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Saturday, October 30, 2010

What Artificial Intelligence Proves

Is the creation of mechanical intelligence – a digital mind capable of free, personal thought – a bioethical issue?  It can be, depending on what one wants to do with it. The actual creation of such advanced artificial intelligence would nonetheless, in itself, be a remarkable achievement of human technology.  I must admit it creeps me out in some way, and yet I find sci-fi intelligences like Data of Star Trek and C3PO and R2D2 of Star Wars to be totally non-threatening.

I think what creeps me out is how people with really poor logic skills are the ones pushing the envelope in the technology.  Consider this slide set by Martine Rothblatt over at IEET, a website always good for examples of wild conclusions drawn from mere theory combined with false or incomplete premises. A lot could be said about this slide set, but I will focus on this aspect only.

The title is the first problem, logically speaking: “Brains are to minds as birds are to flight.” Is “mind” an action, like flight? Yes – BUT only if one takes as proven the premise that there is no such thing as an immortal intellectual soul.  If there is no soul then “mind” is what the brain does.  In fact, the slide set in a way attempts to prove that mind is an effect of the brain the way flight is an effect of a bird.  Yet, logically, the analogy fails.  A brain is not a complete organism, but a bird is.  The bird flies because its brain tells it to and because its body can.  It is a whole organism. “Person is to thought as bird is to flight” would be a more precise analogy and indisputable – but not ordered to Ms Rothblatt's agenda.

She attempts to prove her point by noting how mechanical things can also fly.  They do not fly by imitating the way birds fly, but such things cause flight nonetheless.  (So, we can expect that mechanical minds to function differently than biological ones, but arrive at thought nonetheless. That seems reasonable.)  What she fails to include in her reasoning, however, is that an airplane does not fly on its own.  It is a mere instrument of human flight, or at least flight directed by a human being toward the purposes of the human controller. "Aircraft" have not "achieved flight"; rather, humans have achieved flight through aircraft.  If the aircraft is a cause of flight, it is only as an instrument; therefore, if a brain is a cause of thought, it also would be only as an instrument.  Yet that is the exact opposite of what Ms Rothblatt wants to prove.

Furthermore, while those who developed flight surely looked to birds in improving the wing, an airplane is more like a really sophisticated arrow or dart than it is like a bird. Indeed, the faster that planes can fly, the more arrow-like they look.  It is an arrow that can change direction and power itself to thwart gravity. The comparison of mechanical flight to avian flight is also therefore false. But fast planes fly very much as arrows do, and arrows are a uniquely human artifact.  Machines simply have not achieved flight. Humans have, and in a very human way.

So there are problems of logic and a lack of really thinking things through.

This fact shows up especially in the notion that somehow digital intelligence will prove that the mind is an effect of the brain, rather than the brain being an instrument of the mind.  Perhaps technology will one day be able to manufacture a truly intelligent computer but that will prove only one thing: The superiority of the human mind, and that the lower mind came from a superior one. The existence of mechanical intelligence proves the existence of a superior, non-mechanical intelligence that created it.

Now, the mechanical intelligence may end up being faster and more capable of storing, sorting, and accessing more data more quickly than a human mind – in some respects the mechanical intelligence will likely be superior to biological intelligence.  Yet, even if the mechanical intelligence is capable of free, self-determining thought, everything it is and can do will be given it from another – the biological intelligence – it is the biological intelligence that will determine the abilities, inclinations, and the purpose of the existence of the mechanical one. It is the biological intelligence that will determine that the mechanical one be intelligent and able to learn, which is to say, human beings will determine what the essential “good” is for the mechanical one.  If we give it the capacity to learn, then the good of the mechanical intelligence will be to learn. If it ever can determine the difference between a good thing to know and a bad one, and the good use of what it knows versus a bad use, the whole concept of “good” operative in its programming (which will also be given it) will be determined by the biological intelligence. And in this sense, the biological intelligence will be prior and superior to the mechanical one.

And the existence of a living, thinking, ethical computer intelligence will only prove one thing: The existence of a superior, non-mechanical intelligence that assembled and programmed it.  Even if the machines learn to assemble and perhaps improve mechanical intelligence on their own, this fact will remain: The existence of mechanical intelligence depends on the existence of a prior and superior non-mechanical intelligence as its creator whose work it imitates and modifies.  It is undeniably true, but a thought far from the mind of Ms Rothblatt.  She wants to prove that mind is essentially mechanical and that there is no immortal soul by making a mechanical mind that clearly has no immortal soul.  Yet, its existence and attributes cannot arise spontaneously but have to be created.

So: Does not the existence of biological intelligence therefore imply the existence of a prior and superior, non-biological intelligence?

We of course are not God; we might be capably only of making the watch, winding it up, and then be powerless to stop or control it.  The “watchmaker” concept of God has God merely leaving the watch run on its own.  But we should learn from our own example. If our existence implies God’s existence, and we humans grow up to a stage of enlightenment that we feel obliged to overthrow God, will not our creatures do the same? Is that really ordered to the enhancement of the human condition?

Sunday, October 17, 2010

How Law Can Define Reality

A recent study published by the British Medical Journal (you can read a synopsis here and the actual study here) showed that half of the euthanasia being administered in Belgium, where euthanasia is legal, goes unreported.  The law requires that every instance of euthanasia be recorded and reported according to specific guidelines and procedures.  The law defines euthanasia very strictly and requires that every incidence of it be reported.

According to the study, 77% of physicians who did not report euthanizing a patient withheld the required paperwork because they believed that what they did was not "euthanasia" as defined by Belgium's law -- yet, it was "euthanasia" in the broader sense. The study, based on a questionnaire, makes it difficult to draw conclusions as to why those physicians did not consider killing their patients to be euthanasia.  For instance, only 37% percent of the incidents were reported when the euthanasia was perceived to shorten life by less than a week, whereas 74% of the incidents were reported if the patient were expected to live longer than a week without being euthanized. Perhaps a fair number did not think it "counted" the closer the patient was to natural death.

The reality is, doctors in Belgium are killing patients based on their own judgments and outside the scope and monitoring of the law.  And the reality is, when people believe what they do is wrong or if they fear some sort of retribution, they will try to hide it. The law, however, was enacted to take euthanasia out of secrecy so that it can be adequately monitored for abuse, and to take away threat of retribution.

So what is the next step for Belgium? Deregulate euthanasia altogether so that what these doctors are doing becomes legal?

The bigger question is, though, did Belgium's law make euthanasia to be a good thing to do to begin with? Legalization of euthanasia does not change what it is, the intentional killing of an innocent person, the surrender of any attempt to provide care and comfort in the last stages of disease, a capitulation to the notion that life in some cases is not worth living, and a step onto that slippery slope where the definition of "a life not worth living" can be incrementally changed. 

The law cannot make euthanasia to be other than what it is, but it nonetheless changes people's hearts and attitudes and makes them susceptible to sliding down that slippery slope.  It can alter the thinking and attitudes of whole societies. In that sense, it can define reality even if it can't change the nature of things.

We can today define "a life not worth living" in narrow terms, but tomorrow the definition will change. Today it is the terminally ill meeting certain criteria in Belgium, and tomorrow it may simply be the terminally ill (irrespective of any additional criteria), and after that, those not terminally ill but chronically ill, and after that.... who knows? The Holocaust has its roots in Nazi euthanasia programs that did not begin nor end with the Jews even if the extermination of the Jews was the goal the Nazis were heading toward by intent.  In another post, I look at the same idea regarding forced sterilization of the "unfit." "Unfit to breed" is just a step away from "unfit to live."

The Holy See's permanent observer at the UN recently warned the General Assembly against the phenomenon of "rule by law" as opposed to "rule of law." The law must reflect justice that is higher than the law.  It cannot define justice to be whatever society legislates. It cannot define realities.  It can make euthanasia to be legal, but it can't make it to be good. "Rule of law" means the legal code conforms to Law Itself: Justice, the natural law to which euthanasia advocates attempt to appeal whether they know it or not, the objective order of right and wrong.  "Rule by law" means people are living in a dream world where reality changes based on what the legal code says.

Those who support the legalization of euthanasia where it is not permitted appeal to a sense of justice that is not reflected in the law -- they perceive a disjunction between what the law says and what seems good and right to their minds. I believe their minds not to be seeing well on this issue, but their manner of advocacy is important to note:  By trying to change the law, they affirm that the law must reflect an eternal justice that is beyond the law.

"Rule by law" results in lawlessness, because the principle enshrined by "rule by law" is a rejection of the authority of the natural law, which exists as the rational being's sense of justice and right and wrong, and which is prior in time and in importance to any law ever passed by any ruling authority. Rule by law places the ruling authority over natural law.  Insofar as it contradicts natural law, it gives injustice the force of law. And where rule by law exists, the people follow its example and set themselves above the legal code and they do what they want. Rule by law creates a reality of anarchy and injustice.

The natural law says it is always wrong to kill an innocent person intentionally and it is always good to comfort and care for the sick and suffering.  The underlying principle of Belgium's law says it is useless to provide some people with comfort and care and that killing those people is good. Ironically, the doctors breaking the law agree with the law by expanding the scope of the underlying principle.  And that is the reality of things in Belgium.

Sunday, October 10, 2010

Abortion and Political Scare Tactics

One could say that whoever refuses to protect innocent life lacks the wisdom to lead and the moral authority to address war and poverty. 

I tend to shy away from overtly political themes, even though bioethics often crosses over into politics.  But it is an election year, and insofar authentic bioethics refers to sound reasoning on matters of human life and health, the bioethical positions of parties and their candidates can be quite telling.

The fact of the matter is, war and poverty (or at least the economy) are two exceedingly important issues facing politicians.  Every two years, the political left attempts to stifle discussion of abortion because there are more important issues facing the country, such as the economy. The economy is always a problem.  I bet it has been the number one issue on the minds of voters since Gerald Ford’s Whip Inflation Now buttons (WIN – get it?).  Whether the economy is the most important issue, I have my doubts.

Yet the left is trying to drum up support this year using the abortion issue, and the right is accusing them of distracting from the war and the economy.  A story from the Catholic News Agency, based on an Associated Press analysis, profiles two races where this is happening.

In New York, women are being warned that they will be treated like criminals if the Republican gets elected because he will outlaw abortion.  I used to live in New York state and worked in Manhattan for quite a while.  I can tell you, the women of New York are not that stupid regardless of their political persuasion.  First of all, the probability of a pro-life governor being able to outlaw abortion is pretty much nil and everyone knows it.  Pro-lifers dream of such a law being passes, to it can be challenged in courts and find its way to the Supreme Court, where we hope it will be upheld and Roe v Wade overturned.  Still, the chances of such a law even passing in the state that elected Hillary as senator are pretty slim.  It would be fitting, though, as New York was the first state to legalize abortion on demand.

Secondly, the restrictions on abortions prior to Roe universally punished the health professionals who provided the procedure, but not always the women who procured it.  After all, doctors are not mere technicians who act mindlessly at the behest of their patients.  Although some laws also punished the women, there is no reason to think that a contemporary law would.  A law could make it illegal to provide an abortion while not speaking to the issue of procuring one.

Meanwhile in Colorado, women are being told that if the pro-life candidate wins, women will lose control of their bodies.  (One supposes that they mean only with respect to reproduction.)  This is also preposterous.  If women have a right to use or not use their reproductive abilities, then abortion simply represents a means.  The illegalization of abortion would not violate the right but only eliminate a particular means, and abortion would take its rightful place next to infanticide, exposure, and selling one’s baby on the "right not to have children" side, and to buying or stealing children on the "right to have children" side.

A right does not justify every means to exercise that right.  My right to free speech does not give me a right to the front page of the New York Times or even to a spot in the Letters section, even though my ability to reach people is certainly restricted thereby. In fact, it is the right of the NYT to freedom of the press that restricts my freedom of speech and prevents me from forcing them to give me space.  In abortion, it is the right to life of the child that restricts the woman’s right to reproductive freedom.

The bioethical reasoning on this issue reveals the clarity of thought of the parties involved.  I personally believe that as important as the war and the economy are, abortion is far more important.

Why?  The abandonment of the most innocent and vulnerable among us undermines any kind of assertion about the tragedy of the death and suffering of innocent people in combat zones or places hardest hit by the economy.  I simply do not believe a politician whose heart bleeds for these admittedly tragic circumstances when it turns to ice with respect to the unborn. While callousness to the plight of the poor or of innocent victims in war also undermines a candidate’s position on abortion, I do not know of a candidate who takes a stand of heartlessness on those issues, except as spun by his rivals.

So, whoever refuses to protect innocent life lacks the wisdom to lead and the moral authority to address war and poverty.

Wednesday, October 6, 2010

Arrogant and Foolish

Over at the oddly named Institute for Ethics and Emerging Technologies, you can find lots of bad logic when it comes to bioethical reasoning.  Russell Blackford there has taken the Vatican to task for criticizing the awarding the Nobel Prize for medicine to the man who invented in vitro fertilization (IVF). Blackford called the Vatican "arrogant" and "foolish" and called on all his minions to resist Vatican attempts to foist its views onto the legal systems of unsuspecting nations across the globe.

One wonders what globe Mr. Blackford is living on.  Knock, knock, sir. The Vatican does not influence the laws of secular states on this planet. You must have it confused with some other monotheistic religion.

Check out these wonderful paragraphs as Mr. Blackford melts down:

"The embryos concerned are tiny dots of protoplasm that are totally unlike an adult human being, a child, or even a fetus that has undergone a period of development in the womb. These little dots are incapable of feeling pain, having any instinct to protect themselves, or possessing any other form of sentience. They possess no fear of being destroyed and experience no suffering when they are destroyed, and no one who is capable of suffering has bonded with them in the slightest. The destruction of these very small collections of cells does no harm to families or the social fabric. There is no reason for them to be protected by our moral norms and sentiments or by the law.

"In short, there is no reason based on social welfare or the welfare of sentient beings why we should regret the destruction of tiny embryos created through IVF; there is no reason to condemn it morally, or attempt to prevent it by law. There is even less reason to regret the destruction of these embryos than to regret early-term abortions. The Vatican’s morality is not based on anything rational but on recondite ideas of natural law, the will of God, and the ensoulment of non-sentient life. It puts human happiness below its bizarre and miserable version of morality."

Now, the first paragraph lists true attributes of embryos. They are tiny dots of protoplasm, incapable of feeling pain or fear, etc., etc. All true.  All irrelevant.  Size is irrelevant, for instance. What the embryo is of course is a tiny human being.  Human beings begin small and get larger, so it is no wonder that the very origin of a human being should be a tiny dot.  The differences listed are not differences of nature, but only of degree.  An embryo is not an organism of a different biological species than man. It is a human organism, the beginning of someone unique and unrepeatable.

Then he states as true fact things he has no way of knowing. How does he know no one has bonded with a given embryo? Or is that anyone who has bonded with it is simply incapable of suffering, but how would he know that? More importantly, a bond with someone else who can suffer does not constitute someone's existence as a human being. Then he says that destruction of embryos does not harm families or society. How does he know? And so what if it's true? The destruction of embryos does not become something other than destruction of human beings because families are not harmed by it. Families are harmed by it.  Every embryo destroyed in IVF is someone's child, someone's sibling, someone's cousin or grandkid. We cannot know what joys those missing kids would have brought their families. Maybe many of those kids would have brought their families only suffering and pain, but some would have brought joy, and even the ones that bring suffering generally still bring joy in other ways.

And he has the nerve to say that the Vatican's morality is not based on anything rational, that it is bizarre and miserable.

Here is the Vatican's reasoning: Human embryos are human beings. There is no science to controvert that statement and in fact all science that can be brought to bear on it only affirms that statement. IVF callously manufactures and destroys human beings, reducing them to possessions to be acquired and things to be used rather than gifts to be received. Elitism and therefore discrimination are evident in the choice of which embryos to implant and which to destroy. IVF fails to diagnose and treat the underlying infertility.  IVF is therefore immoral.  Furthermore, it is wrong to honor the man who invented the technology.

It holds together logically. It is not bizarre, miserable, arrogant, foolish, or irrational.

And Blackford's rational argument? It would go something like this: C'mon, that's not a human, be serious, it's soooo small and tiny and little, it can't feel anything, no one likes it, no one cares about it, you call that tiny dot a human being? It's TINY for crying out loud! You gotta be nuts, you and everyone who thinks like you, it's not a human being, human beings are BIG, not tiny, you only want to force everyone to agree with you, you're stupid, arrogant, bizarre, and miserable, I will fight you and your insane defense of those TINY dots! Can't you see how tiny they are?

Keep repeating it, Mr. Blackford: "It's just a tiny dot of protoplasm, it's just a tiny dot of protoplasm, it's just a tiny dot of protoplasm..."  Maybe one day it'll become true.

....While you're over on IEET's website, check out this video on why it is absurd to consider fetuses persons.

The Gold Standard

Great news for stem cell research was revealed this week at Harvard Medical School: Scientists were able to make differentiated human cells become pluripotent stem cells, the kind that can become virtually any other tissue of the body.  This means that stem cells and the medical promise they hold can be efficiently derived from a wide variety of sources from the patient's own body and programmed to treat the diseases treatable by stem cells. 

Up until this week, induced pluripotent stem (iPS) cells were derived from differentiated tissues by the insertion of messenger RNA (mRNA), using viruses to inject the cells with the mRNA. As one can imagine, the use of viruses tends to contaminate the cell culture with viral material, induce the cells to have an immune response, and directly change the cellular DNA, all of which simply gunk up the whole medical application of the cells.  The Harvard scientists used a novel technique -- if you want the science, then look here. But be forewarned, you really need to be a cellular geneticist to know what they're talking about. I'm not one. It doesn't use viruses, however, and it focuses on RNA rather than DNA.

The practical benefit is that iPS cells can be obtained without the use of embryonic stem cells, which require that a living human embryo be destroyed. Some scientists, such as the director of the National Institutes of Health, cling to the fact that as far as stem cells go, embryonic stem cells are "a gold standard," meaning they are the ones that iPS cells need to measure up to, to justify continued research on human embryos.

OK, I can buy that embryonic cells are a gold standard in that sense.  However, the point of iPS cells isn't to reprogram a differentiated cell into an embryonic cell, but into a stem cell that can become any other kind of cell. Embryonic stem cells are not necessarily the gold standard of that -- because embryonic cells taken from a random embryo cannot become "your" heart or pancreas or brain cells. They can become heart or brain cells, but not any of any benefit to "you." They will always be donor cells and so induce an immune response in you, they will always act weird after a while being separated from the system in which they belong (namely an embryo developing normally into a fetus) and prone to tumor generation, and they will retain a tendency also to become what they were destined to become had the embryo they came from were permitted to live.

"Your" skin cells, however, can become stem cells and then some other needed tissue.  Now, this new technique is too new so these cells have not been used to treat diseases yet.  And, the NIH director points out that iPS cells may retain some memory of the tissue they came from.  So that is something to keep in mind as research progresses.

But something else to keep in mind: Adult stem cells are already being used to treat hundreds of diseases whereas the number of diseases successfully treated by embryonic cells is.... ZERO.  So in terms of actual medical therapies and therapeutic promise, embryonic stem cells are not the gold standard at all.

All that embryonic stem cell research appears to be good for anymore is refining our understanding of the target that iPS cells are trying to reach.  However, studying embryonic cells is not the only way to improve iPS cells, since this new technique did just that without researching embryonic stem cells at all.  And, are embryonic cells really the ones we want iPS cells to be like?  Now I'm no cellular scientists, but it seems reasonable to say that we are going to improve iPS cells by refining our ability to make them do what we want, not by making them be or act more like embryonic cells.

So. What is the need to destroy human beings to do research? Embryonic stem cells are a gold standard.  A gold standard of.... what, exactly?

Tuesday, October 5, 2010

The Signs of the Time

Is it me, or is Time magazine slipping its gears? In the Catholic and non-Catholic circles alike, Time has been recently - and rightly - chastised for its repeatedly bad reporting on the alleged ordination of women as Catholic priests.  Now, here's a real winner of a headline relevant to bioethics: "Building a Brighter Kid: Consider IVF."

The article is about a recent study in the journal Human Reproduction, founded by recent Nobel Prize winner Robert Edwards, who invented IVF. The study claims to show that IVF children scored better than age-matched peers in the same schools on the Iowa Tests used to evaluate and monitor the performance of school children. While I do not dispute that IVF babies may have scored higher on these tests, the investigators found other factors associated with higher test scores, too.  So, it may not be the procedure that results in smarter kids, but other factors that coincide with the use of IVF.

For instance, children also score higher if the parents are better educated.  Considering the cost of IVF, it would be no surprise that those who can afford it are also better educated.  And, considering the fact that achieving a better education (by which is meant more education) is generally associated with the intellectual ability to understand what one is learning (that is, intelligence), one would expect the biological offspring to do better on tests than their peers.

The expert cited in the Time article even noted that the study is not an argument to use the procedure to have smarter kids.

Yet, there is the article's headline: Building a Brighter Kid: Consider IVF.

Look at what this headline does.

Contrary to the data it cites, it draws a causal connection between the use of IVF and the outcome of smarter kids.  That causal connection is nowhere in the study; it is merely a coincidence.  For instance, if you notice that everyone in China has black, straight hair, you might think that it is being in China that causes it.  So, Time magazine could have an article with the title, For a Kid with Black, Straight Hair: Go to China.  Sure, it sounds ridiculous - because it is - but it is precisely the logic Time uses with respect to IVF.

It also reduces the conception of a child to a manufacturing process.  None of my kids were built.  Not a one. They were conceived. Building children reduces them to mere possessions, made to order, constructed, and loved for the features and benefits chosen from a list of options - and not simply because they exist and are worthy of love by virtue of existing.  This is one of the inherent bioethical difficulties with IVF: The reduction of a child to a thing, a thing to be attained, to be made to order, to be seized.

Now, I am all for helping couples struggling with an inability to conceive, but there are better ways - treatments and technologies that have up to four times the success rate of IVF, depending on the specific cause of infertility and the associated treatment.  These treatments enable couples to conceive in the natural way, and I am all for that - and that should be the first route infertile couples take: To detect the cause of infertility and treat it. Remember, IVF is not a treatment - infertility is not properly assessed or treated. It is a child-building procedure, which, by the way, destroys way more children than it brings to term.

Time also encourages the use of IVF, since the title circumvents the whole notion that IVF is for couples who cannot conceive, and dangles it out to even fertile couples so they can go out and purchase a child with the latest options, too.

This is just plain irresponsible reporting as far as I can tell. Either that, or Time is pushing an agenda of some sort. (Ya think?)

And, I have to admit something.  I am a little skeptical of the data in the study itself. A journal founded by the inventor of IVF probably has a vested interest in making IVF look good. At least the conclusions were conservative, given the lack of causal connections between the test scores and the procedure.

I am not surprised that Robert Edwards won a Nobel Prize for his work on IVF.  After giving the Peace Prize out to someone with absolutely no Nobel Prize worthy accomplishments regarding world peace neither before nor since the prize was awarded, I think they really just hand out the prizes to whomever suits their socio-political priorities.

And it seems their priorities and those of Time largely overlap.

Saturday, September 25, 2010

The Authentic Liberal Spirit

When I was an adolescent and a teen, I was a liberal.  I simply liked the whole spirit of liberalism as I saw it then: Defending the defenseless, helping the helpless, speaking for the voiceless. It spoke of heroism and self-sacrifice in the name of justice, like those civil rights workers who were killed down south.  I admired them in the same kind of way as I admire the martyrs of the Church.  Somewhere around the early to mid 1970s, though, liberalism got off track and it abandoned the most defenseless, helpless, and voiceless among us in the name of defending another oppressed group.  Suddenly, liberalism's platitudes fell flat.

There is an Australian woman whose website title is her name, Melissa Ohden.  The subtitle: "Abortion survivor. Voice of the Voiceless."

There you go.  As an abortion survivor, she speaks for the contents of the uterus that are removed and discarded in abortion.

In the pursuit and defense of the rights of minorities against injustices of all kinds, liberalism began grasping for "rights" that exceeded justice.  Everyone and every group has a right to an education and other services that are every bit as good as what any other group is getting. But does any oppressed group have a right not only to secure equal treatment, but to go beyond that and attain preferential treatment?

Logic and justice tell us No. When the fight for justice become a fight for preferential treatment, it becomes instead a fight for institutionalized injustice, which is exactly what liberalism is supposed to fight against. It also becomes a fight simply to overturn social structures - social structure requires an authority structure, which in some people's minds is inherently oppressive to someone; therefore, social structures are evil and must be overthrown. It doesn't really matter what those social structures are. (This is a principle, by the way, of the Communist Manifesto.) The destruction of the social order is couched in phraseology of social justice.  Insofar as contemporary liberalism actually does stand for social justice, I would support it.  Insofar as it goes beyond that, I do not.

The abortion issue is certainly a key bioethical issue of our day.  Authentic bioethics must adequately consider the plight of the pregnant woman, and do so thoroughly of course.  I have extreme compassion for women in difficult pregnancies. However, authentic bioethics must also give adequate consideration also to the other end of the abortion procedure. Abortion is never the only way of dealing with a medical difficulty in pregnancy, and most abortions - like the one that failed in Melissa's case - are not for medical difficulties.  What was in her mother's uterus? The question is actually falsely worded.  Not "what" but "who".  Either way, the answer is Melissa. A Melissa or Ashley or Michael or Stephen is in every uterus in every pregnancy that is terminated. There is no science to prove otherwise, and all scientific evidence that can be brought to bear on the topic, not to mention reasoned logic, only supports that answer.

Their position on abortion has caused what we call "liberals" today to fall on the wrong side of a whole host of bioethical issues as far as I can tell - almost all of them in fact, except for maybe the death penalty, and so I wonder why they are on the side they are about that. 

Instead of heeding Melissa's voice, abortion providers have stopped using that particular procedure, so as to better ensure that voices like Melissa's are never heard. Silencing the small voices. Keeping the weak in their place. If liberalism lived up to its original principles, the principles that resonated in my heart when I was a kid, I'd be a liberal today. Melissa Ohden is living up to those principles.

One last thing.  If I call liberalism to task for abandoning its roots - for abandoning me - that is not to say I am therefore endorsing any other place on the political spectrum.  If I say I don't like orange, it doesn't mean I therefore like blue.  Maybe I do like blue, but maybe I like green or red or something else or maybe nothing else.

Thanks to NewAdvent.org for linking to a post on ProlifeBlogs.com for relaying a post on AustralianChristianLobby.org.au for linking to Melissa's website.

Sunday, September 12, 2010

Know the Tree by the Fruit

There clearly was no deep friendship among the four, a lesbian couple and a gay couple; their association was simply one of utilitarian expedience.  As soon as the relationships experienced a little stress, it fell apart.

They had an arrangement to conceive a child among them. Then they fought over parental rights of the child, much like four collaborating inventors or songwriters would over the rights to their common labors. Yet, it's easy to divide a song or an invention into four equal parts by dividing the revenues it may generate.  It is not so easy to divide a child in that way.

The child is "a product" of a "number of fine people," reasoned the judge in the case. That says it all: The child has no rights because it is property of four people, four people so fine they can't even agree as to what is best for the child and they squabble over him like spoiled brats. He doesn't need to know who all four are and how he came to be; it is more likely that such knowledge will only give him difficulties later in life.

Where is Solomon when you need him?  Solomon at least understood that the real mother of the child would out of love prefer the child be given to the other woman than let him be divided.  Even if Solomon said that one woman should raise the child for half the year and the other woman the other half of the year, the child would still be divided.  This child is split four ways.

Of course, only two the people involved are actually the child's parents.  What happens if the two same-sex couples both split up? This arrangement cannot be good for the child, and all four of the "parents" agree that the child should be split.  Not one has said, "No, do not divide the child but let the others raise him undivided." One could conclude, contrary to what the judge has said, that the child is not "dearly loved" by them -- except insofar as they dearly love their car or computer.

Such things don't happen except in cases of artificial insemination, in vitro fertilization, and surrogate motherhood.  When was the last time four people argued over visitation rights for a baby born to a married couple who conceived so as to add to their family?

But they fought a bloody war to stop the Nazis

We all know that the Holocaust was a horrible genocide against the Jewish people.  But lest we forget how horrible it was, we need to remind ourselves that it didn't begin with the Jews nor did it end there.  It began with sterilization and elimination of "undesirables" and the "unfit" in a general sense, to keep them from breeding.

The Nazis signed a peace treaty with Poland, and then attacked them.  Same with the British.  Now, sadly, there is a British "intellectual" advocating Nazi-like policies in Britain, namely, the forced sterilization of the "unfit" to keep them from breeding.  You can find an article here.

This fellow is a little more subtle.  The Nazis didn't want them to breed at all and perpetuate their genetic code in society.  This fellow says it's for the sake of the children, so that they don't grow up with abusive or dysfunctional or otherwise irresponsible parents. Those kids are better off not being born.

But note the arbitrary definition of the unfit. Drug addicts, alcoholics, and people with psychological problems, whose unfitness has persisted at least 5 years.  OK, why have a 5-year duration? Why not 1-year? Why not immediate?  Why limit it to those difficulties? Oh, and what exactly constitutes a psychological problem anyway?  I am sure there are influential intellectuals who think that believing in a God is insane or at least indicative of subnormal intelligence, just as some think that disagreeing with the gay-lesbian social agenda constitutes a hate crime, which in turn indicates an irrational phobia and an inability to control oneself.  But I do not pin this mentality on gays, since they (particularly those not butch) were among the first of the Nazi's victims.

The point is, it is a dangerous mentality to target certain subgroups of society as requiring forced sterilization. It begins with drug addicts, etc., but it will not end there. Indeed, it begins with the low-hanging fruit, the ones for whom -- if it makes any sense at all -- that it makes the most sense and finds the least opposition in society.  I am surprised he did not mention criminals, particularly those convicted of violent crimes.  But give it time.  I would not be surprised to find that the fellow in Britain has his sights not on drug addicts and people with mental illnesses, but on some other group.  (I am not saying that he does, I am just saying it would not be surprising to find out that he does.)

Just like the other person in the article notes, the notion of it being "for the children" is just plain silly. But she still sees the sense of forced sterilizations; she simply is more willing to endorse it for what it is: Elitism.

Saturday, August 28, 2010

The Most Dangerous Idea in Bioethics

Professor Margaret Somerville of McGill University argues that the most dangerous idea in the world today is that human beings are not special compared with lower animals and even robots. I believe she has the right idea, but she has argued rather timidly.  She concludes more or less that the danger of denying human specialness stems from what things it leads to—but the idea is designed precisely to lead to those things.  If one does not see those things as dangerous but desirable, then the idea becomes desirable as well.  The idea is dangerous, therefore, for an entirely different reason that hinges on truth, as I will show.

Critics in the combox under her article argue that Prof. Somerville has not adequately proved that human beings are special.  That critique, however, is entirely bogus. Human specialness does not need to be proven because it is self-evident.  It is a simple fact that human beings differ in important ways from all other animals (not to mention robots), even if there are similarities as well.  Take farming for instance. I am not saying that our specialness hinges on farming, but farming serves as one piece of evidence of what a human being is, and how a human being differs from other life.  Whereas every other life form has to find read-to-eat food occurring spontaneously in nature, we do not and can instead purposefully modify and control our environment to make the environment produce our food, and then modify the food to make it look and taste good. Granted, some critters engage in farm-like activities (such as ants that “farm” aphids) but the difference between critter farms and human farms is infinite. Not all humans farm, but any human could; farming is a uniquely human activity. Human specialness is self-evident.

Anyone who demands that human specialness be proven ought to try thinking like an animal, since in his view he is no different from an animal.  Dogs can tell that humans are different from cats, and not merely different but superior as well.  Who ever heard of a dog being a cat’s pet?  Who ever heard of a cat training a dog? Who ever heard of a dog domesticating a human or any other animal for that matter?  Yet, dogs respond well to domestication by humans.  If humans are, in fact, not superior to other animals, what does it mean if other animals who are not inferior to us understand humans to be different from and superior to themselves and other animals?

Also, human specialness is impossible to prove to the satisfaction of everyone.  Who can stop someone from saying, “Sorry, that doesn’t prove it to me” or “I reject that argument; human beings are still no different from other animals”?  These are people who already reject the evidence of their own existence compared to that of their pets, how on earth will a cogent argument sway them?

I say in response, prove that human ingenuity and accomplishments in science, technology, poetry, and the arts are meaningless differences from other animals and robots.  Birds can sing, none has written an opera. Bees build hives, but none has built a pyramid that has survived for millennia. Not all humans can write operas or build pyramids, but only humans can and any human could if he set his mind to it.

Prof. Somerville also mentions many arguments that deny humans specialness. Unfortunately, she doesn’t do anything with them but mention them.  One of these arguments goes like this: Human superiority resides in the ability to reason.  Some human individuals do not have that ability, so they lack the defining trait of human superiority.  These individuals at least are no better than other animals, and other animals would be at least as good as them.  Therefore, there should be parity between our treatment of these individuals and other kinds of animals.  This line of argumentation of course is a red herring.  Individuals lacking in traits proper to their kind are still of that kind.  Cars have two headlights. Some have only one because one is broken.  But it is still a car.  A car may lack wheels, a motor, seats, doors, glass, and be just a rusting piece of junk, but it is a car, a car lacking those things. We can quibble and say it really is just a part of a car or the remains of a car, but not a car—which is a matter of semantics and not ontology.  If your kid asked you, “What is that thing?” your answer will likely be, “It’s a car,” and quibble as much as you like over semantics, your answer would not be wrong. It is a car—one lacking in things proper to being a car, yes, but a car nonetheless.  A car lacking things a car is supposed to have a) doesn’t make it not to be a car, b) doesn’t render cars in general to be non-cars, and c) doesn’t make other things lacking those traits to be no different from a car. Likewise with the lack of human attributes both high and low in some humans: a) it doesn’t render them non-human or non-special, b) it doesn’t render humans in general to be non-special, and c) it doesn’t render other things lacking those traits to be no different from a human.

The fact is, our specialness cannot be pinpointed to DNA or a single power or ability unique to human beings.  Rather, a human being is one thing with several properties, and it is the sum total of what a human being is that makes a human being special in comparison to other animals.  The notion that human specialness hinges on one identifiable thing to the exclusion of all other things is simply a false premise.

Now, why is this idea so dangerous? There are three main reasons.  First, it denies self-evident truth.  Secondly, support for the idea depends on poor logic presented as sound reasoning.  Thirdly, people propose the idea not because it has merit in itself, but to justify to themselves and to others courses of action that they want to engage in. No one who supports the idea does so merely because they believe it to be true and want others to know the truth, too. It is not about the metaphysical, concrete reality of human ontology. It is purely about what doors it opens if it were to be seen as true. Truth should be an end, not a means; but the fact is, the truth is irrelevant to those who support the idea.  It is its acceptance that is important.

So, in a nutshell: The idea that human beings are not significantly different from and superior to other animals and robots is dangerous because it is a patent falsehood masquerading as truth, supported by deviousness, and intended to manipulate the minds and actions of others. Its plausibility to unsuspecting minds makes it the most dangerous idea in bioethics.

Sunday, August 15, 2010

The $93,000 question

In this short case presentation, you might think the difficulty is the age of the patient.  In reality it is the cost of the medication.

Comfort food, revisited

Here's an interesting take on that same NYTimes article about the use of feeding tubes in end-stage Alzheimer's disease.  The author, a doctor who spent the early part of her medical training caring for Alzheimer's patients, appears aghast to learn that feeding tubes were used in the first place, let alone that there is a controversy surrounding their discontinuation in favor of hand feeding.

Some beautiful nuggets in the article.  I was concerned that hand feeding may lead to neglect or quickly giving up by those not dedicated to provide care.  But she had genuine persistence: "What else did they have to do all day and what else was I there for, after all?" I would hope that anyone who provides daily care for such patients would have the same attitude.  I guess the stories of neglect are what we hear about most in the news or from family and friends. And neglect is what we have to be on guard against.  Yet this lady is the real thing, someone who knows what "care" means.

Go take a look and read the article to the end.  Something to think about there.

Wednesday, August 4, 2010

Comfort food

I haven't decided what I think yet about the idea of "comfort feeding" rather than using a feeding tube.  Comfort feeding refers to giving normal food and drink by mouth to someone unable to feed himself, up to his tolerance for the process and the ability to swallow without choking.

Employed in patients with advanced Alzheimer's disease, whose brains are degenerating to the point of them forgetting how to eat and drink, it appears to be a way of providing comfort, nutrition and hydration that does not distress the patient or require sedation or restraints.  It enables the caregiver to feel like she's not starving or dehydrating Dad to death, while at the same time providing direct nurturing care to a loved one.  It would be used instead of a feeding tube.  The tolerance level of the patient, though, virtually ensures that too little nutrition and hydration are given.

The feeding tube has the advantage of ensuring that the patient receives adequate nutrition.  It has the disadvantage of being very uncomfortable and restrictive for someone in the last weeks or months of life as a terminal disease inexorably progresses.

The ethical question for the caregivers -- the patient's loved ones and the health professionals -- is whether their responsibility to the patient involves feeding or nutrition.

The statement by the US Catholic Bishops cited in the article suggests an obligation to nourish and to hydrate the patient.  The NYT points out, however, that feeding tubes do not necessarily prolong life.

The logic is clear: Is there a moral obligation if the outcome -- longevity -- does not improve?

Outcomes are only part of the equation, however.  Human beings need water and nutrition.  These are necessities, not means to any particular end other than to provide what every human being needs without depriving them.  The ability of hydration and nutrition to prolong life seems irrelevant: As long as the patient lives, he needs hydration and nutrition, and we have a duty to provide him with what he needs.

Comfort feeding almost seems more like it comforts the caregiver more than the patient.  I am also concerned about the slippery slope: If food and drink are given in accord with the patient's tolerance to eat and drink, at a certain point it becomes frustrating to continue to give food, whether it be "right now" at a given feeding, or day after day after day. Caregivers can easily give up when they ought to persist, and over years and years with this policy, it eventually morphs into a pro-forma "I tired to give him food but he wouldn't take it so I didn't force him" -- at the slightest resistance -- and then, eventually, getting to the point of asking, "Why bother even trying?"

And, by the way, since when are Alzheimer's patients competent to determine their own care?

I appear to be arguing myself out of comfort feeding, and I have to admit, it makes me, well, uncomfortable.  But I haven't decided yet.

This I know: There is no wrong in giving someone adequate hydration and nutrition.  It's a matter of how best to do that. Each way appears to do well in some respect while falling short in another, albeit in opposite ways.  I need to think about it some more.

If it’s bad, is it an enhancement?

The whole idea that a human “enhancement” can be seen as good or bad just goes to show that the Institute for Ethics and Emerging Technologies has a bit of a difficulty with the “ethics” part of their name.

Yet, it’s true: Newly named Affiliate Scholar at IEET, Richard Eskow, has identified two basic kinds of human enhancements, good and bad.  He actually claims there are three (good, bad, and inevitable), but the diagram in his article shows that inevitable is where the good and the bad enhancements overlap.  The diagram could have been drawn the other way, with “improbable” enhancements as the overlap between the good and the bad, depending on the point one wants to make.  So perhaps there are four kinds of enhancements: Good and bad, and among each kind, improbable and inevitable.

What intrigues me, though, is the notion of “bad enhancements.”  Extreme plastic surgery, he says, is a bad enhancement.  Whatever else may be said of extreme plastic surgery, if it’s bad, it’s not an enhancement.

He goes on to talk about the advent of personal devices such as cell phones, PDAs, and laptop computers, chaining people to their professions.  He said he was at the time “appropriately horrified.” However, what were considered “bad enhancements” became today’s addictions.  Now he feels uneasy when he’s parted from his cellphone.  And he doesn’t appear to mind.  As useful and even necessary a cell phone is, I would hope he would remain “appropriately horrified” at his uneasiness at being parted from it.

So, there are four lines of ethical reasoning at work, none of which are adequately ordered to determining an authentic good or evil in acts that affect human life and health. 

First is the outcomes-based ethics revealed in the example of bad plastic surgery. The word “extreme” implies a bad outcome, surgical “enhancements” that disfigure rather than repair defects or refine good but imperfect traits.  If only good outcomes are attained, who’s to call it “extreme”?  There’s no way to know otherwise what a bad enhancement is, except what happens as a result of it.  Authentic bioethics, however, must go beyond mere outcomes, or at least expand the notion of “outcomes” to include more than just the objective result of the act.  Take massive cosmetic surgery. We must ask, does it make someone to be a better person, or does it merely make him look better (which might actually make him arrogant and selfish, i.e., worse as a person)?

Second is culture-define acceptability: A thing is acceptable if the society wants it.  Accepting the concept that societal and cultural mores change over time, frankly, is just another way of saying we’re on a slippery slope and that’s okay.  How long before we connive ourselves again that slavery is good? It’s unthinkable today, but will it be unthinkable when future humans with their technological enhancements see themselves as ontologically superior to natural, unenhanced humans, whom the supermen of tomorrow find morally indistinguishable from pets or livestock?  Slavery it will be, but it will be called something else.  But it will be slavery.  Can’t happen? Ask Dr. Eskow how he became addicted to the very thing that horrified him a few short years earlier.

Third is the absence of a true concept of what a human being is.  I do not say, “an inadequate idea of what it means to be human,” but of what a human being is.  Eskro says that what it “means” to be human is constantly in flux and defined in the present moment by the prevailing whims of culture and society.  Anything is possible if, for instance, the body is seen as a mere possession rather than a constitutive component of a human person.  A human being is what he is, however, and societal opinions cannot change the concrete reality of a human being.  In this respect, man is an image of God, who also is unchangeable.  Human nature is immutable; human beings individually can be altered, the human gene code modified, but in the one case human nature remains and in the other the result is not really human.  Yet, if man creates a rational animal, it will be a person, a person manufactured for a purpose defined by the humans that bred it. A slave.

Fourth is the notion that the natural functioning of the human body (in the absence of any defect or disorder) is intrinsically defective.  For instance, there is probably a limit as to how fast a human being can run, given the natural development of a person’s muscles and bones. But perhaps if we replace natural leg bones with titanium steel and natural muscles with computer controlled mechanisms, we can break those limits of human speed.  We have to ask, though, is it really a human being who attains that speed, or a man-made machine surgically attached to a remnant of a human person? Is it really an enhancement? Is it really a human enhancement, or a mechanical one with some human elements going along for a ride?

That is the kind of distinction that Dr. Eskow appears unable to make.  These are the questions that need answering that find no resolution in his article.  In a way, it is funny that he calls some enhancements “bad,” since he doesn’t have a concrete way of determining that they are bad.  One must truly wonder about IEET’s first E.

Tuesday, August 3, 2010

Life Support, or a Replacement Part?

When transhumanists equate wearing eyeglasses with replacing healthy flesh and bone with cybernetics, one must not downplay the power of analogy in bioethical reasoning. The simple response to the transhumanst is that eyeglasses do not alter the body at all nor do they become part of the person nor do they consider otherwise healthy eyes as disposable. (We'll not explore all of the ways the analogy limps in this post.)

Analogy is the very heart of the reasoning used by the Mayo Clinic in deciding that physicians can ethically withdraw a left ventricular assist device (LVAD) at a patient's request.  The device keeps the heart going in the cases of heart failure, where left ventricular hypertrophy has diminished the heart's ability to pump blood.  It is often used by patients awaiting a heart transplant.

According to a WSJ article on the topic, some clinicians feel uncomfortable with withdrawing LVAD because the device seems more like a replacement device than life support -- more like an artificial heart that lets a patient engage life than a ventilator that simply forestalls death when there is no life-saving treatment to be had.  Withdrawing LVAD would thus appear to be more like assisted suicide an euthanasia, rather than discontinuing a useless treatment.

The Mayo Clinic saw things in the exact opposite way. Withdrawing LVAD imposes no new pathology, but simply lets underlying pathology run its course. They consider it a treatment that any patient has a right to refuse and they recommend that clinicians respect their patients' wishes.

Yet that is also the weakness of the analogy.  The right to refuse treatment, like every other right, carries with it some responsibility.  No right is absolute -- people do not have the right to say whatever they want, whenever they want.  They have a responsibility to speak truthfully and not to slander, to keep the peace and not to incite a riot, and to keep silent and not to breach a confidence.

Patients can refuse treatments, but they have a responsibility -- to themselves, their loved ones, society and, yes, God -- also to maintain and restore their health.  Allowing existing pathology to run its course can be a form of murder, euthanasia, or assisted suicide -- not saving a savable life is the same as taking it. Circumstances will determine whether withdrawing LVAD means discontinuing a useless treatment that has no benefit, or causing an unethical hastening of death.

The discomfort of advanced heart failure and a life maintained by a mechanical device can make things seem pretty dismal to the patient. The patient needs advice, not obedience.  Above all, bioethics cannot make physicians into obsequious technicians that abdicate all ethical responsibility to others and remain authentic.

Sometimes a physician has to say, "No, it would be wrong." The Mayo Clinic seems to have taken that responsibility away from them.