Current Volume

Volume XIII, 2022

Editor-in-Chief: Lily Chang. Editors: Nicole Au, Alexandra Deutsch, Siddhant Kumarapuram Ganapath, Arielle Cohen, Anjana Ramesh, Swetha Sriramoju, Prianka Kunadia, and Nikhil Ramavenkat. This year’s theme for our Journal is “Healthcare Autonomy in a Post-Covid World”, where our authors touch upon a wide-range of bioethical concerns such as
COVID-19 vaccine distribution, advance care planning, and contraception ethics.

Anjana Ramesh opens this volume with an analysis of psychedelic drug policies in both the U.S. and Portugal, while Nikhil Ramavenkat critically examines the moral dilemma of nootropics, a class of substances that can improve cognitive function. Next, Ranjitha Vasa advocates for yearly comprehensive contraception education. Adele Jasperse argues that phenomenal value is the only sound moral framework we should use when determining the bioethical implications of part-human chimera research. Given the COVID-19 pandemic’s devastating impact on people’s lives, Sydney Goldberg and Dr. Brian Cummings recommend using social networking sites as a method to motivate young people to participate in their own advance care planning. Juliana Kim and Jennifer Geller explore the bioethical implications of global COVID-19 vaccine distribution between wealthier and poorer countries. Lastly, Xudong Ma examines how to best preserve the bioethical integrity of patients with impaired competence, ultimately recommending the usage of a legal guardianship system. It is truly impressive how all these pieces add to the body of bioethical literature in various fields, disciplines, and schools of thought.

Editorials:

A New War on Drugs: Significance of Psychedelic Legalization

By Anjana Ramesh.

Commencement of Contraception Education

By Ranjitha Vasa.

Articles:

Ethical Implications of Research on Part-Human Chimeras: The Need for a More Rigorous Moral Status Framework

By Adelaida Jasperse.

Research on part-human chimeras, creatures possessing animal and human cells, raises the ethical concern of whether this technology changes chimera’s moral status such that to render this research morally impermissible. This paper argues that the current conception of moral status for these beings should not be rooted in uniquely human qualities but, rather, in properties that are morally significant in their own right. In this context, moral status should be conceived in terms of what is valuable in diverse kinds of conscious experience, otherwise designated as phenomenal value. Chimera research primarily entails inserting human embryonic stem cells “hES cell” into animal embryos. Another pertinent stem cell type, human-induced pluripotent stem cells (“iPS”) of which capacity for division allows them to transform into any type of the adult body cells including brain cells, are used to create structures called brain organoids. Apart from stem cell technology, chimera application involves grafting human somatic cells or tissues into animals that have been rendered immune-deficient. The current prevalent arguments offer varied views about the moral status of chimeras and their corresponding interests. Differing views lead to confusion about the treatment of chimeras and bring into question the views’ epistemic merits. More significantly, their one commonality; namely, that they ground the chimera moral status in uniquely human qualities such as intelligence, memory, self-awareness, communication or numeracy, is vulnerable to moral scrutiny. Instead, phenomenal value—which connotes the value found within different conscious experiences including but not limited to smell, taste, motor activities, mental states and processes unique to that being—is epistemically and morally sounder. This is so because phenomenal value does not favor emphasizing intellectual features or disregarding other shared qualities and experiences. It also provides consistency and avoids the moral risk inherent in the present moral judgments and practices. Our moral obligation to such a being would hinge on the types and the degree of phenomenal value. This type of phenomenal value that is not uniquely human should deserve sufficient moral weight for safeguarding against inflicting pain and killing. Guided by this moral status framework, we should implement regulations that ban this unethical form of research.

Young Adults and Advance Care Planning: A Promising Path Forward with Social Networking Sites

By Sydney L. Goldberg and Brian M. Cummings.

Advance care planning (ACP) is an essential part of health management for patients and caregivers, with the COVID-19 pandemic illuminating the crucial role of understanding patients’ preferences when hospitalized and seriously ill. Although ACP awareness was increasing pre-pandemic, current collaborative efforts to improve patient’s knowledge and documentation of their preferences has not engaged young adults. The cause of serious illness and death for young adults is frequently unintentional or unexpected, leaving limited opportunity for exploration of medical care desires when ill. Proactive engagement is crucial and social networking sites (SNS) can serve a potential role. Young adults spend time on, and their identities and communities can be shaped by their SNS involvement. Evidence from pilots in organ donation and smoking cessation reveal SNS can motivate behavior in stigmatized health-related topics. Given the existing gaps and the availability of SNS, the time is right to operationalize ACP into SNS.

COVID-19 Vaccine Distribution: A Current Ethical Assessment

By Juliana E. Kim and Jennifer E. Geller.

With the declaration of COVID-19 as a global pandemic on March 11, 2020, difficult discussions concerning the ethical allocation of limited resources such as ventilators began. With the approval of vaccines worldwide, the conversation has pivoted to how to ethically and efficiently distribute vaccines worldwide to achieve global herd immunity. As vaccine distribution progresses in countries such as the United States, and stalls in others such as India, the strategy of vaccine allocation must be revisited. In doing the greatest good for the greatest number of people, efforts must target those who are vulnerable and from poorer countries to not only distribute the vaccine but establish a vaccine administration program. In addition to being a moral quandary concerning human rights, the breakdown of proper primary prevention poses the potential development of perpetual variants that can further destroy the world economy as a result. This review piece seeks to describe the present status of vaccine distribution to assess where wealthier nations need to go from here in protecting the world stage.

Building Better Brains: Exploring the Societal Effects of Nootropics

By Nikhil Ramavenkat.

A nootropic is any synthetic or natural substance that has the potential to enhance an individual’s cognitive capacities. While the scope of their effects is currently limited to mild boosts in memory and performance, as pharmacological research continues their use may become more mainstream. The promise of nootropics, however, also paves the way for several moral conundrums, such as their impact on educational and occupational disparities as well as the long-term effects they may wreak on human biology. These questions highlight the need for a continued discussion on the ethicality of cognitive performance enhancers as they relate to societal standards of fairness and equality. The goal of this paper is to examine and explore the social consequences of nootropics through the lens of the four pillars of bioethics: autonomy, beneficence, nonmaleficence, and social justice. By framing a discussion about nootropics around the ideas of social coercion, competition, and the brain itself, we can better assess the effect they might have on our society and the questions we must continue to ask ourselves about their use.

Autonomy and Depression: Preserving Bioethical Integrity For Patients with Impaired Competence

By Xudong Ma.

In bioethics, the principle of autonomy stipulates that patients’ rights to make their own medical decisions should be preserved as much as possible. In some complicated cases, especially cases of mental disorders, patients might lose the competence of making rational medical decisions. For example, some mental disorders impair a patient’s cognitive capacity and deprive their ability to think rationally. For these cases, MacCAT-T is an assessment tool often used to determine if it is appropriate to preserve rights of autonomy for a certain patient with a mental disorder. However, this paper indicates that MacCAT-T does not work for some prevalent mental disorders, such as depression. This is because these mental disorders do not impair one’s cognitive capacity such as memory, reasoning, and perception, but rather negatively affect the patient’s psychological tendency of making any rational medical decisions, and this is what the MacCAT-T is not capable of detecting. Moreover, as this paper indicates, since the pathological cause of depression is still unclear, the ethical dilemma of preserving the rights of autonomy for patients with depression has further complications. Thus, an expedient for the current situation that would not rely on the invalid assessment tool is needed. This paper proposes that a legal guardianship system would fulfill this need, as it not only avoids the questionability of allowing patients with depression to make medical decisions that are possibly irrational, but also preserves the maximal rights of autonomy for these patients indirectly.

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