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No Pain, All Gain: The Case for Farming Organs in Brainless Humans

10 Jun, 17 | by Iain Brassington

Guest post by Ruth Stirton, University of Sussex (@RuthStirton) and David Lawrence, Newcastle University (@Biojammer)

It is widely acknowledged that there is a nationwide shortage of organs for transplantation purposes.  In 2016, 400 people died whilst on the organ waiting list.  Asking for donors is not working fast enough.  We should explore all avenues to alleviate this problem, which must include considering options that appear distasteful.  As the world gets safer, and fewer young people die in circumstances conducive to the donation of their organs, there is only so much that increased efficiency in collection (through improved procedures and storage) can do to increase the number of human organs available for transplantation. Xenotransplantation – the transplantation of animal organs into humans – gives us the possibility of saving lives that we would certainly lose otherwise.

There are major scientific hurdles in the way of transplanting whole animal organs into humans, including significant potential problems with incompatibility and consequent rejection.  There is, however, useful similarity between human and pig cells, which means that using pigs as the source of organs is the most likely to be viable.  Assuming, for the moment, that we can solve the scientific challenges with doing so, the bigger issue is the question of whether we should engage in xenotransplantation.

A significant challenge to this practice is that it is probably unethical to use an animal in this way for the benefit of humans. more…

Gene Editing For A Long Life – A No Brainer?

28 Apr, 17 | by miriamwood

Guest Post: Isabelle L Robertson
Paper: Student Essay- Designing Methuselah: an ethical argument against germline genetic modification to prolong human longevity

I am 16 years old. I am at the start of my life and looking towards my future, deciding on universities, career options and how I want my life to be. At the moment I can expect to perhaps live to 90 years of age. To me, this seems like a pretty good life. If I was offered more would I take it? I’m not sure; perhaps, if my health and independence can be guaranteed, then yes, I might.

Scientists have identified genes in mice that regulate lifespan. They have then edited these genes and have bred mice that have lived a full generation longer than their peers. These genes have their equivalents in the human genome too. Gene editing is becoming more refined by the day and it is predictable that it will one day be technically possible to edit the genome of human embryos to extend their lifespan. Again, extending from mice trials humans with these same genes altered could live to around 130 years old, the equivalent of a whole extra generation.

Gene editing technology brings with it many exciting opportunities such as the possibility of ridding some individuals of disease causing genetic variants. The possibilities extend beyond this though. It is not an unlikely prospect that in my lifetime I will be faced with the choice of deciding if I want my children to have any genetic alterations. These alterations might not just be limited to lifespan extension either; it is foreseeable that enhancements to traits as varied as intelligence, appearance and athletic capability may be potentially on offer. It’s clear that ethical discussion around each of these scenarios is needed. In my paper I have concentrated on whether genetically editing the human genome to extend lifespan is likely to enhance the quality of a person’s life.


Treatment of Premature Ejaculation: Alleviating Sexual Dysfunction, Disease Mongering, or Both?

25 Mar, 17 | by bearp

by Brian D. Earp / (@briandavidearp)

An interesting new paper, “Distress, Disease, Desire: Perspectives on the Medicalization of Premature Ejaculation,” has just been published online at the Journal of Medical Ethics. According to the authors, Ylva Söderfeldt, Adam Droppe, and Tim Ohnhäuser, their aim is to “question the very concept of premature ejaculation and ask whether it in itself reproduces the same sexual norms that cause some to experience distress over ‘too quick’ ejaculations.” To prime the reader for their project, they begin with a familiar story:

a condition previously thought of as a variant within the normal range, as a personal shortcoming, or as a psychological issue is at a certain point cast as a medical problem. Diagnostic criteria and guidelines are (re-)formulated in ways that invent or widen the patient group and thus create or boost the market for the new drug. Those involved in developing the criteria and the treatment are sometimes the same persons and, furthermore, cultivate close connections to the pharmaceutical companies profiting from the development. Sufferers experience relief from personal guilt when they learn that their problem is a medical and treatable one, whereas critics call out the process as disease-mongering.

Something like this pattern has indeed played out time and time again – methylphenidate (Ritalin) for ADHD, sildenafil for erectile dysfunction, and more recently the development of flibanserin for “hypoactive sexual desire disorder” (see the excellent analysis by Antonie Meixel et al., “Hypoactive Sexual Desire Disorder: Inventing a Disease to Sell Low Libido” in a previous issue of JME). Having set up this narrative, Söderfeldt, Droppe, and Ohnhäuser turn their attention to the case at hand—the “medicalization” of premature ejaculation (PE).

The begin by noting that certain selective serotonin reuptake inhibitors (SSRIs), normally used to treat depression (itself the “medicalization of sadness” on some accounts), have been known since at least the 1990s to sometimes delay ejaculation as a “side-effect.” They then call attention to a 2004 application by Johnson & Johnson for FDA approval of dapoxetine for on-demand—as opposed to off-label—“treatment” of PE.

Rather than digging into debates over medical evidence concerning the efficacy of the drug, they jump right to a set normative questions touching on the medicalization of sexual experience and behavior. As they note, ethical discussions concerning the prescription of Ritalin and sildenafil (among other pharmaceutical innovations) centered on questions about what we see as “normal” behavior—and on how adding drugs to the mix might change those perceptions in ways that are potentially concerning.

But with few exceptions, according to Söderfeldt et al., the introduction of dapoxetine as a “treatment” for PE “has not yet elicited reactions of that sort.” They see this as surprising, because PE is to a large extent “a diagnosis that reflects cultural standards and is contingent on normative social behavior.”


Combating Doping in Sports: More of the Same or What?

7 Feb, 17 | by miriamwood

Guest Post: Bengt Kayser and Jan Tolleneer

Paper: Ethics of a relaxed antidoping rule accompanied by harm-reduction measures

Doping in sports continues to be prominently present in the media. Regularly ’scandals’ surface that then trigger flurries of articles, documentaries and reactions in the media. The general tone is one of moral opprobrium, dopers are considered deviant and bad. Frequently these episodes are accompanied by arguments for more means for repression of doping. These efforts, in principle coordinated by the World Anti Doping Agency (WADA), aim at eradicating doping from sports.

Doping is  considered cheating and dopers are bad. But despite increasing means doping remains rife, leading to what some call an arms race in a war on doping. Anti-doping still continues to cling to its essentialist objective, getting rid of this behaviour, even though it appears increasingly clear that this objective cannot be reached. Already today athletes have to comply with exceptional rules, such as the obligation to inform about their whereabouts 365 days a year in order to allow in and out of competition unannounced urine and blood sampling for anti-doping controls. But calls for more means and more repression resound. Increasingly countries, pressurized by the International Olympic Committee and WADA, introduce criminal law to repress doping, in several countries also applicable to non-athletes.

But repression of human behaviour comes with a cost. Prohibition of alcohol in the USA in the first part of the last century is good example, as is the so-called war on drugs. Like the latter, anti-doping also has unintended side-effects and it is possible that the overall societal cost of anti-doping may surpass the positive effects of anti-doping. The question then arises if there exist alternative approaches to dealing with doping. But so far the only two discourses on alternatives for dealing with doping focus on either repression or liberalisation.

In our recently published paper in the Journal of Medical Ethics we argue that there is an ethically acceptable alternative somewhere mid-stance. Our point of departure is a partial relaxation of the anti-doping rule, accompanied by harm reduction measures, in a dynamic setting, i.e. adaptable over time in reaction to what the effects would be. We develop our arguments on five levels: (1) What would it mean for the athlete (the self)? (2) How would it impact other athletes (the other)? (3) How would it affect the phenomenon of sport as a game and its fair play basis (the play)? (4) What would be the consequences for the spectator and the role of sports in society (the display)? and (5) What would it mean for what often is considered as essential to being human (humanity)? Our analysis suggests that a partial relaxation of the anti-doping rule accompanied by harm-reduction measures appears ethically defensible on all five levels. Our proposed alternative framework thus potentially provides an escape from the present spiralling towards criminalisation of doping and doping-like behaviour in society. It is time to start discussing the practical details of such a policy change and to start experimenting.

Amoral Enhancement

10 Oct, 16 | by miriamwood

Guest Post by Saskia Verkiel

Re: Amoral Enhancement

A reply to Douglas’ reply to Harris’ reply to Douglas regarding the issue of freedom in cases of biomedical moral enhancement

Wouldn’t it be awesome if we could just swallow a pill and become better people?

With many aspects of life, growing numbers of people are embracing biomedical interventions to improve physical or cognitive performance and endurance, whether indicated for those purposes or not. Think doping in sports. Think Ritalin in college. Think beta blockers in stage performers. Think modafinil in pilots and surgeons who have to be alert for long stretches of time.

The funny thing is that when it comes to moral enhancement, we tend to think more in terms of its application to others, who are ‘obviously’ not such good people. Swindlers. Rapists. Basically all kinds of performers of crime.

Thomas Douglas was the first to write an analysis specifying when certain kinds of biomedical moral enhancement would be permissible, in 2008, and he realised that it’s important to make this distinction of whom we want the enhancement for. He focused on voluntarily enhancing the self. It’s a jolly nice read.

This paper triggered a cascade of replies.

To be fair, seeing the replies fly back and forth in this debate is not unlike watching a ballgame, albeit more enlightening (or so I think). Compare with Monty Python’s Philosophers’ Football. There’s team “Let’s put it in the drinking water!” (roughly: Oxford) and there’s team “Hold it, hold it…” (captained by John Harris and including yours truly).


We’re all Gonna Die… Eventually

6 Oct, 16 | by Iain Brassington

It might just be a product of the turnover of people with whom I have much professional contact, but I’ve not heard as much about human enhancement in the past couple of years as I had in, say, 2010.  In particular, there seems to be less being said about radical life extension.  Remember Aubrey de Grey and his “seven deadly things“?  The idea there was that senescence was attributable to seven basic processes; those basic processes are all perfectly scrutable and comprehensible biological mechanisms.  Therefore, the argument went, if we just put the time and effort into finding a way to slow, halt, or reverse them, we could slow, halt, or reverse aging.  Bingo.  Preventing senescence would also ensure maximum robustness, so accidents and illnesses would be less likely to kill us.  To all intents and purposes, we’d be immortal.  Some enterprising people of an actuarial mindset even had a go at predicting how long an immortal life would be.  Eventually, you’ll be hit by a bus.  But you might have centuries of life to live before that.

Dead easy.

I was always a bit suspicious of that.  The idea that death provides meaning to life is utterly unconvincing; but the idea that more life is always a good thing is unconvincing, too.  What are you going to do with it?  In essence, it’s one thing to feel miffed that one isn’t going to have the time and ability to do all the things that one wants to do: life is a necessary criterion for any good.  But that doesn’t mean that more life is worth having in its own right.  Centuries spent staring at a blank wall isn’t made any better by dint of being alive.

But a letter published this week in Nature suggests that there is an upper end to human lifespan after all.  In essence, the demographic data seem to suggest that there’s an upper limit to survivability.  That being the case, we should stop worrying about making people live longer and longer, and concentrate on what’s going on during the 125 years or so that Dong, Milholland and Vijg think is allotted to us. more…

Making Humans Morally Better Won’t Fix the Problems of Climate Change

25 Aug, 16 | by miriamwood

Guest Post by Bob Simpson, Monash University

Re: Climate change, cooperation and moral bioenhancement

The Intergovernmental Panel on Climate Change has repeatedly said that greenhouse gas emissions increase the likelihood of severe and irreversible harm for people and ecosystems. And in his State of the Union address in 2015, Barack Obama emphasised these problems, saying that climate change poses the greatest threat to humanity’s future. We’ve come to expect pronouncements like these. Political leaders and transnational policy institutions both have an important role to play in implementing the measures needed to address threats from climate change – measures like international economic agreements, energy sector reform, and technological research.

By contrast, we wouldn’t expect advocates of biotechnological human enhancement to be proposing solutions to climate change. What does human enhancement have to do with oceanic warming or greenhouse gas emissions? According to people like Ingmar Persson and Julian Savulescu, who advocate “moral bio-enhancement”, these things are in fact related. They say that we should be finding ways to use biotechnological interventions to make people more trusting and altruistic towards strangers, and hence more willing to make personal sacrifices – like, say, dramatically reducing their carbon footprint – in order to cooperate in global policies aimed at mitigating the impact of climate change.


Enhancement as Nothing More than Advantageous Bodily and Mental States

20 May, 16 | by BMJ

Guest Post by Hazem Zohny

Some bodily and mental states are advantageous: a strong immune system, a sharp mind, strength.  These are advantageous precisely because, in most contexts, they are likely to increase your chances of leading a good life.  In contrast, disadvantageous states – e.g. the loss of a limb, a sense, or the ability to recall things – are likely to diminish those chances.

One way to think about enhancement and disability is in such welfarist terms.  A disability is no more than a disadvantageous bodily or mental state, while to undergo an enhancement is to change that state into a more advantageous one – that is, one that is more conducive to your well-being.  This would hugely expand the scope of what is considered disabling or enhancing.  For instance, there may be all kinds of real and hypothetical things you could change about your body and mind that would (at least potentially) be advantageous: you could mend a broken arm or stop a tumour from spreading, but you could also vastly sharpen your senses, take a drug that makes you more likeable, stop your body from expiring before the age of 100, or even change the scent of your intestinal gases to a rosy fragrance.

Would all such changes be instances of enhancement? more…

Putting a Price on Empathy

12 Aug, 15 | by BMJ

Guest Post by Sarah Carter

My paper is another to add to the ever-increasing number of articles about moral (bio)enhancement – but why is this issue so important?  To take a cynical view: if we had a pill or injection that could make people more moral, less prone to harming others, and so on, it would likely be very attractive to governments (perhaps because of real concerns that we’re headed for disaster unless such steps are taken, or simply because it would save on policing and military bills).  So it’s very important to try to get our heads around this subject while it’s still something that’s merely an idea, rather than waiting until it’s something in our medicine cabinets.  This means thinking about and discussing everything from what moral enhancement would actually involve, right through to questioning how it should be distributed, regulated, and even – as my paper addresses – promoted to the public.

Writers such as Persson and Savulescu argue that there is a need to undertake moral bioenhancement as a means to avoid mankind wandering down the path of ultimate harm, but they concede that many people (especially those we might say to be most in need of moral bioenhancement) would be unlikely to undergo it willingly.  In 2014, Vojin Rakic suggested that incentives such as tax breaks, retirement benefits, schooling allowances, and affirmative action policies, should be used as a way to encourage people to undergo moral bioenhancement.  I think that Rakic’s idea, while prima facie sensible and reasonable, simply will not work. This is not due to issues of coercion or social justice that we would normally associate with the use of incentives, but rather because likely public perceptions of moral bioenhancement mean that the use of incentives for this purpose may present a taboo trade-off. more…

How to be a good (consequentialist) bioethicist…

6 Jul, 15 | by David Hunter

There has recently been a pattern of papers (and I am not going to identify which ones) which I take as being slightly embarrassing to academic bioethicists because they portray us in a less than flattering light because of the naive mistakes they seem to make, or the outlandish poorly argued claims they make. I have noted a trend for these to have come from relatively new, consequentialist bioethicists and being the helpful sort that I am, the aim of this blog post therefore is to help consequentialist bioethicists from falling into these pitfalls.


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