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Sex and Sexual Reproduction: What's Morality Got to Do with It?
Harvard bioethicist Glenn Cohen knows in his gut that sex and sexual reproduction are areas of human life that involve moral dilemmas. But when it comes to resolving those dilemmas and taking action, he recognizes the need to "go beyond the gut."
Glenn Cohen: So, reproductive technology is sort of a family of technologies. We have in vitro fertilization where essentially an egg is being fertilized outside of the body. So that involves harvesting eggs from women and then implanting sperm into that and putting it in. There are some variations on that. Another very common form of productive technology is surrogacy. In surrogacy an embryo is being carried by a woman who is not the genetic mother of the child, so another woman is caring the egg and sperm combined into a fetus. And then we have a series of other brand new technologies like mitochondrial replacement therapy where you're taking the egg from one woman, you're removing the mitochondria from that egg and putting in the mitochondria from another egg to deal with mitochondrial disease and here there's an idea that there's actually three genetic parents: the genetic father who provides the sperm, there's the mitochondrial donor and there's the woman who donates the rest of the egg. So in reality there's three genetic parents, even though the mitochondrial donor is only giving a very small part of genetic material in the DNA. So those are three reproductive technologies. Two are very common. One is brand-new.
And, of course, the oldest one that we have is artificial insemination. And in fact this goes back to the 1800s I believe in the United States at least. And this is essentially when a man ejaculates his sperm and it's used to inseminate a woman typically through an injection, although the old things they say about turkey basters are actually true. You can do at home insemination with a turkey baster. So those are four technologies: artificial insemination, in vitro fertilization, surrogacy and mitochondrial replacement therapy.
As a society there's a series of I would say traditional and then more novel challenges posed by these technologies. So the traditional ones involves first of all how do you get the sperm and egg? Is it ethical to purchase sperm and egg, and in particular egg were women have to take hormones, with egg retrieval there's some medical risks. Is it ethical or unethical to ask a woman to donate her egg or to sell her egg? How much can you pay a woman for that purpose? With sperm there's also in particular a question of sperm donor anonymity. In the United States we allows sperm donors to be anonymous if they want to be. Most sperm donors in the United States are anonymous. Many other countries in the world require individuals to put their names and identifying information into a registry available to the child that's born. The donor can see child at age 18. So the child can try to track down that person and try to make contact. And many donor conceived children say they have a right to know their genetic origins, a right to encounter this person. In the U.S. as a matter of law we don't recognize that right.
In terms of surrogacy we really have two kinds of surrogacy. We have gestational surrogacy where a woman carries a fetus from the sperm and egg of other people. In traditional surrogacy where the surrogate is inseminated by a man's sperm but it's her egg. In traditional surrogacy she's both the carrier of the baby as well as the genetic mother. In gestational surrogacy she only carries the baby. There are cases that we have reported in literature like the famous Baby M case where women who carry babies for other people become attached to them. They want to have the children as their own. And there is a break up of the agreement that was made ahead of time when the baby is delivered. How should we adjudicate the rights of a surrogate? Do we think of the surrogate, just to use a provocative a phrase, just an oven, just a cupboard? Or do we think about that as a person who is a real mother to the child and not to have rights? There's also a lot of transnational surrogacy where people go abroad to use surrogates, in particular to India in part because the cost is so much lower and you have women serving as surrogates from poor villages making for them a lot of money, much less than surrogates make in the United States living in compounds signing contracts where they can't have an abortion. They get paid by the month and if they miscarry they stop getting paid and there's questions about whether this is exploitative of these poor women or say giving them a great economic opportunity.
So I would say these fall in the bundle of the more traditional objection questions. The new technologies we've been talking about, mitochondrial replacement therapy, also CRISPR/Cas9 gene editing, which is a technology we're going in the lab. They're not yet human beings in terms of reproduction where we edit some of the genes, you particularly try to eliminate disease causing genes. Both of these raise issues about human enhancement. What should be the limits of enhancing human beings? When do we stop being human and start becoming post human? Is that a problem? Are there safety risks involved? Is it problematic for parents to try to control not only the upbringing of children but their genetic make up as well? At what point does it become oppressive? And these technologies pose really interesting but ethical but also biological and safety questions for what the future of humanity might look like.
So let me say a word about method of how does one go about analyzing this if you're new to the field how should we think about this? So I often call the method going beyond the gut. Think about things, we think about case, a concrete case. It might be a real case you encounter. For example, the story of a woman in her 60s or 70s in India having her first child with reproductive technologies, how old mother can be just for example, or it could be a fictional case something from literature like Brave New World for something from films. The film Ex Machina or the film Gattaca where we talk about a kind of genetic arms race in Gattaca among people who are becomingly increasingly perfect and those who are instead the products of traditional births.
So we have a concrete case that we think about. And we have a gut reaction. That's very normal. But then the next thing we have to do is kind of interrogate where that gut reaction comes from and it's kind of a top down and bottom up. We start with the gut but then we ask ourselves let me compare this case to a series of cases that are like this in some relevant respects but unlike this in others and ask myself how do I react to these new cases adding more items on the board if you will? From those in sorting through my reactions to new cases, our reactions and talking about it to people, we then try to test out some principles and derive some principles. So we say case A, case B, case C, yes, case D no. And we ask ourselves what distinguishes those cases and identify a principal. Say this is the principle that distinguishes them and then we try to apply that principle to a new set of cases to see whether it's a good principle; does it have to be thrown out; can it be refined? So that's a very abstract way of putting it.
Now let me just try to put it in practice in thinking about human enhancement and what makes us better. So take the case of trying to enhance genetically enhancing intelligence genetically as an example. So imagine we could make an alteration and we could either do this and the question would be would it be different to do it this way through choosing entirely intelligent sperm donors and egg donors or actually manipulating the genome. So one question we'd have to ask ourselves is does it matter in which way I arrive at that end? And imagine now the goal is to produce a set of children who will do better on a test where you're a wealthy parent and you want your children to succeed academically. People have strong reactions to that case. Maybe they think it's wrong because we're controlling these children's future; it's oppressive. Maybe they think it's wrong because it has bad distributive consequences. The rich have a way of perfecting themselves and getting better, poor do not. Well now we want to test it against a very different kind of case and that's the kind of SAT tutoring for example.
There are test centers across America where children can get tutored for standardized test to improve their performance, tutors for all sorts of subjects. Ordinarily most people don't have a strong negative moral reaction to the idea of tutoring and the pressure point to ask yourself is are the tutoring examples different from the enhancement examples I've started with? Both have the aim of improving the intelligence or the performance of children. And then we could throw in other cases, performance enhancing drugs in sports, for example, versus the use of Adderall and other drugs to cram for exams in colleges. Now we have four kinds of cases. We have doping in sports, we've got college students doing Adderall, we've got tutoring and then we have genetic enhancements. So now the question is we have a pattern of reactions to these cases, can we derive a set of principles or distinctions and make a difference and help explain these intuitions? And then also can be used for new cases in ways that are satisfactory. So kinds of lines I draw is the difference between biological versus non biological enhancement. Now all forms of learning are really biological deep down, but you might think the biological enhancement of altering the genome looks different from the biological enhancement of taking Adderall or cramming for a test or getting tutored.
You might also try to draw and distinctions between who's making the decision as to who will be enhanced. The case of this sports player or the case of the student who's cramming for an exam there is a lot of self agency; the person is choosing for themselves. In the case of a parent choosing will be the sperm or egg donor or choosing what genetic manipulations to do to an early embryo you have someone else imposing the will. Does that help explain our intuitions? And so on and so on and so forth. It gets pretty complex. You start drawing charts of distinctions and thinking about it. But in this form of contestation you can try to get really to understand what we really think.
Harvard bioethicist Glenn Cohen knows in his gut that sex and sexual reproduction are areas of human life that involve moral dilemmas. But when it comes to resolving those dilemmas and taking action, he recognizes the need to "go beyond the gut."
The impulses we feel toward issues of sexual reproduction—whether it's abortion, sperm donation, or surrogacy—are undeniable. The true reasons we feel one way or another, however, can be complex, and not immediately available to ourselves, even if we perform introspection. Here Cohen discusses human reproduction, and the difference between our current moral concerns, and what kinds of concerns we may have in the future, mainly resulting from technological innovation.
Should a mother or father be able to select an intelligent sperm or egg donor for their future children? If so, why not allow parents to genetically improve the intelligence of their unborn children? We feel a distinction between natural methods and contrived methods in our gut, but what do those feelings really come down to? Are they just feelings? Is that a good enough defense of moral reasoning?
Cohen describes the hoops that ethicists jump through to determine the difference between right and wrong, or least understand why we feel certain behaviors to be right, and other to be wrong. Crucial to many disagreements over morality is the question of human agency. Explore that topic, and many others, with the fascinating and articulate Professor Cohen.
Glenn Cohen's book is Patients with Passports: Medical Tourism, Law, and Ethics.
Innovation in manufacturing has crawled since the 1950s. That's about to speed up.
A new Harvard study finds that the language you use affects patient outcome.
- A study at Harvard's McLean Hospital claims that using the language of chemical imbalances worsens patient outcomes.
- Though psychiatry has largely abandoned DSM categories, professor Joseph E Davis writes that the field continues to strive for a "brain-based diagnostic system."
- Chemical explanations of mental health appear to benefit pharmaceutical companies far more than patients.
Challenging the Chemical Imbalance Theory of Mental Disorders: Robert Whitaker, Journalist<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="41699c8c2cb2aee9271a36646e0bee7d"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/-8BDC7i8Yyw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>This is a far cry from Howard Rusk's 1947 NY Times editorial calling for mental healt</p><p>h disorders to be treated similarly to physical disease (such as diabetes and cancer). This mindset—not attributable to Rusk alone; he was merely relaying the psychiatric currency of the time—has dominated the field for decades: mental anguish is a genetic and/or chemical-deficiency disorder that must be treated pharmacologically.</p><p>Even as psychiatry untethered from DSM categories, the field still used chemistry to validate its existence. Psychotherapy, arguably the most efficient means for managing much of our anxiety and depression, is time- and labor-intensive. Counseling requires an empathetic and wizened ear to guide the patient to do the work. Ingesting a pill to do that work for you is more seductive, and easier. As Davis writes, even though the industry abandoned the DSM, it continues to strive for a "brain-based diagnostic system." </p><p>That language has infiltrated public consciousness. The team at McLean surveyed 279 patients seeking acute treatment for depression. As they note, the causes of psychological distress have constantly shifted over the millennia: humoral imbalance in the ancient world; spiritual possession in medieval times; early childhood experiences around the time of Freud; maladaptive thought patterns dominant in the latter half of last century. While the team found that psychosocial explanations remain popular, biogenetic explanations (such as the chemical imbalance theory) are becoming more prominent. </p><p>Interestingly, the 80 people Davis interviewed for his book predominantly relied on biogenetic explanations. Instead of doctors diagnosing patients, as you might expect, they increasingly serve to confirm what patients come in suspecting. Patients arrive at medical offices confident in their self-diagnoses. They believe a pill is the best course of treatment, largely because they saw an advertisement or listened to a friend. Doctors too often oblige without further curiosity as to the reasons for their distress. </p>
Image: Illustration Forest / Shutterstock<p>While medicalizing mental health softens the stigma of depression—if a disorder is inheritable, it was never really your fault—it also disempowers the patient. The team at McLean writes,</p><p style="margin-left: 20px;">"More recent studies indicate that participants who are told that their depression is caused by a chemical imbalance or genetic abnormality expect to have depression for a longer period, report more depressive symptoms, and feel they have less control over their negative emotions."</p><p>Davis points out the language used by direct-to-consumer advertising prevalent in America. Doctors, media, and advertising agencies converge around common messages, such as everyday blues is a "real medical condition," everyone is susceptible to clinical depression, and drugs correct underlying somatic conditions that you never consciously control. He continues,</p><p style="margin-left: 20px;">"Your inner life and evaluative stance are of marginal, if any, relevance; counseling or psychotherapy aimed at self-insight would serve little purpose." </p><p>The McLean team discovered a similar phenomenon: patients expect little from psychotherapy and a lot from pills. When depression is treated as the result of an internal and immutable essence instead of environmental conditions, behavioral changes are not expected to make much difference. Chemistry rules the popular imagination.</p>
Why Depression Isn't Just a Chemical Imbalance<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="fbc027c9358dad4a6d9e2704fc9ddb04"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/GAC9ODvSxh0?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Many years ago, my best friend tried to quit smoking. He asked for help. While I'm no addiction expert, I offered what I knew from my fitness toolkit: breathing exercises and cardiovascular training, methods for strengthening his body and mind that could, I hoped, inspire him to take better care of himself in general. He replied, "No, I meant something like a pill."</p><p>A few years later, he quit for good. After failing the cold turkey method a number of times, it finally stuck. Maybe it was watching his children grow up—the reason my parents quit when I was young. This method is not easy, however. It challenges you; it forces you to confront your demons; it drastically affects your brain chemistry. Yet, in the long run, it sometimes works. </p><p>Sometimes pills work, too. But often they do not. The journalist Robert Whitaker, author of "Anatomy of an Epidemic," discussed the clinical trial process <a href="https://bigthink.com/mind-brain/antidepressants-dangers" target="_self">during our recent conversation</a>. While the FDA process appears thorough from the outside, pharmaceutical companies only need to prove that a drug works better than placebo, not that it works for the most amount of people. He continues, </p><p style="margin-left: 20px;">"Let's say you have a drug that provides a relief of symptoms in 20 percent of people. In placebo, it's 10 percent. How many people in that study do not benefit from the drug? Nine out of 10. How many people are exposed to the adverse effects of the drug? 100 percent."</p><p>Even though some pharmacological interventions show little efficacy, and even though Xanax, an addictive and destructive benzodiazepine that only showed <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/" target="_blank">short-term (four weeks) efficacy</a> in clinical trials, is being prescribed for many months and years, doctors continue to use the language of clinical neuroscience to describe mental health issues. If chemistry is the problem, people will turn to chemistry for the solution. </p><p>Perhaps we should, as psychiatrist Dean Schuyler <a href="https://bigthink.com/surprising-science/antidepressant-effects" target="_self">writes</a> in a 1974 book, recognize that most depressive episodes "will run their course and terminate with virtually complete recovery without specific intervention." The problem is that idea isn't profitable. As long as the gatekeepers continue to use the language of chemical imbalances to describe what for many is just an episodic case of the "blahs," we'll continue creating more problems than we solve.</p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
SEAL training is the ultimate test of both mental and physical strength.
- The fact that U.S. Navy SEALs endure very rigorous training before entering the field is common knowledge, but just what happens at those facilities is less often discussed. In this video, former SEALs Brent Gleeson, David Goggins, and Eric Greitens (as well as authors Jesse Itzler and Jamie Wheal) talk about how the 18-month program is designed to build elite, disciplined operatives with immense mental toughness and resilience.
- Wheal dives into the cutting-edge technology and science that the navy uses to prepare these individuals. Itzler shares his experience meeting and briefly living with Goggins (who was also an Army Ranger) and the things he learned about pushing past perceived limits.
- Goggins dives into why you should leave your comfort zone, introduces the 40 percent rule, and explains why the biggest battle we all face is the one in our own minds. "Usually whatever's in front of you isn't as big as you make it out to be," says the SEAL turned motivational speaker. "We start to make these very small things enormous because we allow our minds to take control and go away from us. We have to regain control of our mind."
Here's why you might eat greenhouse gases in the future.
- The company's protein powder, "Solein," is similar in form and taste to wheat flour.
- Based on a concept developed by NASA, the product has wide potential as a carbon-neutral source of protein.
- The man-made "meat" industry just got even more interesting.
Seriously sustainable<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTk0MDIzNS9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTYyMjM4NTMzMX0.BCEfYnn6C3z1zUHIS38xOWjXktgamNBi5iyqklSMYK8/img.png?width=980" id="ea524" class="rm-shortcode" data-rm-shortcode-id="50533380eeb18eb5833b6b6aa3abec38" data-rm-shortcode-name="rebelmouse-image" />
Image source: Solar Foods<p>Solar Foods makes Solein by extracting CO₂ from air using <a href="https://www.fastcompany.com/90356326/we-have-the-tech-to-suck-co2-from-the-air-but-can-it-suck-enough-to-make-a-difference" target="_blank">carbon-capture technology</a>, and then combines it with water, nutrients and vitamins, using 100 percent renewable solar energy from partner <a href="https://www.fortum.com" target="_blank">Fortum</a> to promote a natural fermentation process similar to the one that produces yeast and lactic acid bacteria.</p><p>When the company claims its single-celled protein is "free from agricultural limitations," they're not kidding. Being produced indoors means Solar Foods is not dependent on arable land, water (i.e., rain), or favorable weather.</p><p>The company is already working with the European Space Agency to develop foods for off-planet production and consumption. (The idea for Solein actually began at NASA.) They also see potential in bringing protein production to areas whose climate or ground conditions make conventional agriculture impossible.</p><p>And let's not forget all those <a href="https://www.bk.com/menu-item/impossible-whopper" target="_blank">beef-free burgers</a> based on pea and soy proteins currently gaining popularity. The environmental challenge of scaling up the supply of those plants to meet their high demand may provide an opening for the completely renewable Solein — the company could provide companies that produce animal-free "meats," such as <a href="https://www.beyondmeat.com/products/" target="_blank">Beyond Meat</a> and <a href="https://impossiblefoods.com" target="_blank">Impossible Foods</a>, a way to further reduce their environmental impact.</p>
The larger promise<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTk0MDI0MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1NjU4MTg2OX0.7dZZYT5WEV_EupBuLVFwHynarTiz8RYR9aJtC6Ts2C4/img.jpg?width=980" id="3415d" class="rm-shortcode" data-rm-shortcode-id="2e6eebe06d795f844752f9e9d30040d7" data-rm-shortcode-name="rebelmouse-image" />
Image source: Solar Foods<p>The impact of the beef — and for that matter, poultry, pork, and fish — industries on our planet is widely recognized as one of the main drivers behind climate change, pollution, habitat loss, and antibiotic-resistant illness. From the cutting down of rainforests for cattle-grazing land, to runoff from factory farming of livestock and plants, to the disruption of the marine food chain, to the overuse of antibiotics in food animals, it's been disastrous.</p><p>The advent of a promising source of protein derived from two of the most renewable things we have, CO₂ and sunlight, <a href="https://solarfoods.fi/environmental-impact/" target="_blank">gets us out of the planet-destruction business</a> at the same time as it offers the promise of a stable, long-term solution to one of the world's most fundamental nutritional needs.</p>
Solar Foods' timetable<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTk0MTEzMS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTU5OTU1OTMwMn0.wnXh56iO_77x2XKV2uIPf78BKw4AJLUpmiyq_JBVGvo/img.jpg?width=1245&coordinates=172%2C146%2C62%2C135&height=700" id="0297c" class="rm-shortcode" data-rm-shortcode-id="125c9a98ec818f5c241fa28ef1423e67" data-rm-shortcode-name="rebelmouse-image" />
Image source: Lubsan / Shutterstock / Big Think<p>While company plans are always moderated by unforeseen events — including the availability of sufficient funding — Solar Foods plans a global commercial rollout for Solein in 2021 and to be producing two million meals annually, with a revenue of $800 million to $1.2 billion by 2023. By 2050, they hope to be providing sustenance to 9 billion people as part of a $500 billion protein market.</p><p>The project began in 2018, and this year, they anticipate achieving three things: Launching Solein (check), beginning the approval process certifying its safety as a Novel Food in the EU, and publishing plans for a 1,000-metric ton-per-year factory capable of producing 500 million meals annually.</p>
The protein powder Solein. Image source: SOLAR FOODS
Is focusing solely on body mass index the best way for doctor to frame obesity?
- New guidelines published in the Canadian Medical Association Journal argue that obesity should be defined as a condition that involves high body mass index along with a corresponding physical or mental health condition.
- The guidelines note that classifying obesity by body mass index alone may lead to fat shaming or non-optimal treatments.
- The guidelines offer five steps for reframing the way doctors treat obesity.