Withdrawal of artificial nutrition and hydration for patients in a permanent vegetative state: changing tack

In the United States, the decision of whether to withdraw or continue to provide artificial nutrition and hydration (ANH) for patients in a permanent vegetative state (PVS) is placed largely in the hands of surrogate decision-makers, such as spouses and immediate family members. This practice would seem to be consistent with a strong national emphasis on autonomy and patient-centered healthcare. When there is ambiguity as to the patient's advanced wishes, the presumption has been that decisions should weigh in favor of maintaining life, and therefore, that it is the withdrawal rather than the continuation of ANH that requires particular justification. I will argue that this default position should be reversed. Instead, I will argue that the burden of justification lies with those who would continue artificial nutrition and hydration (ANH), and in the absence of knowledge as to the patient's advanced wishes, it is better to discontinue ANH. In particular, I will argue that among patients in PVS, there is not a compelling interest in being kept alive; that in general, we commit a worse violation of autonomy by continuing ANH when the patient's wishes are unknown; and that more likely than not, the maintenance of ANH as a bridge to a theoretical future time of recovery goes against the best interests of the patient.     

Substance,rights, value,and abortion

Most serious contemporary opposition to abortion is grounded on the belief that human fetuses are members of the same moral category as beings like us, and that the loss of any such life is one of the worst possible losses. Substance view theorists oppose abortion for this reason: in their view beings like us are essentially rational substances with inherent moral worth, and those who perform induced abortion fail to recognize this moral worth. In a recent series of articles, Rob Lovering presents reductio‐style arguments against the substance view, in part arguing that it is inconsistent with our intuitions in rescue and spontaneous abortion cases. In a recent reply, Henrik Friberg‐Fernros argues that the substance view can evade these problematic implications because of a distinction between killing and letting die. According to this argument, the fetus’s right to life is a negative right not to be killed, not a positive right to be rescued, thus the anti‐abortion theorist who lets fetuses die acts acceptably. I argue this stance fails to recognize the inherent moral worth that the substance view contends fetuses possess. One who refrains from saving a person, or doesn’t care how many people she saves, cannot reasonably claim to value life. Furthermore, this stance is at odds with most contemporary anti‐abortion views that oppose induced abortions of both the killing and letting die variety.     

Biological explanations and social responsibility

The aim of this paper is to show that critics of biological explanations of human nature may be granting too much to those who oppose such explanations when they argue that the truth of genetic determinism implies an end to critical evaluation and reform of our social institutions. This is the case because when we argue that biological determinism exempts us from social critique we are erroneously presupposing that our social values, practices, and institutions have nothing to do with what makes biological explanations troublesome. My argument is that what constitutes a problem for those who are concerned with social justice is not the fact that particular behaviours may be genetically determined, but the fact that our value system, and social institutions create the conditions that make such behaviours problematic. Thus, I will argue that even if genetic determinism were correct, the requirement of assessing and transforming our social practices and institutions would be far from superfluous. Biology is rarely destiny for human beings and the institutions they create.     

Which Way to Life?

If the emergence of life is seen as the evolutionary transition between the non-living and the living, then it may be meaningless to draw a strict line between these two worlds. A comparison between the metabolic- and genetic-first origin-of-life proposals is made. A comparison of the empirical evidence used in favor of the metabolic-first and genetic-first theories of the origin of life shows that many of the observations and experimental findings that are used to argue in favor of one or another view are equally consistent with the premises of both theories and do not unambiguously support neither of them. However, current biology indicates that life could not have evolved in the absence of a genetic replicating mechanism insuring the stability and diversification of its basic components.     

Four Ways Life Extension will Change Our Relationship with Death

Discussions of life extension ethics have focused mainly on whether an extended life would be desirable to have, and on the social consequences of widely available life extension. I want to explore a different range of issues: four ways in which the advent of life extension will change our relationship with death, not only for those who live extended lives, but also for those who cannot or choose not to. Although I believe that, on balance, the reasons in favor of developing life extension outweigh the reasons against doing so (something I won't argue for here), most of these changes probably count as reasons against doing so. First, the advent of life extension will alter the human condition for those who live extended lives, and not merely by postponing death. Second, it will make death worse for those who lack access to life extension, even if those people live just as long as they do now. Third, for those who have access to life extension but prefer to live a normal lifespan because they think that has advantages, the advent of life extension will somewhat reduce some of those advantages, even if they never use life extension. Fourth, refusing life extension turns out to be a form of suicide, and this will force those who have access to life extension but turn it down to choose between an extended life they don't want and a form of suicide they may (probably mistakenly) consider immoral.     

Cycling on the fast track: Ovulatory shifts in sexual motivation as a proximate mechanism for regulating life history strategies

In an ancestral world without modern contraception, how did women regulate their fertility? We argue that fertility may be regulated by context-dependent changes in sexual motivation that are specific to the high-fertility phase of the menstrual cycle. Accordingly, we predicted that ovulatory changes in sexual motivation would vary as a function of women's life history strategies, operationalized in terms of exposure to adverse childhood environments (high unpredictability, low SES, and low father quality). We tested this prediction in a sample of 1004 naturally cycling, pair-bonded women recruited using Amazon Mechanical Turk. Data show that women from adverse childhood backgrounds experienced higher in-pair sexual motivation and engaged in more in-pair sexual behavior at high fertility, compared to women from childhood backgrounds with low adversity. Women from low-adversity childhood backgrounds were more likely to exhibit ovulatory decreases in sexual motivation at early stages in their relationships. We found little evidence, however, that childhood environments interact with conception risk to predict women's extra-pair motivation and behavior. Results offer evidence that women may possess evolved psychological and behavioral mechanisms for regulating the timing of reproduction.     

The ethics of life expectancy

Some ethical dilemmas in health care, such as over the use of age as a criterion of patient selection, appeal to the notion of life expectancy. However, some features of this concept have not been discussed. Here I look in turn at two aspects: one positive — our expectation of further life — and the other negative — the loss of potential life brought about by death. The most common method of determining this loss, by counting only the period of time between death and some particular age, implies that those who die at ages not far from that one are regarded as losing very little potential life, while those who die at greater ages are regarded as losing none at all. This approach has methodological advantages but ethical disadvantages, in that it fails to correspond to our strong belief that anyone who dies is losing some period of life that he or she would otherwise have had. The normative role of life expectancy expressed in the 'fair innings' attitude arises from a particular historical situation: not the increase of life expectancy in modern societies, but a related narrowing in the distribution of projected life spans. Since life expectancy is really a representation of existing patterns of mortality, which in turn are determined by many influences, including the present allocation of health resources, it should not be taken as a prediction, and still less as a statement of entitlement.     

Is it Good to Make Happy People?

Would it be good, other things being equal, for additional people to exist whose lives would be worth living? I examine and reject several arguments for the answer that it would not be good; then I offer opposing arguments that I believe are more successful. Thus, I agree with utilitarians who say that it is better for there to be more happy people. Next I argue for the stronger claim that the happiness of potential people is as important as that of adults. Potential quality of life, then, matters in a host of bioethical issues: abortion, commercial surrogacy, the treatment of defective newborns, and so on. What is the practical upshot of all this? I reject the idea that we must do whatever is necessary to prolong life worth living. But I also reject the view that the side-effects of overpopulation always outweigh the value of realizing potential happiness. So I advocate a middle position, which I do not identify precisely. Even from this middle position, however, potential happiness is more important than is commonly assumed in bioethics.     

Evolution of trophic transmission in parasites: why add intermediate hosts?

Although multihost complex life cycles (CLCs) are common in several distantly related groups of parasites, their evolution remains poorly understood. In this article, we argue that under particular circumstances, adding a second host to a single-host life cycle is likely to enhance transmission (i.e., reaching the target host). For instance, in several situations, the propagules of a parasite exploiting a predator species will achieve a higher host-finding success by encysting in a prey of the target predator than by other dispersal modes. In such a case, selection should favor the transition from a single- to a two-host life cycle that includes the prey species as an intermediate host. We use an optimality model to explore this idea, and we discuss it in relation to dispersal strategies known among free-living species, especially animal dispersal. The model found that selection favored a complex life cycle only if intermediate hosts were more abundant than definitive hosts. The selective value of a complex life cycle increased with predation rates by definitive hosts on intermediate hosts. In exploring trade-offs between transmission strategies, we found that more costly trade-offs made it more difficult to evolve a CLC while less costly trade-offs between traits could favor a mixed strategy.     

Do Committees Ru(i)n the Bio‐Political Culture? On the Democratic Legitimacy of Bioethics Committees

Bioethical and bio-political questions are increasingly tackled by committees, councils, and other advisory boards that work on different and often interrelated levels. Research ethics committees work on an institutional or clinical level; local advisory boards deal with biomedical topics on the level of particular political regions; national and international political advisory boards try to answer questions about morally problematic political decisions in medical research and practice. In accordance with the increasing number and importance of committees, the quality of their work and their functional status are being subjected to more and more scrutiny. Besides overall criticism regarding the quality of their work, particular committees giving political advice are often suspected of being incompatible with democratic values, such as respect for affected parties, representation of diverse values and transparency in the decision-making processes. Based on the example of the German National Ethics Council, whose inauguration caused a still ongoing debate on the aims and scopes of committees in general, this paper discusses: (1) the requirements of modern democratic societies in dealing with complex scientific-technical problems; (2) the composition and organisation of committees working as political advisory boards; and (3) the appointment procedures and roles of laymen and experts, and here in particular of ethicists, who may legitimately be taken on by a committee. I will argue that bioethics committees do not necessarily endanger democratic values, but can considerably improve their realisation in democratic decision-making procedures--if, and only if, they do not act as substitutes for parliamentarian processes, but help prepare parliamentarian processes to be organised as rationally as possible.     

Brain death: a durable consensus?

Is it even conceivable that this global consensus [on the whole-brain definition of death] could, in time, be regarded as a very temporary and makeshift expedient, a momentary substitute for a resolution of some profoundly difficult issues which for a time, perhaps a brief time, fit with both the technical capacities and the legal needs of those who endorsed it? And that in the long run it could linger as a footnote, or perhaps a chapter heading, in the long history of man's conceptions of life and death? This suggestion is so far from conventional wisdom today that one who espouses it risks being regarded as a crank. Nevertheless, I believe that the argument in its favor, while not conclusive, is much stronger than the argument against it (and in favor of the prevailing consensus). I will state the argument briefly, with particular reference to the landmark report in 1982 in Washington of the President's Commission for the Study of Ethical Problems in Medicine, and will situate the argument in the context of trends in contemporary bioethics. I do not expect to win over, in this one pass, those who have been convinced of the validity of the conventional view. I do hope, however, to re-open the issue; in particular, to provide reasons to regard the issue as far from settled.     

Community-equipoise and the ethics of randomized clinical trials

This paper critically examines a particular strategy for resolving the central ethical dilemma associated with randomized clincial trials (RCTs) -- the "community equipoise" strategy (CE). The dilemma is that RCTs appear to violate a physician's duty to choose that therapy which there is most reason to believe is in the patient's best interest, randomizing patients even once evidence begins to favor one treatment. The community equipose strategy involves the suggestion that our judgment that neither treatment is to be preferred (that there obtains a state of "equipoise") is to be assessed according to a community rather than an individual standard. Thus, though a physician may personally believe that there is some reason to prefer one treatment, patients can legitimately be randomized if there remains disagreement in the community of medical professionals. Rationales in favor of this conception include the following: (i) medical knowledge is best understood as residing in the community, (ii) the judgments of others count as evidence, and so should change one's own opinion, (iii) subjects would not be better off outside the trial, and (iv) the point of any trial is the resolution of dispute in the medical community. I critically examine these rationales and argue that they are insufficient. Amongst the problems are tensions between various of these underlying rationales, and important ambiguities in just what the CE criterion is to amount to. Finally, I argue that even if use of CE was justified, it would not justify carrying out RCTs anywhere near long enough to discharge our duty to gain reliable knowledge on which to base safe and effective medical practice. Hence, we need some different justification for carrying out RCTs.     

SongMakers: An industry-led approach to arts partnerships in education

Reported benefits of arts partnerships with schools range from improvements in students' motivation and engagement in learning to teachers' increased confidence in teaching the arts, and strengthened school and community relationships. Yet, in the scholarship on arts partnerships to date, limited critical attention has been given to the impact of programs primarily driven by government supported industry-based imperatives. There may be legitimate concerns that, in primarily servicing economic or employment needs, industry–school partnerships overlook social and interpersonal aspects of learning in favor of goal-orientated skills training to meet “the market.” This article informs arts education policy and industry directions by acknowledging this concern and reporting on the outcomes of an industry–schools partnership where industry “training” appears to be leveraging a number of more holistic student learning outcomes. Jointly funded by industry and government, SongMakers is an Australian artist in residence program that aims to improve the export potential of Australia's contemporary music industry and contribute to the implementation of a contemporary music curriculum. It involves professional songwriters and producers with international recording experience working as mentors to students who create and produce new music in intensive two-day workshops. This article outlines how the program is demonstrating emergent positive impact not only on students' music knowledge and skill development, and understanding of the contemporary music industry, but on engagement, confidence in learning, and self-efficacy. It does not argue that all industry programs can or will achieve such impacts, but that diverse kinds of arts partnerships in schools can contribute to a viable ecology of quality educational practice in the arts.     

Authoritative regulation and the stem cell debate

In this paper I argue that liberal democratic communities are justified in regulating the activities of their members because of the inevitable existence of conflicting conceptions of what is considered as morally right. This will often lead to tension and disputes, and in such circumstances, reliance on peaceful or orderly co-existence will not normally suffice. In such pluralistic societies, the boundary between permissible and impermissible activities will be unclear; and this becomes a particular concern in controversial issues which raise specific anxieties and uncertainty. One context that has repeatedly raised issues in this regard is that of biotechnology and, in particular, the recent stem cell debate, on which this paper concentrates. While such developments have the potential to make significant improvements to therapeutic progress, we should also be sceptical because predicting the impact of these developments remains uncertain and complex. For the sake of socio-political stability, it will therefore be necessary to enact and enforce rules which limit these competing claims in public policy but which may not be compatible with what individual moral commitments ideally permit. One way to achieve this is to establish procedural frameworks to resolve potential disputes in the public sphere about what is right, wrong, or permissible conduct. I argue that for one to commit to authoritative regulation, an idea of harm prevention through state intervention is necessary; and that this requires optimum mechanisms of procedure which allow the individual the opportunity to compromise and yet to continue to oppose or fight for changes as demanded by his or her moral position.     

Childhood Association and Sexual Attraction: A Further Test of the Westermarck Hypothesis

A preliminary study of household registration records from Taiwan supports Edward Westermarck's contention that intimate childhood association promotes sexual aversion. Women who are forced to marry a childhood associate bear fewer children than those who marry a stranger. They are also more likely to leave their husband by divorce or avoid him in favor of other men. This evidence suggests that the incest taboo does not prohibit what men's feelings incline them to do, as Westermarck's critics argue, but that it is instead an expression of these feelings, socially unnecessary but psychologically inevitable. [incest taboo, law, China, Taiwan]     

Who’s in conflict? Racialization of Puerto Ricans in relation to other Latinxs in the New York Times, 2010–2015

ABSTRACT

Puerto Rican migration to the United States has skyrocketed as a result of various political and economic factors faced in Puerto Rico. I focus my attention on how Puerto Ricans are represented in newspapers through narratives of belonging, exclusion and/or perceived threat. I seek to answer is: how are Puerto Ricans and other Latinx groups framed in relation to each other in the New York Times? To answer this query, I perform a content analysis of the paper of record, the New York Times. I argue that Puerto Ricans are not only framed as in conflict in relation to other Latinos, while also being framed as possessing some sort of colour capital that can be transferred over to particular spaces. The NYT constructs boundaries that reinforce while also transform what groups are perceived as threats.     

Valuing Lives and Allocating Resources: A Defense of the Modified Youngest First Principle of Scarce Resource Distribution

In this paper, I argue that the ‘modified youngest first’ principle provides a morally appropriate criterion for making decisions regarding the distribution of scarce medical resources, and that it is morally preferable to the simple ‘youngest first’ principle. Based on the complete lives system's goal of maximizing complete lives rather than individual life episodes, I argue that essential to the value we see in complete lives is the first person value attributed by the experiencer of that life. For a life to be ‘complete’ or ‘incomplete,’ the subject of that life must be able to understand the concept of a complete life, to have started goals and projects, and to know what it would be for that life to be complete. As the very young are not able to do this, it can reasonably be said that their characteristically human lives have not yet begun, giving those accepting a complete lives approach good reason to accept the modified youngest first principle over a simple ‘youngest first’ approach.     

Cellular differentiation and individuality in the ‘minor’ multicellular taxa

Biology needs a concept of individuality in order to distinguish organisms from parts of organisms and from groups of organisms, to count individuals and compare traits across taxa, and to distinguish growth from reproduction. Most of the proposed criteria for individuality were designed for ‘unitary’ or ‘paradigm’ organisms: contiguous, functionally and physiologically integrated, obligately sexually reproducing multicellular organisms with a germ line sequestered early in development. However, the vast majority of the diversity of life on Earth does not conform to all of these criteria. We consider the issue of individuality in the ‘minor’ multicellular taxa, which collectively span a large portion of the eukaryotic tree of life, reviewing their general features and focusing on a model species for each group. When the criteria designed for unitary organisms are applied to other groups, they often give conflicting answers or no answer at all to the question of whether or not a given unit is an individual. Complex life cycles, intimate bacterial symbioses, aggregative development, and strange genetic features complicate the picture. The great age of some of the groups considered shows that ‘intermediate’ forms, those with some but not all of the traits traditionally associated with individuality, cannot reasonably be considered ephemeral or assumed transitional. We discuss a handful of recent attempts to reconcile the many proposed criteria for individuality and to provide criteria that can be applied across all the domains of life. Finally, we argue that individuality should be defined without reference to any particular taxon and that understanding the emergence of new kinds of individuals requires recognizing individuality as a matter of degree.     

Spreading disease: a controversy concerning the metaphysics of disease.

This article concerns the metaphysics of disease. Is disease a fixed feature of the world or a social value or preference? I argue that disease is not a value-laden concept and thus debates concerning it differ fundamentally from debates concerning health, harm, or suffering where evaluative judgements are central. I show how the so-called social constructionist view of disease has been motivated both by ethical concerns with medical practices and general theoretical doubts about scientific naturalism. If I can show that ethical concerns about medical treatment can be answered without adopting social constructionism, that leaves only the broader theoretical question of naturalism. I cannot completely answer those theoretical doubts, but I show that the theoretical motivation is less convincing when it is separated from the moral challenge often accompanying it. I conclude that a convincing defense of the non-naturalistic conception of disease is rarely attempted and proves more difficult and counter-intuitive than its proponents assume.