What Is Natural?

For several weeks now I have been trying to write about the Nuffield Bioethics Report called (un)Natural. The Nuffield Bioethics Council is a non-partisan bioethics think tank that analyzes particular issues of importance in science, medicine, and technology. They are based in the UK and have some influence over policy issues because of their presence in the mainstream media. Their report with the longer title of “Ideas about naturalness in public and political debates about science, technology, and medicine,” analyzes the various ways that the terms “natural,” “unnatural,” and “nature” are used in the media, in journal articles, and in other venues. They are particularly concerned with how those terms shape people’s perceptions of new technologies. They solicited the help from experts in language and had poetry readings. Continue reading

Identifying the Person as the Problem: Euthanasia for Mental Illness

It was a practice that is foreign to most us today: The victim was executed for a crime committed against her. In the case of sexual defilement in which the woman was the victim, the woman was stoned to death in order to keep her uncleanliness out of the tribe.

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  • It seems barbaric to our modern-day sensitivities. But, what if a woman wants to be punished for something done to her? What if she sees herself as too defiled to enter into the community? What if she thinks she should be killed? Today victims of child sexual crimes and sexual assault are not put in jail or executed for being dirty. The Enlightenment brought with it the idea of autonomy, and with autonomy comes personal responsibility. The just response to sex crimes is to have the perpetrator tried and convicted in a court of law. However, in our modern world, the community’s responsibility toward the victim is a bit hazy. Dealing with the aftermath of sexual crimes, in particular, tends to be private and personal. The Dutch Euthanasia Commission granted a 29-year-old woman permission to die by physician-assisted suicide. nike air zoom pegasus 32 hombre She suffered from post-traumatic stress from childhood sexual abuse that occurred from age 5 to 15. Among her mental health co-morbidities (because people with PTSD tend to express several types of symptoms), she had what was deemed “untreatable” anorexia due to depression and anxiety. new balance 577 marron homme The Psychological Damage of Sex Crimes In the up-coming issue of Salvo (Issue 37), I wrote the Casualty Report on sex trafficking. In doing the research for this report, one of the key ways that traffickers and pimps maintain control of their victims is by making them feel worthless. By shaming their victims through abusive and degrading tactics, the victim will not only lose her will to fight back, but she will lose hope for a way out. This is how pimps “train their victims.” Once the cycle of shame has begun, the victim will stay in the abusive relationship because she doesn’t believe she deserves better.

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  • Even once she is out of the abusive situation, she will often engage in self-harm as a way to cope with her deep-seated sense of worthlessness. In his book Shame Interrupted Ed Welch says that “any sexual violation brings shame on the victim…it should be bring shame on the perpetrator” (Welch, 14). Shame is something far deeper and more intense than guilt. It is dehumanizing. Welch defines shame as

    [Y]ou were disgraced because you acted less than human, you were treated as if you were less than human, or you were associated with something less than human, and there are witnesses. (Welch, 2)

    The 29-year-old woman was treated as something less than human for most of her childhood. When she was approved for physician-assisted suicide, she was treated as less than human then, too. PTSD Is NOT Incurable In an op-ed for TIME online, Joan Cook, a trauma psychiatrist, says that “No provider anywhere should ever tell a trauma survivor that their condition is incurable.” She points out that treatment can be hard and it can take a long time, but it is not incurable.

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  • In a Huffington Post article by Jenni Schaefer, author and survivor of sexual abuse, she attests that she was not competent to make a rational and informed decision about physician-assisted suicide while in the throes of her mental illness. The feelings of hopelessness, she says, are part of the illness. In The Netherlands, one of the criteria for approval for physician-assisted suicide is that the patient must be competent to make the decision. How can she be both rational and competent and have an “incurable” mental illness? Jenni’s mentor and PTSD expert, Dr. Tim Brewton, said that it is the obligation of the therapist to instill hope. He says that from a clinical perspective,

    I do not believe in ever giving up on an individual’s potential for recovery. In fact, I think it is the duty of a doctor or therapist to instill hope of improvement, particularly in a young person. Cheap Nike shoes One very important lesson that I have learned over the years is that I can never predict who will improve and who will not. I have been proven wrong too many times, and we cannot see the future.

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  • It is better to be present in the moment with patients and to do one’s best to help them sit with their discomfort and move forward in all ways possible.

    Shame consumes a person until the person is completely gone. Welch points out that the deep logic of anorexia, which the woman suffered from, is that the person feels unworthy and deserves nothing, so she gives herself nothing and perhaps she can just disappear (Welch, 28). This woman felt unworthy of life and the Dutch Euthanasia Commission agreed with her. Autonomy and Compassion Sexual crimes violate the person, not only physically, but also mentally. It is the ultimate expression of treating another as an inhuman piece of meat, a means to an end. If the victim survives the attack, she is not free; she is in mental bondage. Her autonomy has been stripped from her. Killing her is not honoring her freedom to choose when and how she will die. It is honoring the perpetrator’s original intent, which is to consume and discard. Our enlightened and progressive culture has a habit of “solving” the problem by getting rid of the person, whether it is the unborn, the disabled, or the mentally ill. The problem of suffering is solved by eliminating the sufferer. New Balance 998 hombre This is sanitized by calling it “compassionate” and justified by invoking autonomy. If Western countries, like The Netherlands, really do value freedom and autonomy, then true freedom means helping the victim out of her mental bondage by showing her the love and dignity that she doesn’t think she deserves. Note: After writing this post, I came across this column by Clare Allen in The Guardian, (“The label ‘incurable’ is not a justification for ending a life”).

    Loneliness, Depression, and Euthanasia

    iStock_000078928757_Small

    Loneliness is part of the trifecta of modern angst (along with boredom and fragmentation).

    A recent study published in JAMA Psychiatry looked at physician-assisted suicide (PAS) cases in Belgium that were approved because the patient had an unbearable psychiatric illness. The study found that in more than half of the cases, the patient declined treatment that could have helped. Often the patient sought approval for euthanasia after visiting with a doctor for the first time, some patients even visiting a mobile clinic that is funded by a euthanasia group. Forty-six of the 66 cases were women. Importantly, loneliness was cited as a common theme.

    You can read the research article here, available by subscription, and the New York Times article here.

    Last year, Rachel Aviv wrote a poignant and insightful article in The New Yorker on euthanasia for non-terminal people in the Netherlands. In it she recounts the story of Tom whose mother suffered from depression and eventually elected to undergo euthanasia. Tom did not know about it until after the fact and was angry that he was not called so he could talk to his mother. His mother died with three photographs in her pocket: one of her holding Tom as a baby, one of her feeding her granddaughter ice cream, and one of her and her daughter in a field. She had just broken up with her boyfriend and was estranged from her daughter. Tom and his wife could visit her sometimes, but career and children took much of their time. Furthermore, her lifelong struggle with depression and inability to form close relationships contributed to her isolation. She was lonely and she elected to die alone.

    Loneliness is pervasive. This is not the idea of someone being by themselves. Many people can be alone and not be lonely. Also, many people can go to parties, have friends, and still feel utterly alone. As social commentators have pointed out, loneliness is part of the trifecta of modern angst: loneliness, boredom (hyperboredom) and fragmentation. Greg Monbiot in an insightful column in The Guardian dubs our time as the “Age of Loneliness.” One of the Dutch psychologists mentioned in Rachel Aviv’s article says that euthanasia for psychiatric disorders is a response to the nihilism pervasive in the Dutch culture. He says that people ask “What is life worth when there is no God?” or “What is life worth when I am not successful?”

    In Japan, the incidence of dying alone, and sometimes not being discovered for weeks, has become so common that the Japanese have a word for it: kodokushi. There is an entire industry dedicated to cleaning after the discovery of someone who has died a lonely death with no friends or relatives. In Japan, many of these lonely deaths are men who had dedicated their lives to their jobs only to be laid off or forced into early retirement. They had no relationships outside of work. Their jobs were the essence of their identity. Without it, they were lost.

    A 2014 report showed that loneliness has greater negative health effects than obesity, and a Washington Post article from this past January reported more studies on the health effects of loneliness. In sum, scientists have found that loneliness leads to physiological changes and is more damaging to one’s health than cigarettes, diabetes, and obesity. Studies have shown a correlation between loneliness and early death, onset of Alzheimer’s and dementia, and increased risk for cancer and heart attacks. This is likely due to increased activity in genes that cause inflammation coupled with decreased activity in genes that produce antibodies.

    Canada recently legalized physician-assisted suicide, and in the U.S., California recently joined Oregon, Vermont, Washington, and Montana as states where PAS is legal. Most of these places have stringent guidelines for who qualifies for euthanasia. The U.S. laws specify that the patient have a terminal illness and some of them require that the patient have less than six months to live. While “slippery slope” arguments can sometimes be spurious, in this case, we do have two examples of what happens when suicide is medicalized and re-framed as a dignified death. Belgium and The Netherlands continue to open up euthanasia to more and more people. They are not required to be terminal and the age limit continues to decrease with some advocating for no age limit for qualifying for euthanasia.

    But, if loneliness is a pervasive problem in our culture, medically-endorsed suicide does little to help and may contribute to the sense of isolation. There was a time when suicide was a cry for help. Now, for the depressed and lonely, it affirms their fears that they are unwanted. Mother Teresa is quoted as saying that “the biggest disease today is not leprosy or cancer or tuberculosis, but rather the feeling of being unwanted, uncared for and deserted by everybody.” Rather than trying to care for people who are struggling, doctors are helping lonely people to end it all. Suicide is not a “solution” for someone struggling with a mental health issue. It is abandoning someone in their time of need.

    See also:
    Dutch Treatment: A Eureka Moment for Holland’s Medical Ethics
    Daily Killings: Euthanasia Grows in Deepest Darkest Belgium
    Dr. Phillip Nitschke and the Reinvention of Assisted Suicide

    Where Do Babies Come From? Induced Pluripotent Stem Cells…Sort of

    Recent headlines tout that it may be possible for same-sex couples to have biological children thanks to stem cell technology. Using skin stem cells, scientists from the University of Cambridge and the Weismann Institute found that it is possible to make primordial germ cells, the cells that eventually form into egg and sperm (gametes), from induced pluripotent stem cells created from a donor’s skin. The opportunity for same-sex couples to have biological children may take over the headlines, but it is not the only, or necessarily the primary reason, scientists are interested in this research. One thing scientists hope to do is to use this technique to study age-related diseases. New Balance 577 hombre As we go through our lives, we accumulate epigenetic messages that tell genes when to turn on or off, when to make more cells, or when to stop making cells. Ryan Kerrigan Redskins Jerseys Recent research shows that certain cancers and age-related diseases are likely due to these epigenetic factors going awry. These epigenetic factors are “reset” in germ cells, meaning scientists can start over and see how these factors develop at the cellular level. There is still much research that needs to be done in this area, including questions as to which epigenetic factors are passed on and which ones are actually reset in germ cells (See Nature’s recent issue on the results of the NIH’s Roadmap Epigenetics Project here). While the epigenetic research is interesting, the headlines emphasize the reproductive possibilities.

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  • This technique could be another option for infertile couples who want to have biological children, including same-sex couples who want children that are biologically related to both of them. New Balance 515 m?skie However, what is not touted as loudly is that, for now, the technology only works for male same-sex couples.

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  • The why this technique can be used for two men but not two women has to do with how the cells are made. Primordial germ cells are made from skin cells are taken from each person to be converted into induced pluripotent stem cells. Those stem cells are then converted into primordial germ cells by turning on or off certain genetic factors involved in converting pluripotent stem cells to particular cell types. Female cells have XX chromosomes and male cells have XY chromosomes, but in order to make primordial germ cells that are precursors to sperm, researchers need a Y chromosome. Lead researcher, Dr. Hannah pointed out, that it is easier to take away a chromosome than to insert one. Women don’t have any Y chromosomes to contribute, meaning that making primordial germ cells from women “is a long way off.” Finally, one of the more troubling factors in this research is that little has been said about the health and well-being of the children that would be produced from this technique. A key point in the original research article in Cell is that SOX17 is a key factor in the process of making primordial germ cells and likely plays an important role in gene regulation. This was surprising to scientists because SOX17 does not play a key role in mouse development. This means that even though mice have been used in prior studies on creating primordial germ cells, they may not be a good model system for creating the subsequent sperm and egg cells. Often before a procedure or a drug makes it to human trials, it is first tested in mice and then in primates. When it comes to human development, though, things do not translate from animal models to human models as easily. Nike Flyknit Donna Once scientists are able to take the primordial cells and advance them to egg and sperm cells, they will be able to create an embryo. However, because the mouse models are different, this is a case in which we have no way of knowing whether these embryos or the children will be healthy until the experiment is actually done. It is unclear from the interviews or the article if the assumption is that “unhealthy” embryos will die off before they implant in the uterus or how exactly researchers are expecting to test whether this technique work as another reproductive technology.

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  • If unhealthy embryos die, this poses an ethical problem for those that assume embryos should be granted dignity in their own right. But even if one does not accept that embryos are accorded a certain level of dignity, what about babies and children? What do scientists plan to do if the children born from this procedure are unhealthy or deformed? Finally, it is worth mentioning that this technique would provide a source of eggs, which are needed for various other reproductive techniques and research endeavors. adidas yeezy boost 750 m?skie For example, The UK just passed legislation permitting what has been dubbed “three-parent IVF” in which scientists transfer the nucleus from one woman’s egg to another woman’s enucleated egg that will then be used in IVF. The hope is to prevent mitochondrial disease which is genetically passed down to offspring from the mother. Obtaining skin cells from a donor is much less invasive and poses less of a risk to the donor than obtaining her eggs after inducing hyperovulation.

    Indiana’s HIV crisis

    Indiana is dealing with an incredible HIV outbreak, centralized in Scott County. The HIV outbreak has been directly tied to needle use for opiate drug users. The Governor has called it a public health crisis, and while normally an opponent to needle exchanges, he is allowing for a 30-day needle exchange to curb the outbreak of HIV. To give you a sense of the numbers, typically Scott County will see about five new cases of HIV in a year. They saw 26 new cases between mid-December and the beginning of March, and the count is up to 72 cases as of March 26. The cause of the cases has been traced to intravenous drug use of a liquid form of Opana, a prescription painkiller. Nike Air Max 2017 Heren Doctors in the area report that the drug addiction problem, like many other places in the US, has been going on for at least the last ten years, with increasing incidences of other blood-borne diseases from needle sharing and deaths due to overdose. Scott County is struggling against poverty as well as addiction.

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  • However, opiate drug addiction is a problem that is spanning all demographics across the US.

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  • My article in Salvo Issue 31 looks at nationwide statistics of opiate drug addiction from both prescription pain medicine and heroin use and the underlying causes. Typically, people start with prescription pain medicines. new balance uomo misure It can even be from their own prescription that they obtained legitimately for a hurt back or a tooth extraction or any number of reasons that physicians dole out prescriptions for hydrocodone. One guy, mentioned in my article, got hooked on fentanyl after receiving it as an anesthetic for a colonoscopy. He was already abusing alcohol and other substances in an effort to cope with depression over a break-up. Fentanyl, indeed, served as a pain reliever in more ways than one. Not everyone becomes addicted to opiate drugs when they take pain medicines, but with chronic use, many people do become addicted. And, unfortunately, it is a very difficult addiction to break. Once you’ve tickled those paths in your brain, the tracks that usually take naturally produced endorphins (named for endogenous morphine), you wear a neurological path that is VERY difficult to undo. Unlike endorphins, which our bodies administer through a sophisticated regulatory process that ensures you are receiving the right amounts, opiate drugs stand in as stronger, more potent endorphin replacements. Nike Air Max 95 damskie On a short-term, temporary basis, opiate drugs, like hydrocodone, are supposed to decrease pain, and many of them, when in pill form, are time-released. When our bodies experience pain, endorphins help to quell the effects; however, the endorphins are not enough for injury or sickness, so people take pain medicine. Sometimes people will experience some physical withdrawal symptoms when they stop taking pain medicine if they have been taking them for a while, but physical withdrawal does not necessarily mean the person is addicted. Even physical tolerance is not the full picture of addiction. Addiction has to do with seeking out a high, and in an effort to do so, the person becomes consumed with overcoming physical tolerance to the point that he or she may grind pills and take them intravenously or turn to heroin which is cheaper and sometimes easier to obtain. Scott County is seeing the effects of people sharing needles for opiate drug use. My article gets into both the neuroscience as well as the cultural and psychological factors that lead to addiction. Suffice it to say that one of the problems is accessibility to a substance that is too potent and too addictive to be administered for trivial reasons (such as tooth aches or minor aches and pains). Atlanta Hawks Prior to 1990, opioids were not typically prescribed as painkillers except for cancer patients. But in 1990, that all changed. Doctors wanted a solution to patients’ chronic pain, patients were desperate for relief, and big pharma was ready to profit from the situation. Asics Whiz?er damskie Fast forward to now. The CDC reports that in 2014, physicians wrote 259 million painkiller prescriptions in a single year, the equivalent of one bottle of pills per American. Air Yeezy For Sale They have seen a four-fold increase in overdose deaths since 2000. Canotte San Antonio Spurs At the end of the Washington Post article reporting on Scott County’s crisis, Dr. asics outlet William Cooke points out that this issue is not unique to Scott County, Indiana.

    Is Being Productive the Highest Good?

    Peter from Office Space (Picture from Rotten Tomatoes)

    What happens when all we live to work. Let’s take a look at two shows that poke fun at the white-collar office worker. In the movie, Office Space, the main character, Peter, is disillusioned with the “rat race” of office life.

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  • His work is repetitive and unimportant, and therefore, he feels that his life is also repetitive and unimportant. His life is centered on his job. He lives to work, and because he does not have the right job, he is unhappy. The “happy ending” of the movie is not that Peter eventually learns that there is more to life than work and his identity is not wrapped up in his job. The happy ending is that he eventually finds a job that has the things he likes, being outdoors and working with his hands. Canotte Charlotte Hornet

    Jim

    Jim from The Office (Picture from http://theoffice.wikia.com/wiki/Jim_Halpert)

    In the television show, The Office (U.S. version), one of the characters, Jim, is apathetic about his job at a paper company, Dunder Mifflin. Jim has hobbies, like cycling and playing guitar, but we get the impression that he generally considers his job boring and one of those necessary evils of life (his views change as the series progresses). Dwight, on the other hand, approaches his job at Dunder Mifflin with enthusiasm, showing up early, leaving late, and always trying to be a team player. He also happens to live and work on beet farm, of which he is equally enthusiastic. adidas superstar uomo miglior prezzo Both Office Space and The Office are written so that we relate to Peter and Jim. They represent the angst that most white-collar workers feel, even if we cannot put our finger on exactly what that angst is. Peter wants to be outside. Jim plays music. But are cubicles and paper-pushing really the problem? Perhaps the problem has to do with how we prioritize our lives. Our Western culture has bought into the idea that productivity is the highest good, and therefore work should be an end in itself. Productivity is certainly one of many signs of a good employee or a well-run business, but it is not an end in itself. Being productive should not be the end-all-be-all of life. To live for productivity is hollow and dehumanizing. Machines are fine-tuned to be optimally productive. People strive for something more, and productivity helps us get there. What is leisure? In pre-modern times, people whose lives were centered on work were called slaves or laborers. They put in twelve or fourteen-hour days and spent their non-working time resting and recuperating so that they can work the next day. Their value is in their productivity. This is contrasted to the aristocracy. They engaged in leisure activities, but these activities are not what we think of when we think of “leisure” today. The aristocracy considered leisure activities important for cultural enrichment. Those that used their freedom to engage in diversions or hedonism were considered slothful. Leisure, in the classical sense of the term, is different from restful activities to help recuperate from a long day or mindless activities to cope with the mental tedium of repetitive, labor-intensive work. Leisure activities consisted of the higher pursuits, like education, art, music, and sport. It is no accident that the word we use for “school” comes from the Latin translation of the Greek word for leisure.

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  • Leisure activities often consisted of difficult things that required hard work to master, but these activities were personally enriching and culturally significant. They often involved creating or writing things that have aesthetic appeal and are good in and of themselves. The Industrial Revolution This two class system was turned on its head with the advance of the Industrial Revolution. Industrialization, over the course of one hundred years, took menial, repetitive, undignified work and automated it. It also meant that people did not have to work as many hours, allowing all people to have a life that consisted of rest (including sleeping, eating, and bodily care), non-work, and work time. The non-work time was to be a time for leisure pursuits so that all men may cultivate a virtuous character and engage in culture-making. This resulted in more people getting an education and engage in the arts and sciences. But something happened that caused people to lose track of those priorities. Mortimer Adler, an early-twentieth century scholar, points out that while the Industrial Revolution did much to dignify work and rid of us a labor/aristocracy class system, it also skewed our understanding of work, leisure, and recreation.

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  • Adler lists four negative consequences of the Industrial Revolution that contribute to our malaise:

    1. The Industrial Revolution eliminated the value of individual craftsmanship. Things that used to be made by artisans and craftsmen, like shoes, clothes, candles, or food, were easily produced in the factory setting, thus trivializing certain kinds of work.
    2. The Industrial Revolution changed our priorities such that producing more and more goods became the purpose of all of our efforts. Adler says that we ought to regard the increase in productivity only as a means and not as an end.
    3. As a result, people now think free time should be used only for recreation (or recuperation) in order to get back to work and produce more. It is no longer a time to engage in those things that are edifying and that often bring people joy. Instead, it is spent engaging in diversions which are not ultimately fulfilling.
    4. Classical, or liberal, education was replaced with training for the job so that a person can become a productive member of society. This perpetuated a kind of empty meaning to education that goes something like this: “Go to school and make good grades, so you can go to a good college, so you can get a good job, so you can be a productive member of society.”

    Meaninglessness By placing an emphasis on productivity, people live to work, and therefore, their free time is spent on things that are not tiring, but also not particularly enriching. This leads to a kind of boredom that philosopher-types like to call hyper-boredom. San Antonio Spurs You get the sense of this hyper-boredom when you watch Peter in Office Space. However, hyper-boredom is more than “being in a funk” or not finding the right job. It is a malaise that is best described as operating as though everything was ultimately meaningless. Purdue Boilermakers Why is a proper view of leisure important? Adler summarizes the classical concept of leisure as “consisting in all those activities by which the individual grows morally, intellectually, and spiritually, through which he attains personal excellence and also performs his moral and political duty.” Essentially, it is the things people love to do and would do whether they were paid or not. Leisure is not the same has having nothing to do or “killing time” and it is not a diversion to cope with life. Adler points out that, based on the classical concept of leisure, the good life depends on labor, but it consists of leisure. Fjallraven Kanken Sale Kids A couple of caveats are in order, though. First, some people are blessed to be able to do the leisure activities that they love as their full-time job. Nike Pas Cher Adler, a college professor, considered his job both work and leisure. But, as anyone who has ever been a full-time teacher, writer, or artist knows, there is still a labor aspect to their leisure activity. Most people do not consider grading papers, filling out tax forms, or making sales pitches leisure activities. These things tend to be compulsory, making them work rather than leisure. Second, this is not to say productivity is bad. It is good to be productive as part of pursuing excellence in work. However, orienting your life around productivity is to enslave yourself. Recall that in The Office, Jim was apathetic about work, but Dwight was not. Their characters are meant to be comic foils of each other, but as always, comedy is funny because it contains elements of truth. Dwight had a beet farm, a leisure activity, while Jim had diversions. Jim’s character started to change when he engaged in a meaningful relationship. Nike buty We often think that our leisure, or non-work time, is unimportant, but in reality, it is very important.