A question about ethics.

[GeraldMonroe]

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you're right - nature is SO stupid when it comes to evolution. i mean how long has nature even been trying? it seems like it's really been phoning it in for the past few millenia.

Precisely. There have been little changes in the past few millenia.

In 100 years, human beings have managed to increase their available energy supply and power by a factor of 100. It's possible to travel 100 times faster, to use up more than 100 times as much energy, and to occupy 100 times as much ecological space. It took nature approximately 2 or 3 billion years to extend the biosphere to cover one planet. We'll be about to match that within 1000 more years. (create an additional planet's worth of biosphere. A couple of ways that could happen. One way is colonizing the moon or mars. Another is to build many, many large space habitats. A third, and simplest, way would be to cover the earth with multi-level greenhouses in order to support a population of 50-100 billion humans. The third way is not science fiction, because it could be done with contemporary technology)

It's been less than 10 years since genome sequencing was invented. About 25 since DNA sequencing was made practical with the Sanger method. And already we know about several thousand genetic diseases, and progress is getting faster and faster.

An iphone app isn't possible because the user interface would be too small, but a single desktop PC could probably let you find a couple previously unknown genetic disorders by lunchtime if you had the data to crunch.

 

[cpants]

Sorry. It's just that your argument is a restatement of "the human body is too complex for scientists to understand it, therefore natural medicine is the only way to go." It's the same argument quacks use to stay in business.

Fact is, if we had a few thousand complete copies of the genome, we could use software to break out each gene into a list of known alleles. If an allele is only present in under 0.1% of the human population and our software indicates that the code has a stop codon, odds are extremely high we can safely edit that gene out. Further, if we do a quick computer search, and find that every person with that allele has a certain set of clinical symptoms, bam, we've discovered a new genetic disease. Most of the current uncertainty is because we don't have complete copies of human genomes to compare. I'm convinced that most of the 'mysterious' genetic diseases are only a mystery because our current maps are too low resolution to spot the faults.

Sure, it wouldn't be perfect, and occasionally you might 'edit out' a gene that turns someone into a super-genius. But it's much, much, much better than what nature does, because nature is blind and puts mutations in random locations.

Epigenetics only plays a small role between generations, most of it is just a way for a cell to maintain a 'memory state' of what it currently does.

As for maintaining genetic diversity : the reason we would do that is mostly to maintain disease resistance. And that's pretty straightforward : make a list of all available MHC alleles. Cross the ones off the list that tend to be connected to auto-immune disease and allergies. Out of the remaining, clean ones, give each genetically edited embryo a random set.

Oh, environmental changes : irrelevant for humans, because we can use tools, and we can make protection better than anything nature has the ability to give us, even with new mutations.

Wow. I said it once, and I'll say it again: Retake population genetics, immediately. You are condescending to others about their knowledge of genetics, yet you seem to lack even a basic grasp of it. Your response was a crazy theory that we would be able to identify and safely edit out portions of the genome, using a "quick computer search" and a few thousand genomic maps. You imply that genetic diversity is only useful in the context of MHC alleles, which is utterly false. You claim that environmental changes are "irrelevant for humans". We are all stupider for having read that post. I hope it was a joke.

 

[GeraldMonroe]

So you're saying it would be crazy dangerous to map a few thousand human being's genomes, and to edit out versions of a gene that almost never occur, and contain mutations that break the gene. Yeah, I sure hope you never have a kid, because what nature does is a lot more random and a lot messier. Perhaps you should retake population genetics, because a rare allele is nearly always deleterious. Reason is
1. Out of all possible mutations, only 1 in many thousands is beneficial. Most are either deleterious or neutral.
2. Beneficial alleles that give a reproductive advance rise to fixation within an evolutionary short time. So if an allele is rare, has an extremely high probability that it is deleterious, by definition.

You probably don't understand what I'm describing.

So you map a few thousand genomes. You use software to pull out all coding genes and promotor sequences. You then use software to compare each individual gene against all the other genomes. Most genes are going to be identical, with a few silent mutations. You tag each "version" of a gene as a separate allele. Alleles that are rare are probably deleterious. You examine each rare allele with software. Perhaps run a protein folding simulation on it. If the allele has a premature stop codon or the protein folding sim indicates a significantly different form, you mark "allele nn of gene 13434 as BAD".

Now, when you do your genetic engineering, you take a human embryo, and do a complete sequence on one of the 8 blastocyst cells. With a computer search of the sequence, you find all sequences that match known BAD alleles. Now, you replace a bad allele with a good one using editing techniques that are still in the R&D stage. The resulting human embryo will have a possible sequence of genes that COULD have resulted from a few thousand controlled breedings, to arrive at that particular gene sequence.

There are other cool things that I think would be interesting, such as reactivating human genes that would work if it weren't for evolution knocking them out (such as extra smell receptors), but this will probably be too dangerous to try on humans.

Selecting for increased intelligence should be fairly straightforward. Essentially, one would compare the genome sequences of people with the highest IQ scores in the world, and figure out which alleles (an allele is a version of a gene) tend to be prevalent. Current theory is that human beings only really differ substantially in less than 1000 total genes, so this would not be as daunting a task as it sounds.

 

[SouthernSurgeon]

Sigh...not to get too involved in this whole argument, but it's kind of sad to see that medicine is sort of turning the clock back on treatment/view of Down's.

"Back in the day" physicians would often let Down's go undiagnosed in a newborn, with the belief that it was more humane to let the child die of the associated heart disease than to diagnose Down's, get the appropriate treatment, and put the parents through such a difficult process of raising the child.

Similarly, some early cardiac surgeons were very willing to try new procedures and operate w/o fear on Down's pts...after all, what was the harm if it didn't go well?

Now, decades after those practices died out, we have the emergence of quad screens and elective termination.

I'm not by any means saying "yay Down's!" or that we should be trying to have more Down's kids, but I challenge anyone who has worked with these children to say their lives aren't worthwhile.

 

[rock_climber]

So you're saying it would be crazy dangerous to map a few thousand human being's genomes, and to edit out versions of a gene that almost never occur, and contain mutations that break the gene. Yeah, I sure hope you never have a kid, because what nature does is a lot more random and a lot messier. Perhaps you should retake population genetics, because a rare allele is nearly always deleterious. Reason is
1. Out of all possible mutations, only 1 in many thousands is beneficial. Most are either deleterious or neutral.
2. Beneficial alleles that give a reproductive advance rise to fixation within an evolutionary short time. So if an allele is rare, has an extremely high probability that it is deleterious, by definition.

I'm sure you'll be the first person in line to have your genome "edited"...just trimming the fat, right?

Everyone on here seems to be disagreeing with your theories on evolution and genetics/eugenics...do you think we are all the ones ignorant of evolutionary processes? I think you may have gotten a few too many of your pearls on evolution from watching NBC's Heroes...which really sucks this season by the way!

 

[cpants]

So you're saying it would be crazy dangerous to map a few thousand human being's genomes, and to edit out versions of a gene that almost never occur, and contain mutations that break the gene. Yeah, I sure hope you never have a kid, because what nature does is a lot more random and a lot messier. Perhaps you should retake population genetics, because a rare allele is nearly always deleterious.

First of all, a 1 in 3000 allele is not extremely rare. Second of all, a rare allele is not nearly always deleterious. More often than not they are harmless, normal variations in the population, which could turn out someday to have tremendous benefit to the species. If they are extremely deleterious, nature does a pretty excellent job of removing them through natural selection. Nature is messy when you look at one case. When you look at the whole population and the history of life on the planet, it is an extremely elegant and beautiful system which we are only beginning to understand. I'll point out that it is rare alleles that permitted the evolution of our species in the first place. I'd also like to point out that the most common defects we see are chromosomal abnormalities like Down's, and not something that could even be fixed by snipping a few genes here and there.

Mapping many genomes is not in and of itself crazy. What is crazy and dangerous is what you propose to do with that knowledge. Have you ever heard the expression "The road to hell is paved with good intentions"? Science has the potential to do both great and extremely destructive things.

 

[GeraldMonroe]

More often than not they are harmless, normal variations in the population, which could turn out someday to have tremendous benefit to the species. If they are extremely deleterious, nature does a pretty excellent job of removing them through natural selection.

Yes, it is elegant. But it's also slow. Human beings will probably develop a complete mastery of biology within another millennium, and will be able to edit in nearly any change they like. So deleting heterozygosity from the living human population (but saving the information in computer files, in case we need it later) would probably not be harmful.

 

[GeraldMonroe]

but I challenge anyone who has worked with these children to say their lives aren't worthwhile.

compared to nothing, or compared to a normal child?

 

[GeraldMonroe]

Second of all, a rare allele is not nearly always deleterious. More often than not they are harmless, normal variations in the population,

Called a "neutral" allele. I said mark alleles as BAD that meet these criteria
1. rare
2. Don't code for a protein that folds to look anything like the normal protein, or don't code for a protein at all due to premature STOP.

If an allele meets both of these criteria, it is probably not deleterious 1 in a million times or less.

 

[GeraldMonroe]

I'm sure you'll be the first person in line to have your genome "edited"...just trimming the fat, right?

Yes

 

[GeraldMonroe]

Everyone on here seems to be disagreeing with your theories on evolution and genetics/eugenics...do you think we are all the ones ignorant of evolutionary processes? !

Yes

 

[SouthernSurgeon]

I wondered how long it would take you to get worked up enough to earn yourself another banning...maybe this thread will turn into the meltdown?

 

[87138]

Don't you guys hate it how URMs have such an easier time getting into medical school???

 

[ngkats]

Don't you guys hate it how URMs have such an easier time getting into medical school???

lol

 

[Excelsius]

Don't you guys hate it how URMs have such an easier time getting into medical school???

Most definitely. They single-handedly drive down the entire numbers of medschool admission statistics thereby making non-URMs believe that they actually have a chance to ever attend medschool within continental US.

Oh, by the way, you are off-topic and in violation of SDN user agreement

 

[TMP-SMX]

Humans are subject to social evolution at a vastly higher scale vs. biological evolution and have been for a long time now. Either way, our previously beneficial traits adapted for the famine/feast world of old is gone. Our resulting benefit is now diabetes and a world where food is too plentiful for those of affluence and scarce for those of poverty.

For humans to evolve we would have to choose mates based on purely physical characteristics where intelligence would be a relatively important factor in the decision. You could say that wealth and personality are based on genes but for the most part it is all about what is good financially for the next generation. Not genetics. As physicians we see genetics as a set of diseases. Rightfully so, our genetic testing involves screening for debilitating disease in newborns that treatment or prevention can provide relief and during fetal testing where the option to abort or plan for a condition is possible. As for genetic engineering I don't see any problem with repairing faults in the DNA. I don't see how we will be able to stop at that, for those individuals that can afford the expense, to have the ability to choose physical and mental characteristics and have a "genetic quotient". For those of you that have seen the film GATTACA know what I am talking about. Though the film has a happy ending for the "degenerate" that was not born as a test tube baby, I find it hard to believe it would be possible to compete in a system where the rest of the species is superior (genetically at least whatever that means). The key to the film is the power of the mind and how upbringing and psychology plays a pivotal role in achievement. Obviously the film is a gross oversimplification of genetics and how the system would work as there is social repression and systematic discrimination in the system, but knowing about the past I don't find it too far-fetched.

 

[Excelsius]

Humans are subject to social evolution at a vastly higher scale vs. biological evolution and have been for a long time now. Either way, our previously beneficial traits adapted for the famine/feast world of old is gone. Our resulting benefit is now diabetes and a world where food is too plentiful for those of affluence and scarce for those of poverty.

For humans to evolve we would have to choose mates based on purely physical characteristics where intelligence would be a relatively important factor in the decision. You could say that wealth and personality are based on genes but for the most part it is all about what is good financially for the next generation. Not genetics. As physicians we see genetics as a set of diseases. Rightfully so, our genetic testing involves screening for debilitating disease in newborns that treatment or prevention can provide relief and during fetal testing where the option to abort or plan for a condition is possible. As for genetic engineering I don't see any problem with repairing faults in the DNA. I don't see how we will be able to stop at that, for those individuals that can afford the expense, to have the ability to choose physical and mental characteristics and have a "genetic quotient". For those of you that have seen the film GATTACA know what I am talking about. Though the film has a happy ending for the "degenerate" that was not born as a test tube baby, I find it hard to believe it would be possible to compete in a system where the rest of the species is superior (genetically at least whatever that means). The key to the film is the power of the mind and how upbringing and psychology plays a pivotal role in achievement. Obviously the film is a gross oversimplification of genetics and how the system would work as there is social repression and systematic discrimination in the system, but knowing about the past I don't find it too far-fetched.

Right. And I think GATTACA is the best film made within the past decades. Fortunately or not, we are getting there. We are also approaching Orwell's 1984. This is a Brave New World.

 

[GeraldMonroe]

Indeed. Once genetic engineering becomes practical, it will be impossible to stop. Sure, people will gripe and try to slow it down.

But the advantages someone would have if their offspring had predictably good intelligence, immunity, resistance to disease, and athletic ability would be too much. Trying to stop the tide would be like trying to stop the automobile. There are people who try, still. They're called Amish.

 

[Excelsius]

Indeed. Once genetic engineering becomes practical, it will be impossible to stop. Sure, people will gripe and try to slow it down.

But the advantages someone would have if their offspring had predictably good intelligence, immunity, resistance to disease, and athletic ability would be too much. Trying to stop the tide would be like trying to stop the automobile. There are people who try, still. They're called Amish.

Problem with humans is that we often use technology without understanding the full consequences first. Although I am pretty liberal, I would definitely want to see very extensive, several decade long studies before I'd agree to a mass scale genetic engineering, though this is unlikely to happen. Right now almost all of us are eating genetically modified fruits and vegetables. Have there been studies of any significant duration? No. Who knows what will happen down the line. Dolly did die prematurely and I think the issue had to do with the shorter telomeres. It would be devastating to find a major flaw in the genetic engineering structure (such as extreme vulnerability to certain pathogens) after the majority of the population is genetically revised. It would be like having pre-1920s bridges and a huge earthquake striking at all locations simultaneously. Whether efficient or not, evolution took billions of years to revise DNA via trials and errors before arriving to our species. Redefining the entire sequence in a matter of decades may disturb some unknown balance with catastrophic consequences.

 

[rock_climber]

Indeed. Once genetic engineering becomes practical, it will be impossible to stop. Sure, people will gripe and try to slow it down.

But the advantages someone would have if their offspring had predictably good intelligence, immunity, resistance to disease, and athletic ability would be too much. Trying to stop the tide would be like trying to stop the automobile. There are people who try, still. They're called Amish.

You think the "Amish" will be the only ones against this? How about anyone that realizes that simply "increasing immunity and athletic ability genes" isn't as simple as sticking an extra single gene or two into the genome? Are you in medical school yet? Have you been taught that there are almost no diseases or phenotypes that are based on a single allele?

 

[rock_climber]

i'd like to retract part of my above post - i just wiki'd it and athletic ability IS a single allele phenotype. if only my mom had been a homozygote i'd be pitchin' in the majors!

 

[87138]

You think the "Amish" will be the only ones against this?

Analogies are tough for some people, eh?

 

[silas2642]

Hello all. I just got out of one of my leadership classes where my teacher got on his soapbox about how doctors that refuse to perform certain procedures, such as abortions, should loose their license. His reasoning is that since abortions are legally allowed in America, doctors who practice here should be required to do them if requested by their patients, regardless of their personal beliefs. My question is this. What are the ethical and legal rules for doctors performing controversial procedures? Are we required to do whatever is asked of us as long as it is legal according to the government? How do personal ethics play into being a doctor? Thank you very much.

The AMA's stance on this currently is that physicians CANNOT discriminate pts based on race, disease, etc. but are not required to perform services such as abortions if it is against their beliefs. For the exact wordings, I'm sure you could google it.

I think that it is one thing to say that you are pro-abortion and another thing to actually perform abortions. It's a pretty raw procedure and not everyone can handle it.

 

[rock_climber]

Analogies are tough for some people, eh?

Are you serious? Do you think I actually thought that only Mennonite communities would be against this copy-paste genetic engineering?

 

[87138]

Are you serious? Do you think I actually thought that only Mennonite communities would be against this copy-paste genetic engineering?

Amish and Mennonite are two completely different populations/cultures.

 

[novastorm]

Ugh. Basically Obama is rescinding Bushes "Conscience Clause" and the long standing "Church Clause". In effect his plan is to have religious hospitals who will not bend, break, breaking our health care and allowing it to go communist on us. In my understanding the new wording will allow federal funding to be denied to any hospital that refuses abortion, contraceptives, etc (may cover other things). Enjoy.

The ethics of it are simple the complicated part is who's ethics do you follow? The hard part is that people are hardly ethical and yet they expect physicians to be, its an awesome paradox.

 

[rock_climber]

Amish and Mennonite are two completely different populations/cultures.

http://en.wikipedia.org/wiki/Amish

 

[thechad]

My question is this. What are the ethical and legal rules for doctors performing controversial procedures? Are we required to do whatever is asked of us as long as it is legal according to the government? How do personal ethics play into being a doctor?

I didn't read many of the other posts because they were too long and just seemed like an argument between a couple of people, but to answer your question; you don't have to do anything you don't want to do.

You don't want to prescribe sleeping pills? Don't. You don't want to prescribe the latest drug for XYZ disease (because there is insufficient research on long term effects, e.g. fen phen, vioxx, et cetera)? Don't. You don't have to do anything you don't want to just because a patient asks you to.

 

[cleoscat3]

I think one of the biggest arguments on this forum looks to be a misunderstanding. Gerald is insisting that it is going to be possible to edit the genetic code easily, which is probably true given where we are now and the research being done. However, what is misunderstood is that the genetic code is only about 5% of the genome. The rest is how proteins interact with the DNA molecule, how methylation affects transcription, and other elements of the actual expression of various genes. This part of the genome is not well understood at all. The general direction of research in clinical genetics is toward this end but it is a very new field and we do not yet know how messing with the code will affect these interactions. I believe what many of the people arguing against Gerald's viewpoint are trying to say is that we don't yet know how these things work.

Overall I agree with gerald that the research will eventually allow us to alter the genome in a responsible and enlightened way. Whether this alteration is through altering the code or not is still up for debate.

As far as ethics are concerned, given our current technology, I would say that those parents who can afford IVF can likely afford to take care of a child with a genetic disability if they so choose. The choice should remain in their hands not in the physicians hands.

 

[GeraldMonroe]

However, what is misunderstood is that the genetic code is only about 5% of the genome.

This is huge for stem cell research, because methylation patterns and what proteins are extant in a particular cell determine the fate of a cell and it's behavior.

But, with a few exceptions*, it looks like most of these mechanisms are turned off for gametes, and that all gametes are in the same machine state. The difference between gametes is in the genetic code itself, not methylation patterns nor proteins present in the gamete, or other complex things that are not yet understood.

So I think what I'm describing will work fine. It already does work quite well for lab animals.

* yes, there's maternal and paternal imprinting but in the long run this makes no difference as genes are passed from generation to generation

 

[Droopy Snoopy]

I didn't read many of the other posts because they were too long and just seemed like an argument between a couple of people, but to answer your question; you don't have to do anything you don't want to do.

You don't want to prescribe sleeping pills? Don't. You don't want to prescribe the latest drug for XYZ disease (because there is insufficient research on long term effects, e.g. fen phen, vioxx, et cetera)? Don't. You don't have to do anything you don't want to just because a patient asks you to.

Doctors are liable for not following the standard of care, and whether that standard coincides with your particular belief system is irrelevant except in well-defined cases. Drunk driver kills a bunch of kids walking to school, needs you to remove his spleen or he'll die. You gotta do the operation, per the legal and ethical guidelines of our profession. You gotta do it under anesthesia and provide appropriate follow-up care, regardless of what you really want to do with the guy (like light him on fire).

Anyway, not arguing with the quoted poster, just wanted to expand on the general sentiment that, although correct in regard to judgment calls and 'new' advances, a doctor isn't empowered to just do whatever s/h wants to do. No one is.

 

[cpants]

Doctors are liable for not following the standard of care, and whether that standard coincides with your particular belief system is irrelevant except in well-defined cases. Drunk driver kills a bunch of kids walking to school, needs you to remove his spleen or he'll die. You gotta do the operation, per the legal and ethical guidelines of our profession. You gotta do it under anesthesia and provide appropriate follow-up care, regardless of what you really want to do with the guy (like light him on fire).

Anyway, not arguing with the quoted poster, just wanted to expand on the general sentiment that, although correct in regard to judgment calls and 'new' advances, a doctor isn't empowered to just do whatever s/h wants to do. No one is.

In an emergency, a physician has a duty to act. The scenario is a lot different if that drunk driver came into your office months later asking you to treat his arthritis. Of course it is never acceptable to provide inappropriate treatment, purposely undertreat, or attempt to make treatment more painful for the patient. This is assault, and the doc could be criminally prosecuted. There is nothing wrong with telling the patient to find another doctor, though.

You are right that doctors are not empowered to do whatever they want. However, they are not obligated to follow some universal code of ethics which dictates they must provide all legal treatments to any patient. There is not a universal code of ethics, and there is significant debate throughout the profession on what is ethical even among legal treatments. Nor is there a universal "standard of care" for most diagnoses. There is tons of debate and disagreement on which treatments are better/worse, and often standard of care treatments are found to be ineffective and injurious as we learn more. Deviation from the standard of care is proven in court by expert testimony showing a significant breech of proper medical care by the doctor. This would be something like treating HIV infection with homeopathic solutions, not something like refusing to perform an abortion.

Obama's overturning of the Bush order does not make it mandatory to provide or even to refer for legal treatments which the doctor finds unethical. The Bush law provided employment protection for doctors and other providers exercising their conscience rights. They won't face loss of license or legal action, just the possibility of losing their job.

 

[LiveUninhibited]

It seems like in the OP we are assumed to be a GP who is opposed to abortion. If that was the case, it would be reasonable to inform them of possible alternatives, but if they insist on it one should be willing to refer them to a competent doctor that does them. Part of the idea behind that is that the woman is likely to find a way with or without you, and without your guidance she may use a way that could threaten her own health, so even if you can’t save the “baby” you can help her.

I think you're a bit off base here. Is a life with Huntington's not worth living at all? Not only is that not for you as the doctor to decide, but that might not be the message you want to be imparting to the mother in this scenario, since either she or her husband has the disease. Most people will live life symptom free for 40 years before the disease starts. You can certainly educate the mother on Huntington's and the embryo's 100% chance of having disease, but in the end it is not for you to play God with her embryos. Your professor was right to respect the mother's autonomy. Also, if the mother is one of "the more religious ones" who insist on implanting all embryos, why would you screen her embryos in the first place?

It all comes down to whether you consider a blastocyst of sufficient sophistication to deserve protection. If there’s no reason to protect it, it doesn’t really matter how arbitrary the reason for not implanting the embryo is, though there should probably be some conditions for which implantation is disallowed. So does a "person" really exist in that ball of cells already? It seems hard to think of a legit argument that one does. It gets sticky if people try to use, say, biblical passages to try to prove that the soul is inserted at conception, or something. But if the person doesn't already exist, isn't implanting one with a serious genetic disease basically intentionally creating suffering where none would have existed otherwise?

This is an intriguing subject.

A paradigm often used to rationalize screening is the treatment-enhancement distinction, but this creates many ethical dilemmas like many of you have pointed out. A standpoint one can take is the freedom of pain principle- screening should be done only when the illness/disorder would inhibit the individual’s capacity to derive pleasure or avoid pain. If anyone cares to analyze this principle addressing precisely this issue, read up the article on page 48-51 of the Ivy Journal of Ethics.

Can't we say with some certainty that 1st trimester embryos do not feel pain, and the ability to feel pain likely begins much later upon further brain development?

Mentioning the +20 million dead due to abortion since 1973 makes one an extremist now a days?

You and I are a good example of the huge cultural divide occurring in America these days. The culture in this country has not been this divided since 1861. I am equally as sad over medical schools admitting so many people who have more respect for the choices of the strong over the life of the weak.

The pro-choice label does miss the point, and I can see why it would lead you away from the actual crux of the issue. It isn't about valuing the choice of one person over the life of a weak person. The real issue is whether or when an embryo/fetus is actually considered a person in the first place. To me it would require a very basic level of mental sophistication. A brain developed enough to feel pain and the capacity for rudimentary sapience. Evidence I have seen would suggest that most abortions are performed before these things are a possibility.

This shouldn't upset you if you consider fetuses to not actually be alive.

If it was only about valuing life, per se, then all pro-lifers would be vegans as well. An embryo is certainly less sophisticated and capable of suffering than the animals that end up in our ovens. I’m not a vegetarian by the way. The only other difference would be the unique human DNA, though those are just instructions, not something with rights in itself. Without consciousness, an embryo is just a tadpole-like collection of developing cells and their destruction is no tragedy.

If fetuses aren't alive then me equating abortion to the holocaust is a silly as a nut equating a nocturnal emission to global nuclear war. Not upsetting but kinda funny and sad.

Well sperm are alive in the same sense embryos and early fetuses are. They don’t have consciousness, but they do fulfill the basic criteria of living things much like cellular organisms. What makes us meaningfully human lies in the conscious mind.

Precisely. There have been little changes in the past few millenia.

In 100 years, human beings have managed to increase their available energy supply and power by a factor of 100. It's possible to travel 100 times faster, to use up more than 100 times as much energy, and to occupy 100 times as much ecological space. It took nature approximately 2 or 3 billion years to extend the biosphere to cover one planet. We'll be about to match that within 1000 more years. (create an additional planet's worth of biosphere. A couple of ways that could happen. One way is colonizing the moon or mars. Another is to build many, many large space habitats. A third, and simplest, way would be to cover the earth with multi-level greenhouses in order to support a population of 50-100 billion humans. The third way is not science fiction, because it could be done with contemporary technology)

It's been less than 10 years since genome sequencing was invented. About 25 since DNA sequencing was made practical with the Sanger method. And already we know about several thousand genetic diseases, and progress is getting faster and faster.

A logical step before space colonization would be to colonize the oceans - probably easier than in terms of energy expended to get infrastructure in place. As for genetic engineering, it’s an exciting idea and it gives me this sense that I was born about a hundred years too early, but still at a better time than before now. Eventually the human body could be hybridized with nanotechnology and the like so that quasi-immortality could be achieved. I say quasi because a freak accident will kill you eventually, but if telomeres, organs, and the like can be repaired indefinitely, the potential lifespan of people could mushroom to unknown limits.

You think the "Amish" will be the only ones against this? How about anyone that realizes that simply "increasing immunity and athletic ability genes" isn't as simple as sticking an extra single gene or two into the genome? Are you in medical school yet? Have you been taught that there are almost no diseases or phenotypes that are based on a single allele?

So your argument is that it's so complex that it's impossible? Or were you saying that there is some ethical truth you have not explicated that makes gene therapy evil?

 

[cleoscat3]

This is huge for stem cell research, because methylation patterns and what proteins are extant in a particular cell determine the fate of a cell and it's behavior.

But, with a few exceptions*, it looks like most of these mechanisms are turned off for gametes, and that all gametes are in the same machine state. The difference between gametes is in the genetic code itself, not methylation patterns nor proteins present in the gamete, or other complex things that are not yet understood.

So I think what I'm describing will work fine. It already does work quite well for lab animals.

* yes, there's maternal and paternal imprinting but in the long run this makes no difference as genes are passed from generation to generation

My only issue is that we don't understand well enough how all that "extra" stuff you want to get rid of affects methylation..etc. in the developed human. Just because it works in gametes doesn't mean it will develop into a working human being. Again, I believe in the future we'll be able to understand all of that but we just don't yet so you can't draw conclusions without that knowledge.

 

[cleoscat3]

This is huge for stem cell research, because methylation patterns and what proteins are extant in a particular cell determine the fate of a cell and it's behavior.

But, with a few exceptions*, it looks like most of these mechanisms are turned off for gametes, and that all gametes are in the same machine state. The difference between gametes is in the genetic code itself, not methylation patterns nor proteins present in the gamete, or other complex things that are not yet understood.

So I think what I'm describing will work fine. It already does work quite well for lab animals.

* yes, there's maternal and paternal imprinting but in the long run this makes no difference as genes are passed from generation to generation

My only issue is that we don't understand well enough how all that "extra" stuff you want to get rid of affects methylation..etc. in the developed human. Just because it works in gametes doesn't mean it will develop into a working human being. Again, I believe in the future we'll be able to understand all of that but we just don't yet so you can't draw conclusions without that knowledge.

 

[eeyore spice]

I would go so far as to say that doctors/nurses/whoever who refuse to perform an abortion on a woman who needs one immediately to save her life...should lose their licences. That's withholding lifesaving treatment.

But elective abortions are....elective. Like a nose job or Botox. It won't kill the patient to have to go looking for another doctor. As far as a requirement to let patients know about other doctors that will do what they want...here's a phone book, lady, knock yourself out.

 

[GeraldMonroe]

Just a comment : I made a lot of noise in previous posts arguing that abortion, while awful, is not so bad that the government should step in and end it. Further, it appears to be a necessary evil, and is the better of two evils when considering a fetus with horrible genetic defects.

With that said, is it hypocritical to say I never want to actually assist or perform an abortion personally? I don't have a problem with other people doing them on other people outside of my friends and family, but I'm not willing to turn on the suction myself.

Just like I think the death penalty is probably a necessary evil, at least in some cases...but I would never want to assist with the execution of the punishment myself.

 

[novastorm]

How is one supposed (and be expected?) to be ethical when the people who you treat are not strictly ethical themsevles?

Besides, as the government sees this it has nothing to do with ethics. Thats how they get away with what they do. They dont force you to do anything, this is key, they just wont fund you if you dont do what they say (proposed).

So you are absolutely free to not recieve any money from the government, and this is why nationalized healthcare is a terrible idea.

Unless you know you dont enjoy actually being able to make medical decicions yourself, might as well pave the way for the DNP's as the government is already spending about a billion dollars deciding what you should do and when to do it (actually being done) and how much money you should be allowed to make (proposed).

 

[barefootmoses]

geraldmonroe: it's interesting to note that planned parenthood was actually founded by a woman named margaret sanger who was actually a strong promoter of eugenics. check it out.

 

[Blesbok]

How about this scenario? You are the only Ob/Gyn in a small rural hospital. You are well versed in c-sections and the such. You are also adamantly opposed to abortion in any way shape or form. A girl comes in with an ectopic and unstable vitals. She will die unless you perform an "abortion". Are there any prolife people out there that would even consider NOT performing the procedure to save this girl's life?

 

[45408]

How about this scenario? You are the only Ob/Gyn in a small rural hospital. You are well versed in c-sections and the such. You are also adamantly opposed to abortion in any way shape or form. A girl comes in with an ectopic and unstable vitals. She will die unless you perform an "abortion". Are there any prolife people out there that would even consider NOT performing the procedure to save this girl's life?

An imminent ruptured ectopic will result in two deaths. You can reduce that to one death, but you're not going to reduce it to no deaths. I don't think there's much argument there. At the least, you MUST stabilize her and arrange transport for definitive treatment.

 

[GeraldMonroe]

An imminent ruptured ectopic will result in two deaths. You can reduce that to one death, but you're not going to reduce it to no deaths. I don't think there's much argument there. At the least, you MUST stabilize her and arrange transport for definitive treatment.

What if there were a choice between saving the life of a mother with twins or the twin fetuses themselves? By a pro-lifer's logic, that would be weighing two deaths versus one. Note, I can't think of a contrived scenario where this would happen, I'm just pointing out the faulty logic in saying the life of a fetus is exactly equal to that of a fully functional adult.

 

[45408]

What if there were a choice between saving the life of a mother with twins or the twin fetuses themselves? By a pro-lifer's logic, that would be weighing two deaths versus one. Note, I can't think of a contrived scenario where this would happen, I'm just pointing out the faulty logic in saying the life of a fetus is exactly equal to that of a fully functional adult.

In a TRUE emergency situation, I would err on the side of the mother's life. Most of the situations that people feel an abortion is medically indicated are not an emergency as a matter of minutes between life or death. I guess if I had a trauma patient who was at full-term, but she took a rifle bullet to the head, and the options were to do a crash C-section or try to code her, I think I'd go for the C-section.

I don't really want to ever get myself into some of these ethical dilemmas, which is one of the reasons why I don't want to do OB.

 

[SouthernSurgeon]

How about this scenario? You are the only Ob/Gyn in a small rural hospital. You are well versed in c-sections and the such. You are also adamantly opposed to abortion in any way shape or form. A girl comes in with an ectopic and unstable vitals. She will die unless you perform an "abortion". Are there any prolife people out there that would even consider NOT performing the procedure to save this girl's life?

Very few if any "pro-lifers" have issues with emergencies like this where the mother's life is threatened. The Catholic church even gives surgery for an ectopic the a-ok as it is necessary to protect the mother.