South Koreans are not the only ones embracing robots. Already iRobot, a company founded by Rodney Brooks, director of the MIT Artificial Intelligence Lab, has sold 6 million Roombas, a little robotic vacuum cleaner. The promise of the robot vacuum and its cousins is that the home robot will become faster, more reliable, and more cost-effective than human domestic work. It has to get this “strong intelligence” part down first. My Roomba is a one-trick pony, sucking dirt while rolling in circles and slapping into the same walls every day as it relearns a 12 in × 12 in room. This is not Rosie from The Jetsons. But the more important issue regarding today's domestic robots and the future is not so much about intelligence as it is about ethics. If you ever watched the Roomba-sized robots hack each other to bits on the aptly named BBC-5 television program, Robot Wars, you know the fear that lives in the souls of many who will never buy a domestic robot: that their Roomba would one day awaken like the robots of The Terminator. A robot with sinister intentions, without ethics, or adhering dispassionately to a code of ethics where intuition and subtlety is required (remember RoboCop?) has been the fuel of science fiction for decades. Should we require robot makers to program in a code of ethics to domestic products?

Perhaps robots should be afraid of us too; whether or not they dream ...