Conversion Therapy

Gender identity is a relevant topic for discussion more now than it has ever been.  It is very prevalent in today’s society with changes in laws and a push for equality among a divided country.  Our ethics topic is based in relation to gender identity, questioning the ethical legitimacy of conversion therapy for those who do not identify as heterosexual.  To first be able to attempt to answer this question, one must understand the current beliefs and research about how gender identity develops.  The sciences have generally found a difference in the hypothalamus between homo and heterosexuals.  Also, there has been a difference in specific cerebral portions of the brain.  Others have seen a correlation with left-handedness and homosexuality.  What’s the general consensus?  We cannot necessarily come to a conclusion of where gender sexuality--be it heterosexuality or non-heterosexuality--develops but we can say that research is showing it is not a choice.  Some people may in fact choose to be homosexual, but more often than not, we find that it is a biological development.

Regardless of how gender development may occur, people deal with bigger issues than trying to figure out with what they identify.  There are so many cultural pressures--societal, religious, family, peer, school, government, and more--that dictate what is normal and acceptable.  The ultimate question is not converting all non-heterosexuals to heterosexuals; the ultimate question is: Is it our job to help “fix” these people to what is culturally normal and acceptable, or is it to help these people accept who they are and allow them to live their lives to the fullest?  How much is someone identifying as a non-heterosexual really going to affect your life?  - written by students

Sources read before class:

http://www.huffingtonpost.com/entry/realities-of-conversion-therapy_us_582b6cf2e4b01d8a014aea66

https://www.lifesitenews.com/news/ex-gay-homosexuality-is-just-another-human-brokenness

Other sources used:

Pinel JP.  Basics of biopsychology.  New York (NY): Pearson; 2007.

Zgourides GD.  Human sexuality: contemporary perspectives.  New York (NY): HarperCollins College Publishers; 1996.

Recommended sources for further engagement/Bibliography

APA:

http://www.apa.org/pi/lgbt/resources/just-the-facts.aspx

http://www.apa.org/news/press/releases/2015/04/therapies-sexual-orientation.aspx

Trump:

https://www.washingtonpost.com/news/to-your-health/wp/2016/11/19/gays-can-be-reformed-just-like-arsonists-trumps-new-domestic-policy-adviser-has-said/?utm_term=.20677faea316

https://www.whitehouse.gov/the-press-office/2017/01/31/president-donald-j-trump-will-continue-enforce-executive-order

https://www.washingtonpost.com/news/to-your-health/wp/2016/11/19/gays-can-be-reformed-just-like-arsonists-trumps-new-domestic-policy-adviser-has-said/?utm_term=.20677faea316

http://www.politifact.com/california/statements/2016/dec/02/gavin-newsom/pences-support-conversion-therapy-not-settled-matt/

https://www.washingtonpost.com/news/to-your-health/wp/2016/11/19/gays-can-be-reformed-just-like-arsonists-trumps-new-domestic-policy-adviser-has-said/?utm_term=.20677faea316

Obama Administration:

https://www.nytimes.com/2015/04/09/us/politics/obama-to-call-for-end-to-conversion-therapies-for-gay-and-transgender-youth.html?_r=0

Gayness is a choice (Cynthia Nixon):

http://www.slate.com/blogs/xx_factor/2012/01/23/is_cynthia_nixon_s_sexuality_really_a_choice_.html?wpisrc=slate_river

ELCA:

https://www.elca.org/JLE/Articles/742

Evolution:

http://www.bbc.com/news/magazine-26089486

Stem Cells

Using stem cells for research and potential treatments options become ethically challenging due to the techniques used to acquire these cells. The ethical dilemma most frequently explored when discussing the use of stem cells is the use of human embryonic stem cells as these must be acquired from embryos and therefore the embryos cannot be implanted into the uterus for growth and development to become a human. Similar to ethical considerations with abortion, the determination of when a life begins becomes an important topic within this conversation. The central argument that destroying embryos to use stem cells for research or treatments relies on the idea that the proliferation of cells occurring within an embryo constitutes, at least, a being that has the potential for productive human life. The issue with this argument lies in defining what is truly a “productive human life.” Another ethical concern regarding the use of human embryos entails the use of discarded embryos following in-vitro fertilization. Those who support using these embryos as a viable option for collecting stem cells posit that without the proper environment, implanted in the uterus, these embryos have no chance at surviving and developing. - written by students

Aside from the use of embryonic stem cells, other types of stem cells have also been and are currently being explored to determine their usefulness and procedural aspects in treatment conditions. Recent research and discoveries, along with an example of a well understood stem cell treatment - bone marrow transplant, are reviewed within the powerpoint found here.

An overview video on the topic of stem cell treatment and its possibilities can be found here.

Source read before coming to class:

Ethics of Stem Cell Research. Stanford Encyclopedia of Philosophy.

Recommended sources for future engagement

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726839/

http://learn.genetics.utah.edu/content/stemcells/scissues/

http://www.bbsrc.ac.uk/documents/1007-stem-cell-resourse-edition3-pdf/

Consciousness, Pain, and End of Life Decisions

End of life and quality of life decisions have great relevance to the field of neuroethics as impacted individuals often present alterations or reductions in mental capacity or nerve-mediated physical capacity. Two neuroscientific features that are important to consider in maintenance or withdrawal of life-sustaining treatment is the perceived consciousness and pain of the patient. While technologies such as neuroimaging, electrophysiology, and specialized devices claim to quantify these parameters, much research still needs to be done to ensure that consciousness and pain are depicted accurately in appropriate brain regions or circuits, especially for those who lack speech abilities. Quality of life itself surprisingly increases in self-reports from disabled or severely injured patients, representing a disability paradox that brings into question how quality of life is itself defined. Finally, conflicts of who has the responsibility to dictate these end of life or quality of life decisions (family, physicians, or legislature) also arise and have not come to a settled consensus.

As many people choose career paths that fit under the health care profession, it seems beneficial to understand the ethical standpoint that future careers take when it comes to pain and consciousness pertaining to quality of life and end of life decisions. Though not all health care professions deal with end of life decisions as often as others, quality of life is a very important point when it comes to health care treatment. Specifically, there seems to be a discrepancy between health care occupations when it comes to the perception of pain for patients whose consciousness may be impaired. This discrepancy can lead to disagreements on the ethical standpoint about pain and consciousness for those who have consciousness disorders, making an established code of procedure difficult to follow through with.  - written by students

Sources read before this class:

Can they suffer? The ethical priority of quality of life research in disorders of consciousness. By L.S.M. Johnson in Neuroethics. 2013.

Recommended sources for further engagement:

1. Pain perception in disorders of consciousness: Neuroscience, clinical care, andethics in dialogue. By A. Demertzi et al. in Neuroethics. 2013.  This article provides some of the background data we mentioned during class, such as ageism in medication administration and the roles of religion and specific healthcare profession in influencing end of life opinions.

2. Coma: Detecting signs of consciousness in severely brain injured patientsrecovering from coma. By C. Schnakers, J. Giacino, & S. Laureys in International Encyclopedia of Rehabilitation. 2010.

Contains good definitions regarding the different types of consciousness disorders and types of behavioral assessments that can be done to help with diagnosis. 

3. Slowing Down Brain Is Still Fraught With Risk. By Ceci Connolly in the Washington Post. 2006. This article discusses the questions that still exist regarding the safety of medically induced comas and suggests alternative treatments such as hypothermia and craniectomy to reduce brain injury.

4. “The locked-in syndrome”: Can it be unlocked? By Kunal Khanna, Ajit Verma, & Bella Richard in Journal of Clinical Gerontology and Geriatrics. 2011.  Demonstrates the format of a AEIOU alphabet board used in eye scanning communication for ALS patients in addition to other techniques such electromyographical (EMG) technology, which is used by theoretical physicist Stephen Hawking.

Popular books or movies that address the topic:

1.  Mar Adentro (“The Sea Inside”) (2004) - A Spanish drama starring Javier Bardem that portrays the real-life story of Ramon Sampedro who fought for the right to end his life for 28 years after a diving incident left him paralyzed from the neck down.

2. Me Before You (book or movie) (2012, 2016) - A romantic novel about a girl who takes a job working for Will Traynor, who is bound to a wheelchair after an accident. The book tells the story about the two’s relationship and the choices Will makes based on his paralysis condition. Made into a major motion picture in 2016.

3. The Diving Bell and the Butterfly (book or adapted movie) (1997, 2007) - A memoir of the editor-in-chief of French Elle magazine, Jean-Dominique Bauby, who describes what life is like in locked-in syndrome following a massive stroke. 

Consciousness, Pain & Abortion

Abortion is a heavily debated topic, especially within politics. There are many aspects to analyze when debating the ethics of abortion, one of which is science. Neuroscientists have been engaging in conversation regarding abortion and what makes it ethical or not. Two topics that are brought into the debate are consciousness and pain. Consciousness has many different definitions depending upon what view you're looking at it from. 17th century French philosopher Rene Descartes defines it as, “the idea that the mere act of thinking about one’s existence proves there is someone there do the thinking.” In the world of neuroscience it is defined as a set of cognitive functions, including learning and memory, in concert with attention. Psychologist see it more as individual awareness of your unique thoughts, memories, feelings, sensations, and environment. However, some neuroscientist and philosophers believe consciousness is just a “pointless” side effect of cognitive process. This brings up the issue of whether basing abortion off of a “consciousness meter” is appropriate.

            There are several major areas in the brain responsible for consciousness. The thalamus is a relay station in the center of the brain that connects many other regions of the brain, while the prefrontal parietal cortex is involved in cognitive processes, attention and working memory. Until the fetus has developed a connection between these two areas, the fetus will be unaware and unable to feel pain. Some legislators want to implement a law making abortions illegal after 20 weeks gestation no matter the circumstance of the pregnancy. Science challenges this policy because connection between the thalamus and the prefrontal parietal network do not happen until 29-33 weeks gestation. Although pain receptors first develop between 7 and 9 weeks gestation, the connection to the pathway that carries them out is not present until 33 weeks along. - written by students

Source read before this class:

When Do We Become Truly Conscious? Daniel Bor. 2012.

Recommended sources for further engagement:

Scientists Closing in on the Theory of Consciousness. Tanya Lewis. 2014.

Does a Fetus Feel Pain at 20 Weeks. Dave Levitan. 2015.

Consciousness and the Prefrontal Parietal Network: Insights from Attention, Working Memory,and Chunking. Daniel Bor and Anil K. Seth. 2012.

When Does a Fetus Feel Pain?: Anesthetizing the fetus during abortion is unnecessary, and maybe even dangerous. Elise Kleeman. 2005.

Consciousness: The Psychology of Awareness. Kendra Cherry. 2016.

(source used during class when asked about how abortions are performed.)

The Drug Approval Process in the US (and Off-Label Uses)

      The Federal Drug Administration (FDA) is responsible for approving medicinal drugs for use within the US, based on perceived safety and efficacy.  Before the FDA will approve a drug, it must go through an extensive research process that involves first testing various compounds on tissues and animals to find promising candidates, then testing the promising drugs on human through a series of trials, each one involving a larger number of people.  Phase I trials aims to determine safe doses. Phase II trials look like the final experiments in animals, having control and experimental groups to determine if the drug has benefits over no treatment or previously used treatments.  Phase III trials are on a larger scale to confirm that all relevant populations respond as determined in Phase II.  An unsuccessful trial at any stage results in cancellation of the process, and successful human trials often last up to 6 years.  Once the drug makes it through Phase III trials it can be patented and made available to the public.  The company that discovered and tested the drug usually maintains exclusive access to marketing the drug for 20 years from the start of trials, after which point other companies can make generic versions that undergo a much shorter testing process. 

      The process is very rigorous, and thus the advantage of the process is that citizens can feel relatively confident that the medical treatments they’re receiving are safe and effective.  However, it also means that the US is slower than many other countries at making some treatments available to its citizens.  As a result, some individuals will seek treatment in other countries with much more flexible rules, all at their own risk.   A related short-cut to access is using drugs for a medical condition other than the one that the clinical trials investigated.  This practice is called “off-label” use.  Although the safety of the drugs has been tested on one type of population, safety is not necessarily guaranteed for another patient population.  Efficacy has also not been fully vetted.  Doctors should make clear to patients when the drugs they’re prescribing are being used off-label, but patients may not always recognize what this term means or the risks and benefits associated with such use. - SLB

Source read before class:

Botox: The drug that is treating everything.  By Alexandra Sifferlin in TIME Magazine.  2017.  

Recommended sources for further engagement:

The $2.5-billion mistake:  A gullibleTrump bought into Big Pharma’s inflated claim about drug R&D costs.  By Michael Hiltzik in the Los Angeles Times.  2017.  – An opinion piece about costs of the approval process and potential plans to alter the approval process 

Testing drugs on the developing world.  By Stephanie Kelly in The Atlantic.  2013. – One way to make drug testing cheaper is to outsource testing to other countries.  This article summarizes the process and potential issues.  

Overview of clinical trials.  At Centerwatch.com. - A bit more about what happens at each stage and how many drugs make it through

Popular books or movies that address the topic:

The Constant Gardener (2005) – fictional thriller about overseas drug trials in Africa; based on a novel of the same name by John Le Carré.  

The Scientific Process and Its Problematic Incentives

When you learn about the scientific process in school science courses, it usually begins with an hypothesis and ends with conclusions or creation of a new hypothesis.  However, there are many other logistics involved with the scientific process, including receiving funding and publishing your findings.  The pressures associated with funding and publishing can lead to questionable research practices (QRPs) and outright fraud by scientists desperate to maintain the right to keep doing science.  Money is necessary for most experiments, and frequently publishing results is often required for receiving grants (and keeping one’s job).  Scientists may plagiarize, selectively choose data to include, and take shortcuts on ethical treatment human or animal subjects, among other things.  Although some of these QRPs are committed with the intent to mislead, others are likely done in good faith, with the researchers just looking to speed up the sharing of exciting findings they “know” to be true.  Whatever the reason, QRPs have the potential to promote misinformation, resulting in 1) the media sharing reactive, but untrue and thus dangerous information with the public, and 2) other scientists wasting time trying to replicate or build upon findings that don’t stand the test of time

The above suggests that researchers are to blame for a lot of the misinformation.  However, the system itself is also problematic, as we prioritize publication of novel, unexpected results.  Science is supposed to be “self-correcting”, in that once we find out that an earlier experiment’s data doesn’t hold up we publish new information, but when only the first study receives publication in prestigious journals or media attention, misinformation lingers much longer than it should.  Some of these cases are now well known (like the [non]link between vaccines and autism), but recent studies suggest that a large percentage of studies, across multiple disciplines, are not replicable, at least in terms of finding statistical significance. - SLB

Source read before class:

Communicating neuroscience: hype and the sources of spin.  By Timothy Caulifield as part of the Brains Matter!  Vancouver. Brain Science and Social Responsibility. Thematic Sessions Video Podcasts.  2014.  

Recommended sources for further engagement:

Falsepositives: fraud and misconduct are threatening scientific research. by Alok Jha in the Guardian. 2012. - A review of reasons scientists cheat and some of the dangers of doing so.

How many scientists fabricate and falsify research? Asystematic review and meta-Analysis of Survey Data.  Daniele Fanelli in PLOS One.  2009. - A peer reviewed article that highlighted just how common problems may be in science. (A bit dense, but nice to see the methods and data so you can draw your own conclusions)

Study that undercut psych research got it wrong. Peter Reuell in the Harvard Gazette.  2016.  - There was a study that made the news last year stating that most psychology studies weren’t replicable.  This article explains some of those findings and some of those critiques.  (The article itself is available through Science if you have access.)

Reproducibility in cancer biology: Makingsense of replications.  Brian Nosek and Timothy M Errington in eLife.  2017. - Since the psychology non-replication study was published, the same group has been trying to replicate other fields.  Here is the most recent, demonstrating that cancer research isn’t replicable either.

The Trolley Problem and Self-Driving Cars

“The Trolley Problem” is an ethical quandary invented by philosopher Philippa Foot in the 1960s and frequently modified by various audiences since then.  The original quandary is this:  Imagine you’re driving a runaway train that is about to collide with a set number of people on the tracks.  You could switch tracks and kill a smaller number of people on alternative tracks.  Do you switch tracks?  The question can be modified to determine how much you are influenced by various variables such as relationship with the individuals, worth of those individuals, and the sense of agency you feel in the resulting deaths.  If you use a truly utilitarian approach to making the decision, you should always choose the track that would kill the fewest people (or at least the people with the lowest societal value).  However, the results of this thought experiment have repeatedly shown that people are not making purely utilitarian decisions.  In the last few decades, neuroscientists have begun to determine which brain areas are active while people are making these decisions, in an effort to better understand brain areas involved in complex decision-making.  This new “scientific” dimension of the question has led to a resurgence of interest in the trolley problem.

Although the trolley problem has often been critiqued as being an unrealistic situation, programmers working on self-driving cars must now wrestle with very similar ethics.  Programmers have the advantage of plenty of time to contemplate the best course of action in various situations, unlike drivers who must react in the moment.  If a self-driving car suddenly detects a small child that runs in front of it, should the car swerve, despite knowing it would hit the brick wall and kill its driver?  Public opinion surveys suggest that people want self-driving cars to prioritize the greatest number of lives, but they’d be much more likely to buy a self-driving car if their particular self-driving car prioritized the life of the driver.  Artificial intelligence will allow us to make the “best” decisions more often; the problem is that as humans, even with plenty of time to think about those decisions, we still struggle to know what those best decisions are. - SLB

Recommended sources for further engagement:

Moral Machine.  by the Scalable Cooperation at MIT Media Lab.  2016.

Simulation that allows you to decide between two options for what a self-driving car should do, and then compares your responses to those who have answered previously

Can You Program Ethics Into a Self-Driving Car? by Noah J. Goodall in IEEE Spectrum.  2016.

Examines the ethics of self-driving cars

The Social Dilemma of Autonomous Vehicles. by Jean-François Bonnefon, Azim Shariff, and Iyad Rahwan in Science.  2016. 

The peer reviewed article that asked people what they would want cars to do in general and what they would want their particular car to do (but you need access to Science to read it)

The Trolley Problem and the Evolution of War.  by Peter Reiner at the Neuroethics at the Core blog.  2011.

Briefly describes the trolley problem in general, and then applies the model to decisions made in war, including the use of drones which is another AI application

The Rational Vulcan.  by Dave Johnson at the Neuropoly blog.  2010.

Some history, other ethical thought problems, and a description of brain areas involved when answering the trolley problem

The Hypocrisy of Professional Ethicists.  by Emma Green in The Atlantic.  2015.

Summarizes findings that suggest that studying ethics (and thus engaging in thought experiences like the trolley problem) does not result in making more ethical decisions

Resources for ethics topics

Websites focused on Neuroethics:
The Dana Foundation (focus on implications of neuroscience)
The Oxford Centre for Neuroethics (list of a few topics, and info on those topics)
Center for Science and Law (interesting views on how modern brain science interacts with law)
The MacArthur Foundation Research Network on Law and Neuroscience
The Neuroethics Blog (hosted by Emory University's Center for Ethics)
U of British Columbia's National Core for Neuroethics (click on the various research groups to see various topics)
U. Penn's Neuroethics Open Educational Resource (videos on various topics)
Columbia U.'s Neuroethics course (the entire course is free online if you're interested; or you can just use their layout of topics for ideas)
Neuroscience for Kids (obviously not at the correct level, but has good ideas)

Peer reviewed journals:
American Journal of Bioethics Neuroscience
Neuroethics
Journal of Ethics in Mental Health

A list of many other sources:  International Neuroethics Society - Resources
(You may find other things on this website useful as well.)

Another excellent source of articles

The journal publisher Elsevier has made available for free (until Dec 2018) their top cited articles of 2016.  The below link is their list of these articles that they consider to be neuroscience, allowing you to quickly find some new, interesting articles and link to free versions of them to see if they'd be relevant and understandable for the class assignment (or to just learn cool new things).

Elsevier's Top Cited Neuroscience Articles of 2016

Resources for New Discoveries in Neuroscience

The below websites highlight interesting new neuroscience findings.  Some of the below merely summarize the findings; others also put them in context and/or critique them.  As a neuroscience major, you might find these interesting to follow in general.  They're also great sources for finding primary, peer reviewed articles for discussing in class.  (If you have additional sources you think I should add to this list, please let me know.  There are many out there; it is just a matter of finding ones that have frequent, information-rich posts.)

NeuroScientistNews - choose from Research News or Clinical Updates (or follow them on Facebook)
The Neurocritic
The Neurocomplimenter 
Neuroskeptic (supported through Discover)
Neurophilosophy (supported through the Guardian)


Below are other blogs that often discuss interesting neuroscience ideas (but don't necessarily highlighting recent discoveries, so they'd be fun to read, but may not be useful for assignments in this course).

Scientific American Mind guest blogs
Not Bad Science (supported through Scientific American; focuses on animal behavior and cognition)
BrainFacts (the blog of the Society for Neuroscience)
BrainBlogger


And finally, the below blogs are interesting reads, but they are no longer being updated, so they won't provide you with brand new findings.  (Both were active until recently, though.)
Neurorexia
NeuroBollocks (as the name suggests, this blog focuses on debunking pseudo-neuroscience, which is interesting, but less informative in the way of new ideas)