The Right and Wrong of Growing Old: Assessing the Argument from Evolution

One argument which is frequently levelled against the enhancement of human biology is that we do not understand the evolved function of our bodies well enough to meddle in our biology without producing unintended and potentially catastrophic effects. In particular, this argument is levelled against attempts to slow or eliminate the processes of human ageing, or ‘senescence’, which cause us to grow decrepit before we die. In this article, I claim that even if this argument could usefully be applied against attempts to enhance other human traits, it cannot be valid in the case of attempts to enhance the various processes that constitute senescence. I begin by reviewing the biology of ageing to show how it consists of a number of unrelated traits. Then, following the arguments of a number of evolutionary biologists, I explain that every one of these traits is a product of evolutionary ‘neglect’ rather than ‘intent’. Finally, I consider the strongest version of the argument against enhancing senescence, which acknowledges these facts about the evolution of ageing but insists that we have nevertheless have prudential reasons to avoid enhancement wherever there is some uncertainty about the genetics or evolutionary function of a trait. I provide two reasons for rejecting this version of the argument as well, even in the case of human senescence, where such uncertainty is currently significant

The Ethical Placebo

Introduction Are placebos indeed deceptive? Is deception necessary in placebo prescription? Is placebo deception unethical? Placebo deception as a special case A limitation Other limitations on placebo deception What to do when pushed Conclusion

Dalit identity in urban Pokhara, Nepal

Urban migration by Nepalese Dalits has not only provided them with social, economic and educational opportunities, but also the possibility of escaping traditional caste-based discrimination. However, despite making the most of opportunities provided by the city, Dalits have not been able to pursue their political agenda to the extent of other ethnic communities. This study in the city of Pokhara, Nepal, explored Dalit identity using two rounds of focus group discussions involving a total of 23 individuals drawn from a range of Dalit caste groups with a variety of livelihoods. The results describe the caste-based discrimination experienced by the participants and the different strategies they employ to either reinvent themselves by changing names; or embracing their caste-heritage and taking advantage of affirmative action programmes. Whilst urban migration can provide some relief from discrimination, the study reveals that caste still remains prominent in the lives of Dalits in Pokhara. The paper argues that Dalit unity and elimination of intra-Dalit caste-based discrimination are needed in order to institutionalise their citizenship rights in post conflict Nepal

Should we live longer?

The project of medicine is to save life, yet there is a strong taboo against Promethean medicines which save life to too great a degree. The mythology of human civilisations is filled with precautionary tales regarding the doomed fate of those who seek to postpone or escape death. These taboos are not easily explained; nevertheless the popular sentiment seems to be that, at some point, it would be wrong to extend the duration of a person's life. Over the past century, the life expectancy of a North American male has almost doubled, mostly through the application of advances in medical technology. This dramatic shift in lifespan has brought about an enormous difference in how we live our lives. We can do more work, have more careers, and have more children who we can expect to outlive us. At the same time, we consume more resources, both in the prime of life, and increasingly in our old age. Though our lives have already increased in length dramatically, we are approaching a turning-point - there are many medical technologies reaching maturity which will soon offer us the opportunity to increase human lifespan. One day these technologies will extend our lives far beyond what we currently consider a 'natural' lifespan. Whether the gains are modest or dramatic, these therapies will make some difference to the lives of those who receive them. We are not facing literal immortality, but we will soon develop the technological capacity to significantly increase human lifespan and decrease the symptoms of ageing, violating the widespread taboos. If no ethical decisions are made, many of these technologies will be deployed and our lives will be extended. If there is any rational basis to the taboo against extending life, we need to discover it soon. By the same token, if these technologies will be beneficial, we need to know why. Both medical research and clinical practice are extremely focused on lifesaving interventions. Current medical practice and current research policy is blind to the effects that medicine has on longevity. This thesis attempts to assess the likely effects that existing and impending medical technologies will have on human longevity, and to assess the normative value of these effects. I begin with a review of various rationales against the use of medical technologies to extend life, which have been put forward by philosophers, biologists and politicians. Some of these arguments are dismissed here on the basis that they lack merit or that they are unanswerable, and the others are retained for analysis in the subsequent chapters. Chapter 2 situates the overall analysis within an evidentiary framework, by reviewing the biological processes that underpin ageing and the technologies that have been developed or proposed for combating these processes. In the light of the available evidence, I propose four archetypal health trajectories that an enhanced person's life may follow, depending on the life-extending therapies which are employed. These orthogonal archetypes locate the different extremes that may be produced by different life-extending technologies. The third chapter seeks to determine the value that each of these archetypes would have for individuals, relative to the value of a normal, un-enhanced life. To do this, I develop a quantified account of utilitarianism based on John Broome's temporal account of benefit and harm. This allows the different health trajectories to be assessed under different assumptions regarding the rate of aged decline and the badness of decrepitude. I then consider various arguments that interfere with the underpinnings of this basic utilitarian account, including several arguments which aim to show that a longer lifespan would be bad for individuals on any theory of value. Following this analysis I am able to sort the archetypal health trajectories by the degree to which they are beneficial or harmful. As a society, we are concerned mainly with the distributed effects of new medical technologies. Chapter 4 focuses on these collective effects of life-extending medicine. Therapies which are unreasonably expensive, or which produce widespread ill-effects for the population as a whole may be unethical even when they are of benefit to individuals. I assess the likely effects of life extension on basic demographic variables such as population size and composition, and draw some conclusions about the ways in which these effects determine the permissibility of different therapies. I consider the types of sacrifices which will be justified in order to obtain the different kinds of health outcomes that will be produced by the new medical technologies. Finally I address arguments against the use of longevity therapies based on egalitarian principles of justice. All technologies which aim to enhance the basic functions of human bodies face a precautionary objection, which warns against the unknown dangers of trying to improve on our biological traits which are the products of the process of evolution. Chapter 5 assesses these arguments in the particular case of enhancements which target the biological processes which underpin ageing. I give an explanation of the evolutionary sources of our ageing and mortality, and compare these sources with our needs and goals. An evaluation is made as to whether or fit nature gives us any moral imperative to preserve the status quo. Finally I am able to draw some broad conclusions about the kinds of limitations which we should place on the development and implementation of medical technologies which extend human lifespan, and whether we should work to live longer than we presently do

A Liberal Account of Addiction

Philosophers and psychologists have been attracted to two differing accounts of addictive motivation. In this paper, we investigate these two accounts and challenge their mutual claim that addictions compromise a person's self-control. First, we identify some incompatibilities between this claim of reduced self-control and the available evidence from various disciplines. A critical assessment of the evidence weakens the empirical argument for reduced autonomy. Second, we identify sources of unwarranted normative bias in the popular theories of addiction that introduce systematic errors in interpreting the evidence. By eliminating these errors, we are able to generate a minimal, but correct account, of addiction that presumes addicts to be autonomous in their addictive behavior, absent further evidence to the contrary. Finally, we explore some of the implications of this minimal, correct view

Refusing to provide a prenatal test: can it ever be ethical?

A couple in which the man carries the mutation for Huntington's disease request prenatal testing during their first pregnancy. Though they would not terminate an affected pregnancy, they would like the information. There is no treatment available that can change the course of the disease so the diagnosis will not result in medical benefit for the chil

Addicted to Love: What Is Love Addiction and When Should It Be Treated?

Recent research suggests that romantic love can be literally addictive. Although the exact nature of the relationship between love and addiction has been described in inconsistent terms throughout the literature, we offer a framework that distinguishes between a narrow view and a broad view of love addiction. The narrow view counts only the most extreme, harmful forms of love or love-related behaviors as being potentially addictive in nature. The broad view, by contrast, counts even basic social attachment as being on a spectrum of addictive motivations, underwritten by similar neurochemical processes as more conventional addictions. We argue that on either understanding of love-as-addiction, treatment decisions should hinge on considerations of harm and well-being rather than on definitions of disease. Implications for the ethical use of anti-love biotechnology are considered