Perfecting Man's Moral Shortcomings

In the Book of Exodus, there's a bizarrely out-of-place story that I've always found hilarious. This is immediately after God has told Moses that he's going to be God's messenger to Pharaoh, listing all the signs and wonders Moses will be able to do to convince the Egyptians of his authority, and sent him on his way:


"At a lodging place on the way, the Lord met Moses and was about to kill him. But Zipporah [Moses' wife] took a flint knife, cut off her son's foreskin and touched Moses' feet with it. 'Surely you are a bridegroom of blood to me,' she said. So the Lord let him alone."

—Exodus 4:24-26

Even disregarding the intrinsic weirdness of this story, this makes no thematic sense, coming as it does immediately after God's choosing Moses to be his messenger. (How often do you persuade someone to do a favor for you and then immediately try to kill them before they can do it?) I've always assumed it was a priestly interpolation intended to stress the importance of circumcision, but from what I've found, the meaning of the passage is much debated among scholars. There's also this line, which is probably the funniest thing ever written on Wikipedia:

Rabbinical commentators have asked how Zipporah knew that the act of circumcising her son would save her husband. A common explanation is that the angel of God... in the shape of a serpent, had swallowed up Moses up to but not including his genitals.

I was reminded of this by two essays I came across recently that both touched on the same topic. First was this post on the blog Practical Ethics (warning: potentially disturbing image at the link), which quotes an article in the April 1860 issue of The Lancet recommending circumcision as a cure for masturbation. It explicitly advises performing the operation not just on infants, but on children, and on doing so without anesthetic:

In cases of masturbation we must, I believe, break the habit by inducing such a condition of the parts as will cause too much local suffering to allow of the practice being continued. For this purpose, if the prepuce [foreskin] is long, we may circumcise the male patient with present and probably with future advantage; the operation, too, should not be performed under chloroform, so that the pain experienced may be associated with the habit we wish to eradicate.

Nor was it just prudish Victorian doctors who thought this way. There's another example, which I first read about in Christopher Hitchens' God Is Not Great and came across again while rereading the book: the medieval Jewish sage Maimonides makes exactly the same argument. In his Guide to the Perplexed, he writes that the purpose of circumcision is to make sex less pleasurable so that people won't want to do it as much:

As regards circumcision, I think that one of its objects is to limit sexual intercourse, and to weaken the organ of generation as far as possible, and thus cause man to be moderate. Some people believe that circumcision is to remove a defect in man's formation; but every one can easily reply: How can products of nature be deficient so as to require external completion, especially as the use of the fore-skin to that organ is evident. This commandment has not been enjoined as a complement to a deficient physical creation, but as a means for perfecting man's moral shortcomings. The bodily injury caused to that organ is exactly that which is desired; it does not interrupt any vital function, nor does it destroy the power of generation. Circumcision simply counteracts excessive lust; for there is no doubt that circumcision weakens the power of sexual excitement, and sometimes lessens the natural enjoyment: the organ necessarily becomes weak when it loses blood and is deprived of its covering from the beginning.

Now, I grant there's a lingering question of whether circumcision might have real medical benefits, regardless of whether it was originally motivated by the sex-phobia of fanatics. This is an issue, it seems to me, where the evidence is murky, and science bloggers I trust have argued on opposite sides of the question.

However, one point isn't murky at all in my mind. The benefits of circumcision can be debated, but I maintain that even if circumcision has health benefits, that doesn't make it acceptable to perform this painful and irreversible surgical alteration on infants who can't give consent - and it's especially unacceptable when it's done without anesthesia or by people with no formal medical training. The horrible case of three New York infants who contracted herpes from an ultra-Orthodox mohel who performed circumcisions according to barbaric medieval principles, which included sucking the blood away from the open wound with his mouth, serves as a worst-case example. (As I was writing this post, I heard the sad news that another infant has died from the same cause. HT: Deborah Feldman, via Twitter.)

There's nothing about circumcision that makes it uniquely effective or uniquely beneficial for children (as opposed to, say, vaccination). A man who wants to be circumcised later in life always can be, and will still get whatever health benefits the procedure has. If the argument is that we need to circumcise men in infancy because they wouldn't want it done later in life, isn't that an excellent argument for not doing it to them in infancy either? Just because an operation may have some medical benefits doesn't make it acceptable to perform it on people without their consent.

I don't believe male circumcision is nearly as harmful as female genital cutting, which is a far more brutal and invasive mutilation of the body. Nevertheless, the motivation in both cases has historically been the same: to deny the pleasure of sexual stimulation and orgasm, to enforce religious puritanism through surgical alteration. There's no good justification for any society to permit such things to be done to vulnerable children of any gender.

Image: Detail from Rubens, "The Circumcision", via Web Gallery of Art

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Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.

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The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

What's dead may never die, it seems

The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. Think a dialysis machine for the mind. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.