Sufficient Scruples

Bioethics, healthcare policy, and related issues.

September 12, 2012

Thomas Szasz: Opposition Whip

by @ 9:30 AM. Filed under Autonomy, BioLibri, General, Healthcare Politics, Provider Roles

Thomas Szasz, MD, has died at the age of 92.

Szasz made a career as the gadfly of psychiatry, excoriating its role as enforcer of political and social orthodoxy and questioning mental illness as a category of disease. He was driven by both a lacerating exactitude of mind regarding the theories of disease and healthcare, and by the libertarian political ideology which caused him to see all forms of behavior modification as an encroachment on freedom. By tireless effort he established a solid, but not popular, beachhead position against mainstream psychiatry and its role in the legal/medical complex.

I was not a close student of Szasz, but, though I did not admire his politics, I greatly admired his insistence on clear thinking and on holding medicine accountable for what it does to people. His death is a loss to a profession that needed his intelligence and keen critical eye.

A short overview of his career and ideology can be found here; a more detailed, and fascinating, report of Szasz’s early experiences in psychiatry and the development of his ideology is here. My own review of one of his books can be found here.

June 17, 2010

Review: Progress in Bioethics

by @ 10:46 AM. Filed under BioLibri, General, Healthcare Politics, Theory

This book review is excerpted from a detailed review in the American Philosophical Association Newsletter on Medicine and Philosophy, v. 10, n. 1, Fall 2010.

Progress in Bioethics: Science, Policy, and Politics

Cover image: "Progress in Bioethics"
Jonathan D. Moreno and Sam Berger (eds.)
MIT Press, Cambridge, 2010
286 pp., with Index
Foreword by Harold Shapiro
Introduction and Afterword by Jonathan D. Moreno and Sam Berger
ISBN: 9780262134880

Bioethics addresses issues shaped by abstruse empirical fact and the technical parameters of the technologized controversies of contemporary culture. It is tempting to imagine that our philosophy must be as technologically-informed as our understanding of our lives has now become – that human flourishing must be in some ways dependent upon technological problem-solving, that the range of values and possibilities accommodated within the morally good life is wider than previously imagined, and that these observations define a particular stance, critical but welcoming, toward the prospect of aggressive engagement with the future through the tools and products of science.

Something like that is the position ascribed to “progressive bioethics” by the authors of the just-issued essay collection, Progress in Bioethics: Science, Policy, and Politics. The volume collects almost 20 essays on questions of the nature of bioethics as a field, its relationship to progressive ideology, and the ways that relationship plays out in particular issues and controversies characteristic of the field now and in the past. The authors are a roll-call of respected and influential figures in contemporary bioethics, not all of them academics, subscribing to a wide range of perspectives on progressivism and the task of progressive bioethics. The impression they give is of a fluid and open-minded community, engaged in a searching and sometimes indeterminate discourse with itself and the wider world.

The Foreword, Introduction, and essays of both Section I: “Bioethics as Politics” and Section II: “The Sociology of Political Bioethics” investigate the nature of progressivism, the issues that are or should be of interest to progressive bioethics, and the practicalities of politics and policy that bioethics is often involved in. Section III: “The Sociology of Political Bioethics”, addresses questions of the professional identity of bioethics, and how progressive ideology meshes with other personal and professional values. Section IV: “Conflicting Views of Biotechnology” contains one unabashedly pro-technology piece, and another warning against an uncritical stance on science. The concluding Section V: “Progress Beyond Politics”, offers higher-level reflections on the field of bioethics in general. In the “Afterword”, the editors remark upon the prospects for progressivism and healthcare reform in the advent of the Obama administration – a question that could not be more timely.

Necessarily, there are gaps: the definition of progressivism needs further exploration, and it remains unclear why progressivism should have any of the content suggested for it; at times the content or scope of bioethics also seem taken for granted. Even the role of science in progressive bioethics awaits further examination. These are not faults in a collection of diverse viewpoints; however, much remains to be discussed. This volume opens that discussion insightfully, searchingly, and provocatively.

Progress in Bioethics is must-reading for political progressives interested in biomedical issues, bioethicists who identify as political progressives, bioethicists in general who are interested in the conceptual landscape of contemporary biomedical policy and cultural controversy, and for those who seek to develop a humanitarian pro-science viewpoint, whether on biotechnology or other complexities of our technologized modernity.

March 31, 2009

Women: Expendable, Negligible

by @ 12:46 PM. Filed under Autonomy, BioLibri, General, Personhood, Reproductive Ethics, Theory, Women's Issues

It could be almost any news story from the developing world, and any of many from the rest of the world, but this one will do:

Afghanistan’s President, Hamid Karzai, has signed a law which “legalises” rape, women’s groups and the United Nations warn. Critics claim the president helped rush the bill through parliament in a bid to appease Islamic fundamentalists ahead of elections in August.

In a massive blow for women’s rights, the new Shia Family Law negates the need for sexual consent between married couples, tacitly approves child marriage and restricts a woman’s right to leave the home, according to UN papers seen by The Independent. . . .
The most controversial parts of the law deal explicitly with sexual relations. Article 132 requires women to obey their husband’s sexual demands and stipulates that a man can expect to have sex with his wife at least “once every four nights” when travelling, unless they are ill. The law also gives men preferential inheritance rights, easier access to divorce, and priority in court. . . .

Even the law’s sponsors admit Mr Karzai rushed it through to win their votes. Ustad Mohammad Akbari, a prominent Shia political leader, said: “It’s electioneering. Most of the Hazara people are unhappy with Mr Karzai.”

The fault in this case lies squarely with the Afghani men, of course. (British officials, rushing to the defense of women, have “raised concerns at a senior level”. Thank God!) But it’s worth noting that this government is America’s “ally” – in the sense that if we don’t acquiesce in their doing these things, and pay them a lot of money besides, they’ll . . . be even less cooperative against Al Qaeda. One might also note that this sort of thing is once more on the rise in Iraq, where women had once had full legal equality under Sadam, now that de facto separatist governments under religious extremists have been established, with American approval, in parts of the country.

It has to be acknowledged how disastrous the situation has always been for women in most of the world, and how little leverage the nascent democracy movements in the most backward countries are. Except in places like Iraq and Iran, where modernist governments have been fully or partially replaced by theocracies, it’s not clear that, however horrendous conditions are, things are getting much worse for women, even in the worst countries. In a practical sense, the new Afghan law may not change anything, since the practices in question are widespread there anyway. The fact that there is even a tiny amount of freedom for women in the capital city is a – very depressing – step forward.

But those facts, inescapbable as they are, do not tell the real story. What’s most galling is not that conditions for women are so bad, but that that is regarded as a negligible problem. Women’s rights, and women’s freedom, are simply not issues worth caring about, to virtually any government or any influential group of (male) people.

We’ll go to war over oil, land, religion, vaguely-articulated political and economic beliefs, other countries’ refusals to do our bidding, or a soccer match. We’ll claim as justification for our wars other people’s freedom to vote for the candidates we approve, be Christian whether they want to or not, and buy American consumer goods. The one thing we’ll never fight for, or even claim as justification for fighting, is women’s freedom to live their own lives. It’s simply not an issue. The idea that we should invade Iraq to establish a quasi-democracy in some parts of the country while igniting an indigenous religious war and all but completely destroying the country’s economy and material infrastructure is somehow not seen as ludicrous. The idea that we would invade Afghanistan – or refrain from invading Afghanistan – because it’s women are subject to widespread, organized rape and open murder – legally – now that is seen as ludicrous. The idea that we would threaten preemptive nuclear war with Iran because they might someday have one warhead to our current 10,000 is not absurd; the idea that we would threaten any serious engagement of Iran because the women of that country have virtually no legal rights and are subject to arbitrary imprisonment, rape, abuse, and murder by the religious police, is beyond absurd – it is unthinkable.

The idea that women’s rights and women’s freedom is an issue that commands our involvement – that it is one of the things we must pursue and protect, among the many things we accept as justification for our adventures and misadventures around the globe – that it would constitute any kind of reason at all for any kind of action at all, let alone aggressive engagement or sacrifice on our part – is quit obviously a joke. Of all the places we’ve invaded, bombed, or threatened over the past few decades – Nicaragua, Grenada, North Korea, Panama, Iran, Iraq, Lebanon, Russia, and on and on and on . . . – and usually on the most ridiculous pretenses (Reagan invaded Grenada because they were building a runway, which he then continued building after occupying the island), in which of these is it even imaginable that the same things could have been done because the women of that country did not have full equality, or even basic rights?

Women’s interests are negligible. Whatever misery, oppression, or lack of freedom motivates political concern, in the US or anywhere else, it is not women’s misery or oppression that provides that motivation. The US courted Afghanistan for decades without any overt action on the basis of the grinding, indescribable misery and abuse of the women of that country, and we continue to tolerate those same conditions while occupying that country and propping up its government. But that occupation was prompted – on little notice and with little debate – by the fleeting presence there of a small group of terrorists we still haven’t managed to locate. That minor military problem was sufficient justification for occupying and remaking the country; the horrific abuse of its female population for all time up to that moment was not such a motivation, and its continuation during our presence there is not motivation for any proportional expenditure of energy on their behalf. Women are not a reason for doing anything, in Afghanistan, though smaller groups of people who catch our male leaders’ attentions are more than enough reason. The US invaded Iraq, twice, on the pretext of its supposed military ambitions; in the process we eliminated the freedom for women that existed there at the time, and returned them to the insecurities of religious politics, and for many of them outright partriarcal theocracy. The oppression of a small percentage of its population who were political opponents of its leader was justification for destroying that country and its government; that that government was the only source of liberty for more than half its population – the female half – was not justification for not doing so. Women simply didn’t count, in that equation. And they never do.

Until women count – until women in and of themselves are a reason for doing anything – until the oppression and misery of women is seen as human oppression and human misery, the sort of thing we say we care about and act on – there will be no progress. And until we powerful nations, nations who shake the world and make and unmake governments and laws and wars, do what we do because women matter at least as much as oil, or land, or religion, or markets, or men, women will not count where it counts.

March 16, 2008

A Long Night’s Journey Into Day

by @ 9:34 PM. Filed under Autonomy, BioLibri, Biotechnology, Child-Rearing, Disability Issues, General, Global/Community Health, Healthcare Politics, Medical Science, Personhood, Provider Roles

There is a terrible tension in healthcare – medicine, especially – between the use of expert knowledge to serve and heal those in need, and its use to aggrandize those with the knowledge and to control, mold, dictate to or torture those who fall into their hands. Knowing what can help another can easily be mistaken for “knowing what is best for them”, and historically has been so mistaken throughout the entire history of medicine as a profession. Today, it’s hard to hear the phrase “Doctor knows best” without an ironic smirk – the same smirk we conjure up for the parallel slogans of wrongheaded patriarchal oppression “Father knows best” and “Trust your government”. But it was not long ago that that slogan was the entirely literal creed of the most respected profession in Western society, and the work of challenging that creed and establishing the primacy of patient values and autonomy was lengthy and hard-fought. Its path was marked by the graves – quite literally the graves – of too many martyrs.

The most entrenched redoubt of medical power (though least well-grounded in research and knowledge) was psychiatry. Not only did the head-shrinkers lay claim to the most occult knowledge of human functioning and health, but they stood against a patient population that was inherently and societally almost unable to defend itself. Members of, possibly, the most severely and unsympathetically stigmatized stratum of society, mental patients were given no credence, and often had no recognized legal standing, to assert their own values and choices in treatment. And it is true that in many cases, patients with mental illness could not in fact act for their own interests or competently manage their own treatment and caretaking. But the presumption that no such patient could have a valid opinion about their own care, coupled with the prejudice that they were unfit for “normal” society, and likely dangerous, meant that virtually anything could be done to anyone, if advocated by a doctor armed with a diagnosis of mental illness. The things that were done were in many cases almost unthinkable.

Howard Dully spent over 40 years thinking about what was done to him. It took him a full life of hardship and failure to finally understand his own fate, and to come to terms with it. That anyone could have survived, let alone found peace and stability, after having lived his story, is an amazement in itself.

Dully is the author (with a professional co-writer) of My Lobotomy: A Memoir. The subject of the book is exactly what the title suggests. The story it contains is heartbreaking.

Dully’s life is difficult to summarize, except to say that it was unremittingly harsh almost from birth. Dully was born in California in 1948; his father was a hard and unemotional man who was driven to work excruciating hours, sometimes at as many as 4 or 5 low-skill physical labor jobs at the same time, partly by the need to support his family, partly by his own obsessive work ethic. Howard grew up a big kid (he’s now 6’7″, 350 lbs) who picked on his younger brother; when he was 4 his mother died after giving birth to a baby brother with a severe neurological deformation – the baby was placed with relatives and never spoken of again within the family. Howard and his family bounced around various friends’ and relatives’ homes as his father struggled to earn a living, and Howard suffered constantly both from missing his mother and from the severe discipline he suffered in some of these homes. Things really got bad when his father married again, to a woman with two sons of her own. Dully claims that she simply resented and hated him; from reading both his own stories of his home life, and some of his doctors’ notes, it is easy to believe he is correct. Howard, in the meantime, was legitimately a handful for any parent: he was apparently flightly and unreliable to an extreme degree, was aversive to school work, discipline, and hygiene, and often fought with his brothers, though they had a generally good relationship. As he got older he began doing stupid kid pranks – shoplifting and stealing items from cars, and playing hooky. As a huge and growing boy, he was constantly hungry, but was not allowed to eat between meals and was beaten for taking snacks. His step-mother also had some sort of obsession with her furniture and household trinkets, and would beat Howard for touching anything in the house, sitting on the parlor furniture, or using the front door. His step-mother would beat him for any infraction, and for things that weren’t infractions; later his brothers confirmed that she did indeed beat him for things she did not mind when done by her own sons, and would rave at him for no reason at all. When his father got home, he would get another beating – his father made him choose a piece of firewood to be beaten with, and Howard developed the skill of picking ones that were flexible enough to hurt less but strong enough not to break (which would encourage his father to continue the beating with his bare hand). Between his actual behavioral problems, his pre-adolescent awkwardness, the fact that his step-mother did seem to truly want him dead, and his father’s absence and emotionally and physically violent treatment, Howard seemed doomed to a life of misery no matter what might have happened. What actually did happen is unbelievable.

Howard’s step-mother apparently conceived the idea that she could get rid of Howard if she got the weight of professional opinion on her side. She began visiting a series of psychiatrists to complain about her son’s behavior, but none of them would agree he had to be institutionalized or removed from the home. Several wrote consulting notes to the effect that they were convinced her harsh treatment was the problem and that she should moderate her behavior toward the boy. She moved from doctor to doctor trying to find one that would agree with her. Finally she stumbled onto Dr. Walter Freeman.

Freeman was the pioneer, in the US, of the new treatment of psycho-surgery. He actually coined the word “lobotomy”, and popularized the use of that treatment in this country. He was the first US physician to see the procedure, after it was developed in Europe just before WWII; Freeman brought it back to the States and traveled the country in specially-modified vans or station wagons that he called his “Lobotomobiles”, giving demonstrations of both electro-convulsive therapy (using a machine he built himself; when it broke down, he simply held the bare wires against the patient’s head for as long as he felt was appropriate, with no mechanism for monitoring voltage or current) and lobotomy. According to the Dully, relating reports of academic researchers who studied Freeman’s career, Freeman was a constant self-promoter and showman: he would perform several lobotomies in a day, every day, in front of medical audiences, liked to demonstrate how easy it was by sometimes using ordinary household implements rather than surgical tools, and developed a signature two-handed bilateral technique in which he would insert “leucotomes” (the lobtomy knife) into both lobes of a patient’s brain and then simultaneously jerk them both through the tissue with a flourish. At times, his death rate ranged upward of 20%. Nobody seemed to think this was cause for alarm. Patients were operated on without their own knowledge or consent, and authorization was freely obtained from courts or patient guardians after reassurances from Freeman that the procedure would solve all the patients’ problems. Often, no precise psychiatric diagnosis was attempted before the lobotomy was performed; lobotomies were used for conditions ranging from headaches to schizophrenia. More than a few were performed on minors, even pre-teens; there were questions about such cases, but little organized opposition. Freeman was profiled in popular magazines, and sometimes hailed as a god, delivering sufferers from their misery. There were many detractors in the medical community, but the great benefit of lobotomy was that it often made patients docile enough to live with their families without monitoring, meaning they could be discharged from the large state mental institutions that were commonplace then. This made the procedure wildly popular with the managers of those institutions, whose patients had no effective representation to oppose the treatment plans made for them by others.

After a few years, Freeman heard about, and again pioneered, a variation of the lobotomy procedure called “trans-orbital lobotomy”, often referred to as “ice-pick lobotomy”. In that procedure, a long, sharp, thin instrument was pushed along the eyeball parallel to the nose, and through the back of the eye socket (“orbit”) into the skull, and into the frontal lobe of the brain. The instrument could then be levered back and forth, and up and down, to tear through the frontal lobes and disrupt their neural circuitry. There was no method for visualizing the exact placement of the instrument in the brain, or the location, depth, or extent of the lesions created; the method was simply to stick the metal rod in through the eye socket and wiggle it back and forth to tear the brain tissue randomly. The effect was almost as dramatic as an open-skull lobotomy, but there was no external wound, and it could be performed under mild anaesthesia. The procedure could be done in an ordinary doctor’s office, and took about ten minutes. In many cases, the surgical instrument used was, in fact, an ice pick. (Freeman’s personal lobotomy instrument was labled “Uline Ice Company”.) Patients were sometimes sent home afterward in a taxi cab.

Freeman began popularizing the trans-orbital lobotomy, sometimes performing as many as two dozen procedures a day on patients in mental institutions and hospitals. In some cases, patients were operated on against their consent; after the procedure, they lacked the drive and wherewithal to sue. After some years traveling the country in his Lobotomobile, he finally settled in the South San Francisco Bay Area, near where Howard Dully’s family were living. Eventually, Dully’s step-mother asked to see him.

Freeman met with her a number of times over a period of two months, duly recording her wild stories of Howard’s unmanageable behavior (some of which later turned out to be pure fabrications – such as the story that he had beaten his brain-damaged baby brother almost to death). From the beginning the step-mother openly solicited some kind of dramatic professional intervention. Freeman hesitated at first, insisting he would have to meet the patient and interview the other family members before coming to any conclusion. (What seems incredible is that he began formulating treatment plans with the mother for weeks before ever once meeting Howard.) He interviewed Howard’s father one time; the father gave a much more balanced report of Howard’s behavior, but Freeman didn’t pick up on the clue. He began to meet with Howard himself, and found him reasonably normal though somewhat uncommunicative (who wouldn’t be?). But he kept meeting with Howard’s step-mother, who still filled him with tales of how afraid she was of Howard, how her other sons were afraid of him and were constantly beaten up by him (they deny this), and finally how Howard had beaten up his baby brother in infancy (his entire family denies this – and note that the step-mother was not part of the family at that time). Freeman seems to have accepted everything she said, and viewed Howard’s truancy and other bad behavior through this fictionalized and delusional lens. After four meetings with the step-mother, only one meeting (ever) with Howard’s father, and four visits with Howard himself, Freeman recommended that they should attempt to “change his personality” with a trans-orbital lobotomy. Howard’s step-mother immediately agreed, and took the papers home for his father to sign, which he did without ever speaking to the doctor again. Freeman cautioned the parents not to tell Howard what would happen – only that he would be admitted to the hospital for “tests”. Howard excitedly looked forward to his night in the hospital, because he had heard they gave you Jell-O there. And they did. It was two weeks after his 12th birthday.

Freeman lobotomized Howard the next day. Howard has no memory of any of the events of that day. He contracted a fever and an apparent infection (Freeman was infamous for not sterilizing his instruments before surgery; you can see, in the actual photograph of Howard’s procedure, [see photo at end, below the jump] that he is not wearing gloves), but recovered soon enough.

The rest of his life was a disaster.

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February 21, 2008

Monstrous Good Reading

by @ 11:33 AM. Filed under Access to Healthcare, Autonomy, BioLibri, Biotechnology, Child-Rearing, Disability Issues, General, Global/Community Health, Healthcare Politics, Provider Roles, Theory

I met Robert Rummel-Hudson last night at his New York book party, celebrating the release of Schuyler’s Monster, his memoir of his daughter’s struggle to meet the challenges of having been born with polymicrogyria – a neurodevelopmental disease that prevents her from developing spoken language – and his own struggle to meet the challenges of parenthood and the demands imposed by his daughter’s condition. The book grew out of Rob’s gripping, heart-rending blog, Fighting Monsters with Rubber Swords.

Robert has been documenting, step-by-step, the pathway he, his equally-admirable wife Julie, and Schuyler (pr. “SKY-ler”) herself have followed, first coming to terms with Schuyler’s developmental difficulties, then battling the public schools’ broken and indifferent system for educating special-needs children until finally moving to a city (Plano, TX, of all places) that offered what Schuyler needed. At the urging of his growing base of enthralled fans and well-wishers, he turned the blog into a book that hit the market just this week. It has already received considerable word of mouth and small-market press attention even before release; I am convinced it is just about to explode into a real sensation, and deservedly so.

Robert has an ability to communicate the pathos and humor of his family’s situation, and even more strongly Schuyler’s unbelievably spunky and winning personality, and her brilliantly unique triumph over the multiple dirty tricks life has played her. Schuyler is without question the star of his blog (which, he says, she still has not read, nor has she the book, either, though she is fully aware that she is a media queen). It is impossible to read their story without falling in love with Schuyler (and indeed she is regularly showered with largesse by fans, often anonymous, who have visited the family’s Amazon wish-lists). “Schuyler has a posse!”, I told Rob, and he agreed that one of the most satisfying side-effects of blogging about her condition is that she has garnered such a wide-spread support base. That is due to Rob’s ability to make her come alive through his words – though it’s obvious Schuyler is giving him a lot of great material to work with.

In person, Rob comes across just as you’d imagine from his blog: funny, personable, thoughtful, fiercely dedicated to Schuyler and her needs, worried about her future, and laceratingly honest about his own uncertainties and shortcomings (which I think he overestimates). It was great fun meeting him, and I was glad to see the St. Martin’s Press staff just as enthused about the book as were the many fans who turned out to meet the author.

I mention all this simply to add this plug for a book that deserves to be read, and will break your heart and change your viewpoint when you have done so. I can’t communicate the impact of Rob’s blog or the book it gave rise to, but I urge everyone to experience them for themselves.

(1) Go buy this book:

Cover image from book

(2) Go read this blog.

You can thank me later.

UPDATE: Fixed an editing mistake.

February 2, 2008

Obligations to the Dead

by @ 2:04 PM. Filed under Autonomy, BioLibri, General, Personhood, Theory

There’s an interesting article by Ron Rosenbaum, in Slate, regarding the fate of Vladmir Nabokov’s final, unfinished manuscript.

Nabokov left a manuscript on index cards, apparently totaling about 30 pages’ worth of text, for an unfinished book titled The Original of Laura. No one outside his family knows what is in the text, or what the title means. Nabokov left unambiguous instructions, at the time of his death, that the manuscript was to be destroyed without publication. This jibes with ideas he expressed elsewhere about refusing to publish imperfect works. His wife, the legendary (infamous?) Vera Nabokov, was his literary executor; she indicated she would follow his wishes but never got around to destroying the cards. When she died in 1991, the cards, and Nabokov’s imprecation, fell to his son Dimitri, who has otherwise actively defended his father’s literary legacy. Dimitri has indicated that he is ambivalent about destroying the work, but is apparently leaning in the direction of carrying out his father’s wishes. Rosenbaum has corresponded with Dimitri over the years, encouraging him to publish the material; in his Slate article, he broadcasts a call for input from readers, promising to forward the best responses to Dimitri, who is apparently finally nearing a decision.

Well. By itself all very interesting, no doubt, and arguably very thinly connected to bioethics by way of Nabokov’s background in biology. (Rosenbaum even tries to link Nabokov’s Laura to Petrarch’s Laura by way of a bird image in the latter and one of Nabokov’s ubiquitous butterfly images in Pale Fire; Dimitri scoffs at this.) But it really doesn’t seem to be an immediate issue in bioethics itself. Or is it?

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July 10, 2007

Spittle-Flecked Rant, and Raving

by @ 10:49 PM. Filed under BioLibri, General, Global/Community Health, Healthcare Politics, Medical Science, Sex

I read Chuck Palahniuk’s latest novel, Rant: an Oral Biography of Buster Casey, on the strength of a description of its plot. I thought it might raise some interesting bioethical issues. I suppose it does. Mostly it makes me want to take a shower.

Honestly, I have no idea what to think about this business, but . . . here goes:

Rant is a pseudo oral history of the life and exploits of the title character, Buster “Rant” Casey. Palahniuk delivers over 300 pages of short-paragraph-length observations from peripheral characters describing their interactions with him from overlapping and mismatching perspectives. (The book reads quickly because, given the large amount of white space between the “recollections”, it’s probably closer to 250 pages of real text.) We’re supposed to reconstruct the events described on the basis of which stories we believe. When you solve the puzzle, you get a picture of a dysfunctional and paranoid society suspiciously like our own, in which the government has vacated all civil liberties, imposed lifetime detention without trial for undesirable elements, and sequestered half the population in a dark underworld in which they are doomed to menial, marginal existences, receive a grudging minimum of social services, and can be shot on sight for being caught in the wrong place with the wrong paperwork; the justification for all this is . . . (wait for it) . . . the security of the nation, in the face of an existential threat from an invisible but omnipresent enemy. Young people respond to this with desperate nihilism, engrossing themselves in bizarre and self-destructive practices, as well as drugs, mindless sex, and violence. Behind the scenes are shadowy conspiracies enacted by powerful individuals who maintain the danger and the resulting oppression for their own interests: corporate, political, or religious.

Palahniuk’s take on this otherwise none-too-fictional theme is that the danger in question is not terrorists or traitors, or weapons of mass destruction, but biology. The world is driven to the brink of collapse by an unstoppable epidemic of rabies, passed mouth-to-mouth through close, casual contact, through sex between unknowing partners, and sometimes by those who deliberately seek infection as an act of rebellion. Rant Casey is the source of the infection, and of much else that goes on in this strained and tortured world.

[Spoilers Follow]

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June 1, 2007

Abortion: History and Attitudes over Time

by @ 5:00 PM. Filed under Access to Healthcare, Autonomy, BioFlix, BioLibri, Biotechnology, Child-Rearing, General, Global/Community Health, Healthcare Politics, Personhood, Provider Roles, Reproductive Ethics, Sex, Women's Issues

Making with the sorely overdue link-love: two months ago, Amanda Marcotte (of Pandagon, and the best thing that ever happened to John Edwards) linked my prior post on right-wing propaganda about Margaret Sanger (as a way of attacking Planned Parenthood). She points out the fact that, in Sanger’s day, PP was actually anti-abortion (largely for reasons of the relative safety of the procedure, much lower then than now), and that the wingers seem to have no conception of the irony of their slanders.

The article generated a fascinating discussion thread, however (with minimal, but nonzero, trollage) - one that I only stumbled across today by following a visitor link (thanks!). I’m sorry to be so late on this but I encourage everyone to run over there; the discussion is interesting and, collectively, it includes a fascinating list of resources on the history of abortion, abortion and race, and sexual autonomy as seen from a variety of times and places, and presented in a variety of media (the rock-opera version of a 19th-century German play about the link between lack of sex ed and unplanned pregnancy sounds . . . wild – and I had no idea there was a whole list of early silent movies on the same topic!). Now I’ve got a lot more reading to do! So do you.

June 23, 2006

Bioethics and Media

by @ 1:00 AM. Filed under BioFlix, BioLibri, General, Healthcare Politics

I attended an interesting conference session today on the relationship between bioethicists and the media. Most of the discussion focused on the ways the media distorts or simply does a bad job reporting controversial issues, especially on difficult or abstract subjects such as arise in bioethics. The question was pitched as “How should bioethicists relate to the media?”

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May 9, 2006

Personscan: High Tech High Anxiety, Just 40 Years Away!

by @ 7:39 PM. Filed under Autonomy, BioLibri, Biotechnology, General, Personhood, Theory

[This is the first post in an irregular series of reviews and discussions of fiction and non-fiction books relating to bioethics or concepts in the field.]

Robert J. Sawyer is a hugely creative sci-fi author (Hugo, Nebula multi-nominee and winner, slews of other awards) with a fascination for issues touching on human personhood and human nature. He has a widely-read series that posits a parallel universe in which H. neanderthalensis evolved to become the dominant species, with a distinctly different human nature from that of H. sapiens, and a number of similar books in which human nature and the science/religion conflict are examined from a perspective slightly removed – by the license granted to science fiction – from our own. His most recent book is Mindscan, an examination of the possibility of cognition “uploads” – the copying of memory and thought from the human mind into a permanently-rebuildable (hence immortal) synthetic substrate. The fact that the copying process does not destroy the original – that it creates two cognitively-identical minds housed one in its original organic body and the other in an indefinitely long-lived synthetic one, which then vie for recognition as the “real” person – gives the plot its tension.

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