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.