Anthropogenic climate change is causing temperature rise in temperate zones resulting in climate conditions more similar to subtropical zones. As a result, rising temperatures increase the range of disease-carrying insects to new areas outside of subtropical zones, and increased precipitation causes flooding that is more hospitable for vector breeding. State governments, the federal government, and governmental agencies, like the Animal and Plant Health Inspection Service of USDA and the National Notifiable Disease Surveillance System of the U.S. Centers (...) for Disease Control and Prevention, lack a coordinated plan for vector-borne disease accompanying climate change. APHIS focuses its surveillance primarily on the effect of illness on agricultural production, while NNDSS focuses on the emergence of pathogens affecting human health. This article provides an analysis of the current framework of surveillance of, and response to, vector-borne infectious diseases, the impacts of climate change on the spread of vector-borne infectious diseases, and recommends changes to federal law to address these threats. (shrink)

The fifteenth-century encounter between previously separate disease environments was not simply an encounter between Europe and the Americas. It was preceded by an encounter between Europe and tropical Africa and followed by a still-more-intense transmission of diseases across the tropical Atlantic, mainly from Africa to the Americas. This transmission principally involved smallpox, yaws, yellow fever, and falciparum malaria. Many other vector-borne diseases failed to make the transfer for lack of suitable vectors in the Americas. The African diseases (...) contributed even more than those from Europe to the depopulation of the humid tropics in the Americas. They also set up conditions that made residence in the tropical Americas dangerous for newly arrived people from Europe. (shrink)

Within the domain of public health, vector-borne diseases are among the most vehemently discussed issues. Recent scientific breakthroughs in genome editing technology provided a solution to this issue in the form of a gene drive that might decrease and even eradicate vector-borne diseases. Gene drives are engineered, and designed genes that can break typical inheritance rules and be passed to almost all of the carrier’s offspring. This genome editing and gene drive technology has become a powerful (...) tool for ecological and environmental engineering, through which man can manipulate his surroundings, adjusting it to himself and directly mastering evolution and the ecosystem. Although the gene drive technology has been perceived as promising in the public health domain, ecological implications of its use are not to be underestimated. The primary aim of this paper is to overcome the ongoing discussion which mostly focuses on whether priority should be given to the environment or to public health, and to find an adequate answer and solution. In this quest to find the proper answer and solution, Pierre Teilhard de Chardin’s thought might be useful, especially his concepts of the biosphere and the noosphere which may provide some clarifications as to why we are at the moment so cautious with gene drive technology and how we need to move towards a better common future on earth. (shrink)

Genetically engineered (GE) insects, such as the GE OX513A Aedes aegypti mosquitoes, have been designed to suppress their wild-type populations so as to reduce the transmission of vector-borne diseases in humans. Apart from the ecological and epidemiological uncertainties associated with this approach, such biotechnological approaches may be used by individual governments or the global community of nations to avoid addressing the underlying structural, systemic causes of those infections... We discuss here key ethical questions raised by the use of (...) GE mosquitoes, with the aim of fostering discussion between the public, researchers, policy makers, healthcare organizations, and regulatory agencies at the local, national, and international levels. We affect that goal by outlining a procedural approach to decision-making about the use of the “biotechnology” that goes beyond “community engagement.” The protocol we advocate for entails informed deliberations and decision-making at the community level. It is designed to ensure that the voices of the marginalized and vulnerable groups that would be disproportionately affected by the decision are heard during the community-wide discussions. Moreover, we make the case that the values embedded in the risk assessment should be identified so that the community can make an informed decision about the use of GE insects. In addition, we advocate for the involvement of a variety of actors whose responsibility would be to ensure that the community has the opportunity to make an informed decision based on deliberations about the use of the “biotechnology.”. (shrink)

Anthropogenic climate change is a global process affecting the lives and well-being of millions of people now and countless number of people in the future. For humans, the consequences may include significant threats to food security globally and regionally, increased risks of from food-borne and water-borne as well as vector-borne diseases, increased displacement of people due migrations, increased risks of violent conflicts, slowed economic growth and poverty eradication, and the creation of new poverty traps. Principles of (...) justice are statements of what persons are owed either by others or by institutions and policies. Climate change gives rise to many concern of justice. This article briefly summarizes some of the most important of these, including claims to have climate change mitigated, claims regarding the sharing of the costs of climate change mitigation, claims for investment into adaptation, and claims to be compensated. (shrink)

BackgroundGene drive technologies (GDTs) promote the rapid spread of a particular genetic element within a population of non-human organisms. Potential applications of GDTs include the control of insect vectors, invasive species and agricultural pests. Whether, and if so, under what conditions, GDTs should be deployed is hotly debated. Although broad stances in this debate have been described, the convictions that inform the moral views of the experts shaping these technologies and related policies have not been examined in depth in the (...) academic literature.MethodsIn this qualitative study, we interviewed GDT experts (n = 33) from different disciplines to identify and better understand their moral views regarding these technologies. The pseudonymized transcripts were analyzed thematically.ResultsThe respondents’ moral views were principally influenced by their attitudes towards (1) the uncertainty related to GDTs; (2) the alternatives to which they should be compared; and (3) the role humans should have in nature. Respondents agreed there is epistemic uncertainty related to GDTs, identified similar knowledge gaps, and stressed the importance of realistic expectations in discussions on GDTs. They disagreed about whether uncertainty provides a rationale to refrain from field trials (‘risks of intervention’ stance) or to proceed with phased testing to obtain more knowledge given the harms of the status quo (‘risks of non-intervention’ stance). With regards to alternatives to tackle vector-borne diseases, invasive species and agricultural pests, respondents disagreed about which alternatives should be considered (un)feasible and (in)sufficiently explored: conventional strategies (‘downstream solutions’ stance) or systematic changes to health care, political and agricultural systems (‘upstream solutions’ stance). Finally, respondents held different views on nature and whether the use of GDTs is compatible with humans’ role in nature (‘interference’ stance) or not (‘non-interference stance’).ConclusionsThis interview study helps to disentangle the debate on GDTs by providing a better understanding of the moral views of GDT experts. The obtained insights provide valuable stepping-stones for a constructive debate about underlying value conflicts and call attention to topics that deserve further (normative) reflection. Further evaluation of these issues can facilitate the debate on and responsible development of GDTs. (shrink)

The COVID‐ 19 pandemic is a critical test for the already overburdened and mostly underfunded public healthcare systems of Latin America. In a region that suffers from severe inequalities, public healthcare systems are the only source of medical care for a large sector of the population who work in the informal economy or are unemployed. State‐run hospitals and clinics are already overstressed by continuous demand for treatment of vector‐borne diseases and community‐acquired infections as well as high rates of (...) non‐communicable diseases. Ideological misconceptions and denial among Latin America’s political leaders prevented timely preparations for the pandemic and added to chronic governance problems. As ethical expertise in Latin America focuses on research ethics, few hospitals in the region have functioning clinical ethics committees or clinical ethics policy, forcing healthcare personnel to make excruciating treatment decisions in an environment dominated by material scarcity and public distrust. This essay examines the emergence of COVID‐19 in Latin America and the serious challenge that it poses for Latin America's public healthcare systems. (shrink)

Definitive diagnosis of malaria requires the demonstration through laboratory tests of the presence within the patient of malaria parasites or their components. Since malaria parasites can be present even in the absence of malaria manifestations, and since symptoms of malaria can be manifested even in the absence of malaria parasites, malaria diagnosis raises important issues for the adequate understanding of disease, etiology and diagnosis. One approach to the resolution of these issues adopts a realist view, according to which the (...) needed clarifications will be derived from a careful representation of the entities on the side of the patient which form the ultimate truthmakers for clinical statements. We here address a challenge to this realist approach relating to the diagnosis of malaria, and show how this challenge can be resolved by appeal to Basic Formal Ontology (BFO) and to the Ontology for General Medical Science (OGMS) constructed in its terms. (shrink)

Rift Valley Fever is a vector-borne disease mainly transmitted by mosquito. To gain some quantitative insights into its dynamics, a deterministic model with mosquito, livestock, and human host is formulated as a system of nonlinear ordinary differential equations and analyzed. The disease threshold $$\mathcal{R}_0$$ is computed and used to investigate the local stability of the equilibria. A sensitivity analysis is performed and the most sensitive model parameters to the measure of initial disease transmission $$\mathcal{R}_0$$ and (...) the endemic equilibrium are determined. Both $$\mathcal{R}_0$$ and the disease prevalence in mosquitoes are more sensitive to the natural mosquito death rate, d m . The disease prevalence in livestock and humans are more sensitive to livestock and human recruitment rates, $$\Uppi_l$$ and $$\Uppi_h$$, respectively, suggesting isolation of livestock from humans is a viable preventive strategy during an outbreak. Numerical simulations support the analytical results in further exploring theoretically the long-term dynamics of the disease at the population level. (shrink)

Malaria is a Plasmodium parasitic disease transmitted by infected female Anopheles mosquitoes. Climatic factors, such as temperature, humidity, rainfall, and wind, have significant effects on the incidence of most vector-borne diseases, including malaria. The mosquito behavior, life cycle, and overall fitness are affected by these climatic factors. This paper presents the results obtained from investigating the optimal control strategies for malaria in the presence of temperature variation using a temperature-dependent malaria model. The study further identified the temperature (...) ranges in four different geographical regions of sub-Saharan Africa, suitable for mosquitoes. The optimal control strategies in the temperature suitable ranges suggest, on average, a high usage of both larvicides and adulticides followed by a moderate usage of personal protection such as bednet. The average optimal bednet usage mimics the solution profile of the mosquitoes as the mosquitoes respond to changes in temperature. Following the results from the optimal control, this study also investigates using a temperature-dependent model with insecticide-sensitive and insecticide-resistant mosquitoes the impact of insecticide-resistant mosquitoes on disease burden when temperature varies. The results obtained indicate that optimal bednet usage on average is higher when insecticide-resistant mosquitoes are present. Besides, the average bednet usage increases as temperature increases to the optimal temperature suitable for mosquitoes, and it decreases after that, a pattern similar to earlier results involving insecticide-sensitive mosquitoes. Thus, personal protection, particularly the use of bednets, should be encouraged not only at low temperatures but particularly at high temperatures when individuals avoid the use of bednets. Furthermore, control and reduction of malaria may be possible even when mosquitoes develop resistance to insecticides. (shrink)

Despite widespread and worldwide efforts to eradicate vector-borne diseases such as malaria, these diseases continue to have an enormous negative impact on public health. For this reason, scientists are working on novel control strategies, such as gene drive technologies (GDTs). As GDT research advances, researchers are contemplating the potential next step of conducting field trials. An important point of discussion regarding these field trials relates to who should be informed, consulted, and involved in decision-making about their design and (...) launch. It is generally argued that community members have a particularly strong claim to be engaged, and yet, disagreement and lack of clarity exist about how this “community” should be defined and delineated. In this paper, we shed light on this “boundary problem”: the problem of determining how boundaries of inclusion and exclusion in (GDT) community engagement should be drawn. As our analysis demonstrates, the process of defining and delineating a community is itself normative. First, we explicate why it is important to define and delineate the community. Second, we demonstrate that different definitions of community are used and intermingled in the debate on GDTs, and argue in favor of distinguishing geographical, affected, cultural, and political communities. Finally, we propose initial guidance for deciding who should (not) be engaged in decision-making about GDT field trials, by arguing that the definition and delineation of the community should depend on the rationale for engagement and that the characteristics of the community itself can guide the effective design of community engagement strategies. (shrink)

During the last decade there has been increasing interest in combining veterinary and human medicine, mainly in the areas of vaccination and the eradication of zoonotic and vector-borne diseases. Although the roots of this "One Health-One Medicine" approach can be found in ancient Egypt and Greece, the roots of the philosophy of "one medicine" have not been so thoroughly discussed. In this paper I will analyse some ideas that could unite veterinary and human medicine, from Rudolf Virchow and (...) Calvin W. Schwabe. Both are recognized as important theoretical founders of the philosophy of one medicine. I will also further develop these thoughts to meet some of the discussions taken place today. (shrink)

John and Curran have convincingly shown that Scanlonian contractualism is a valuable resource for evaluating pandemic response policies, and that we should reject cost–benefit analysis in favour of a contractualist framework. However, they fail to consider the part of contractualism that Scanlon constructed precisely to deal with the question of when the state can restrict individuals from making choices that are harmful to themselves and others: the value of choice view. In doing so, they leave it open for opponents of (...) lockdowns to misuse contractualism to justify mistaken policies. This is because the most powerful contractualist objections to locking down are likely to be based on the VoC. When we apply the value of choice view, we see that a lockdown policy’s justifiability depends on the extent to which particular values of choice are found to be threatened by the policy in question, and what safeguards policy-makers have put in place to increase the value of choice and protect people from the harmful consequences of lockdown. Without the VoC, it is harder to explain why lockdowns, to be non-rejectable, must have certain features. With the VoC, the case for contractualism over cost benefit analysis can be made even stronger. (shrink)

Developmental models that account for the metabolic effect of temperature variability on poikilotherms, such as degree-day models, have been widely used to study organism emergence, range and development, particularly in agricultural and vector-borne disease contexts. Though simple and easy to use, structural and parametric issues can influence the outputs of such models, often substantially. Because the underlying assumptions and limitations of these models have rarely been considered, this paper reviews the structural, parametric, and experimental issues that arise (...) when using degree-day models, including the implications of particular structural or parametric choices, as well as assumptions that underlie commonly used models. Linear and non-linear developmental functions are compared, as are common methods used to incorporate temperature thresholds and calculate daily degree-days. Substantial differences in predicted emergence time arose when using linear versus non-linear developmental functions to model the emergence time in a model organism. The optimal method for calculating degree-days depends upon where key temperature threshold parameters fall relative to the daily minimum and maximum temperatures, as well as the shape of the daily temperature curve. No method is shown to be universally superior, though one commonly used method, the daily average method, consistently provides accurate results. The sensitivity of model projections to these methodological issues highlights the need to make structural and parametric selections based on a careful consideration of the specific biological response of the organism under study, and the specific temperature conditions of the geographic regions of interest. When degree-day model limitations are considered and model assumptions met, the models can be a powerful tool for studying temperature-dependent development. (shrink)

Tick and tick-borne diseases, especially East Coast fever, caused byTheileria parva, are amongst the most important factors limiting cattle production in Eastern, Central, and Southern Africa. In the past, they have been controlled mainly by the use of acaricides to kill ticks. Immunization has been shown to be an effective alternative method of control of tick-borne diseases in limited field trials. A development program has been initiated to produce vaccines and implement immunization on a wide scale in the (...) region in a sustainable manner as part of an integrated tick and tickborne disease control program. The consequent reduction in cattle mortality is expected to have far-reaching benefits for the region. (shrink)

In the early 1970s, a World Health Organization‐initiated and United States‐funded project released lab‐reared mosquitoes outside New Delhi in the first large‐scale field trials of the genetic control of mosquitoes. Despite partnering with the Indian Council of Medical Research and investing significantly in outreach to local communities at the release sites, the project was embroiled in controversy and became an object of vehement debate within the Indian parliament and diplomatic contretemps between the United States and India. This early episode of (...) genetic control research demonstrates how a scientific collaboration was entangled in geopolitics and shaped by the legacy of colonialism. This historical case study has implications for public deliberation in the present, pointing to the challenges of shared decision‐making in the context of structural inequality, the way that a backdrop of military interest in a technology can impede trust, and the long‐term consequences of projects that foster mistrust. (shrink)

Schistosomiasis, a vector-borne chronically debilitating infectious disease, is a serious public health concern for humans and animals in the affected tropical and sub-tropical regions. We formulate and theoretically analyze a deterministic mathematical model with snail and bovine hosts. The basic reproduction number R0\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R_0$$\end{document} is computed and used to investigate the local stability of the model’s steady states. Global stability of the endemic equilibrium is carried out by constructing a (...) suitable Lyapunov function. Sensitivity analysis shows that the basic reproduction number is most sensitive to the model parameters related to the contaminated environment, namely: shedding rate of cercariae by snails, cercariae to miracidia survival probability, snails-miracidia effective contact rate and natural death rate of miracidia and cercariae. Numerical results show that when no intervention measures are implemented, there is an increase of the infected classes, and a rapid decline of the number of susceptible and exposed bovines and snails. Effects of the variation of some of the key sensitive model parameters on the schistosomiasis dynamics as well as on the initial disease transmission threshold parameter R0\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R_0$$\end{document} are graphically depicted. (shrink)

This essay examines the debate surrounding New York City’s controversial diabetes registry program. Exploring the tensions between public health officials and privacy advocates, the article explores how diabetes is imagined in the public sphere. Although rhetorics underscoring privacy may seem the more progressive discourse, I argue New York City’s Department of Health and Mental Hygiene has the more forward-looking plan, attempting to reconstitute diabetes not as a chronic condition necessitating individual management but as a disease that requires systemic intervention.

Zika virus was recognised in 2016 as an important vector-borne cause of congenital malformations and Guillain-Barré syndrome, during a major epidemic in Latin America, centred in Northeastern Brazil. The WHO and Pan American Health Organisation, with partner agencies, initiated a coordinated global response including public health intervention and urgent scientific research, as well as ethical analysis as a vital element of policy design. In this paper, we summarise the major ethical issues raised during the Zika epidemic, highlighting the (...) PAHO ethics guidance and the role of ethics in emergency responses, before turning to ethical issues that are yet to be resolved. Zika raises traditional bioethical issues related to reproduction, prenatal diagnosis of serious malformations and unjust disparities in health outcomes. But the epidemic has also highlighted important issues of growing interest in public health ethics, such as the international spread of infectious disease; the central importance of reproductive healthcare in preventing maternal and neonatal morbidity and mortality; diagnostic and reporting biases; vector control and the links between vectors, climate change, and disparities in the global burden of disease. Finally, there are controversies regarding Zika vaccine research and eventual deployment. Zika virus was a neglected disease for over 50 years before the outbreak in Brazil. As it continues to spread, public health agencies should promote gender equity and disease control efforts in Latin America, while preparing for the possibility of a global epidemic. (shrink)

Many studies have attempted to assess the relative effects of different vectors of a disease on animal populations. To this end, three measures have been proposed: Vectorial efficiency, Vectorial capacity and recently Vectorial effectiveness (or Vectorial impact). In this study we relate these measures to derive some of their properties emphasising in the vectorial impact for its importance in both, population performance of parasites and the proportion of the prevalence of one parasite due to a given vector. We (...) applied the quantitative expressions advanced in this study to a simple Chilean example with one parasite (Trypanosoma cruzi), two vectors (Triatoma infestans and Mepraia spinolai) and one animal population (humans: Chagas's disease). (shrink)

Livestock are important assets in Africa, helping improve the nutritional status of their owners, and contributing to economic growth. Can these roles continue and can livestock production systems be further developed so that they will be sustainable? A key feature of livestock in Africa is that they fulfill multiple roles, ranging from draught power, to providing manure, milk, and meat. Constraints to increasing productivity include both physical and institutional. In the former category, constraints to adopting draught power include insufficient numbers (...) at the individual household level. Lack of adequate pasture is probably the most important constraint. Diseases are also notable constraints to improving productivity, particularly those categorized as Group I (highly contagious — e.g., rinderpest) or Group II (vector-borne parasitic and viral—e.g., trypanosomiasis). Institutional constraints include lack of research and market distortions. To improve productivity, at the macroeconomic level, governments must continue or start policies aimed at liberalizing markets and revaluing exchange rates. Also, research institutions need an increase in funding for periods of ten or more years. Research and other livestock institutions may be able to leverage limited resources by forming more collaborative relationships at the regional level. Research priorities include breeding on specific aspects, such as increased milk production. However, it must be realized that breeding programs have an inherent problem in disseminating improved breeds in a rapid and equitable manner. Quality of pasture may be improved by further research on more accurately calculating stocking rates and on developing mechanisms to control numbers on pastures (e.g., community controlled grazing schemes). Other research priorities include new technologies to improve animal health, funding of micro-enterprises to add value to livestock products, and market information systems for small-scale farmers. Schemes to increase livestock production in Africa will only occur if innovations closely match the local sets of circumstances. Given the multiple roles of livestock, research into innovations that local communities will readily adopt must take a systems approach. (shrink)

'The Patient as Victim and Vector' is jointly written by four authors at the University of Utah with expertise in bioethics health law, and both clinical practice and public health policy concerning infectious disease.

The prelims comprise: Seeing Infectious Disease as Central The Birth of Bioethics Amid the Decline of Infectious Disease The Shifting Concerns of Public Health Bioethics and Public Health: How the Twain Didn't Meet The Case of HIV Bridging the Gap: Seeing Bioethics in Terms of the Patient as Victim and Vector An Ordinary Example Summing Up: Autonomous Agency in the Context of Infectious Disease Notes.

For focal neurodegenerative diseases or brain tumors, localized delivery of protein or genetic vectors may be sufficient to alleviate symptoms, halt disease progression, or even cure the disease. One may circumvent the limitation imposed by the blood-brain barrier by transplantation of genetically altered cell grafts or focal inoculation of virus or protein. However, permanent gene replacement therapy for diseases affecting the entire brain will require global delivery of genetic vectors. The neurotoxicity of currently available viral vectors and the (...) transient nature of transgene expression invivomust be overcome before their use in human gene therapy becomes clinically applicable. (shrink)

For nearly a century, and until very recently, the majority of U.S. states required a blood test for marriage license applicants. The tests identified people with conditions formerly designated as "venereal diseases," most importantly gonorrhea and syphilis. Those who tested positive were barred from civil marriage. Although the premarital testing requirement is no longer a feature of state law, numerous related enactments are common features of law in most states.The historical literature describing the rise and fall of laws prescribing marriage (...) restrictions related to VD has treated those enactments as public health measures, meant primarily to forestall the spread of disease to intimate partners. But laws to... (shrink)

While across the animal kingdom offspring are born smaller than their parents, notable exceptions exist. Several dipteran species belonging to the Hippoboscoidea superfamily can produce offspring larger than themselves. In this essay, the blood‐feeding tsetse is focused on. It is suggested that the extreme reproductive strategy of this fly is enabled by feeding solely on highly nutritious blood, and producing larval offspring that are soft and malleable. This immense reproductive expenditure may have evolved to avoid competition with other biting flies. (...) Tsetse also transmit blood‐borne parasites that cause the fatal diseases called African trypanosomiases. It is discussed how tsetse life history and reproductive strategy profoundly influence the type of vector control interventions used to reduce fly populations. In closing, it is argued that the unusual life history of tsetse warrants their preservation in the areas where human and animal health is not threatened. (shrink)

Mass vaccination has been a successful public health strategy for many contagious diseases. The immunity of the vaccinated also protects others who cannot be safely or effectively vaccinated—including infants and the immunosuppressed. When vaccination rates fall, diseases like measles can rapidly resurge in a population. Those who cannot be vaccinated for medical reasons are at the highest risk of severe disease and death. They thus may bear the burden of others' freedom to opt out of vaccination. It is often (...) asked whether it is legitimate for states to adopt and enforce mandatory universal vaccination. Yet this neglects a related question: are those who opt out, where it is permitted, morally responsible when others are harmed or die as a result of their decision? In this article, we argue that individuals who opt out of vaccination are morally responsible for resultant harms to others. Using measles as our main example, we demonstrate the ways in which opting out of vaccination can result in a significant risk of harm and death to others, especially infants and the immunosuppressed. We argue that imposing these risks without good justification is blameworthy and examine ways of reaching a coherent understanding of individual moral responsibility for harms in the context of the collective action required for disease transmission. Finally, we consider several objections to this view, provide counterarguments and suggest morally permissible alternatives to mandatory universal vaccination including controlled infection, self-imposed social isolation and financial penalties for refusal to vaccinate. (shrink)

This paper resists the virality of contemporary paranoia by turning to “French epistemology”, a philosophical ethos that embraces uncertainty and complexity by registering the transformative impact of scientific knowledge on thought. Despite its popular uses describing phenomena of communication today, the idea of virality comes from biomedicine. This paper, therefore, investigates the extent to which an epidemiological concept of viral transmission—the disease vector—can comprehend and encourage new possibilities of thought beyond paranoia. Briefly, I attempt to analyze thought as (...) a vector. I pursue this by examining Delaporte’s important, but neglected, study of the 1832 Parisian cholera epidemic. First elucidating his reconstruction of the ways tentative epistemological progress intertwined with and supported projects of working-class and colonial control. My vectorial analysis then considers how his argument infects contemporary readers with doubts that undo the bases of paranoia. I pursue this analysis further via a methodological examination of Delaporte’s study as both carrier of predecessors’ methods and host in which they alter, becoming newly infectious. I conclude by reflecting on this formulation of thought as disease vector and what Delaporte’s singular treatment of the problem of error reveals about an ethos committed to registering the impact of knowledge on thought. (shrink)

This book brings together an international collection of experts in reproductive ethics, law, disability studies, and medicine to explore the challenging future of reproduction and children. From the medical to the social and from the financial to the legal, the authors explore the expanding impact of reproductive genetics on our society. New advances in genetic technologies are revolutionizing the practice of reproductive medicine. We have expanded our ability to detect genetic changes in embryos and fetuses in ways that potentially allow (...) to identify, treat, or prevent a growing range of diseases. The development of gene-editing technologies raises questions about the possibility of removing disease-causing variants from embryos before pregnancy implantation. The growing sophistication of prenatal genomic sequencing offers us glimpses into the whole genome of the developing fetus. And, the increasingly sophisticated science of 'gene matching' allows us greater and greater foreknowledge of how the genomes of two individuals will combine in a future child. This is an indispensable book on the newest developments in bioethics caused by the sciences. Chapter 5 is available open access under a Creative Commons Attribution 4.0 International License via link.springer.com. (shrink)

BackgroundThe SARS-COVID-19 pandemic and its associated disease control restrictions have in multiple ways affected families with young children, who may be especially vulnerable to mental health problems. Studies report an increase in perinatal parental distress as well as symptoms of anxiety or depression in children during the pandemic. Currently, little is known about the impact of the pandemic on infants and their development. Infant regulatory problems have been identified as early indicators of child socio-emotional development, strongly associated with maternal (...) mental health and the early parent–infant interaction. Our study investigates whether early parenthood under COVID-19 is associated with more maternal depressive symptoms and with a perception of their infants as having more RPs regarding crying/fussing, sleeping, or eating, compared to mothers assessed before the pandemic.MethodsAs part of a longitudinal study, 65 women who had given birth during the first nationwide disease control restrictions in Northern Germany, were surveyed at 7 months postpartum and compared to 97 women assessed before the pandemic. RPs and on maternal depressive symptoms were assessed by maternal report. Number of previous children, infant negative emotionality, and perceived social support were assessed as control variables.ResultsCompared to the control cohort, infants born during the COVID-19 pandemic and those of mothers with higher depressive symptoms were perceived as having more sleeping and crying, but not more eating problems. Regression-based analyses showed no additional moderating effect of parenthood under COVID-19 on the association of depressive symptoms with RPs. Infant negative emotionality was positively, and number of previous children was negatively associated with RPs.LimitationsDue to the small sample size and cross-sectional assessment, the possibility for more complex multivariate analysis was limited. The use of parent-report questionnaires to assess infant RPs can support but not replace clinical diagnosis.ConclusionsThe pandemic conditions affecting everyday life may have a long-term influence on impaired infant self- and maternal co-regulation and on maternal mental health. This should be addressed in peripartum and pediatric care. Qualitative and longitudinal studies focusing on long-term parental and infant outcomes under ongoing pandemic conditions are encouraged. (shrink)

Mosquito‐borne diseases take a tremendous toll on human populations, especially in developing nations. In the last decade, scientists have developed mosquitoes that have been genetically modified to prevent transmission of mosquito‐borne diseases, and field trials have been conducted. Some mosquitoes have been rendered infertile, some have been equipped with a vaccine they transmit to humans, and some have been designed to resist diseases. This article focuses on ethical issues raised by field trials of disease‐resistant, genetically modified mosquitoes. (...) Some of these issues include: protecting the public and the environment from harm, balancing benefits and risks, collaborating with the local community, avoiding exploitation, and safeguarding the rights and welfare of research subjects. One of the most difficult problems involves protecting the welfare of community members who will be impacted by the release of mosquitoes but who are not enrolled in the study as research subjects. To address this concern, field trials should take place only when the targeted disease is a significant public health problem in an isolated area, the benefits of the trial for the community are likely to outweigh the risks, community leaders approve of the trial, and there are measures in place to protect the welfare of un‐enrolled community members, such as informing the community about the study and offering free treatment to people who contract mosquito‐borne diseases. Since the justification of any field trial depends on a careful examination of the scientific and ethical issues, proposed studies should be evaluated on a case‐by‐case basis. (shrink)

Mosquito-borne diseases take a tremendous toll on human populations, especially in developing nations. In the last decade, scientists have developed mosquitoes that have been genetically modified to prevent transmission of mosquito-borne diseases, and field trials have been conducted. Some mosquitoes have been rendered infertile, some have been equipped with a vaccine they transmit to humans, and some have been designed to resist diseases. This article focuses on ethical issues raised by field trials of disease-resistant, genetically modified mosquitoes. (...) Some of these issues include: protecting the public and the environment from harm, balancing benefits and risks, collaborating with the local community, avoiding exploitation, and safeguarding the rights and welfare of research subjects. One of the most difficult problems involves protecting the welfare of community members who will be impacted by the release of mosquitoes but who are not enrolled in the study as research subjects. To address this concern, field trials should take place only when the targeted disease is a significant public health problem in an isolated area, the benefits of the trial for the community are likely to outweigh the risks, community leaders approve of the trial, and there are measures in place to protect the welfare of un-enrolled community members, such as informing the community about the study and offering free treatment to people who contract mosquito-borne diseases. Since the justification of any field trial depends on a careful examination of the scientific and ethical issues, proposed studies should be evaluated on a case-by-case basis. (shrink)

In a laboratory on a university campus in Santa Cruz, California, Ben Novak is doing everything he can to bring Ectopistes migratorius back from the dead. Using techniques now available in genome reading and gene synthesis, he and paleogenomicist Beth Shapiro hope that, by 2032, a flock of passenger pigeons ten thousand or more strong will have resumed an ecologically significant role in the mast forests of the Eastern United States. Novak knows—and the International Union for Conservation of Nature (IUCN) (...) affirms—that the challenges involved in making de‐extinction work are far from solely genetic. Novak is doing an ecological risk assessment of passenger pigeon reintroduction to figure out whether flocks of the resurrected species would pose any special hazards to ecosystems. Ecological harm is one of several worries attending the prospect of de‐extinction. Among other concerns are the possible harm that individuals born through this process might suffer and the possible introduction of disease vectors. But I want to step back from these immediate questions and think about some conceptual ones that operate in the background. Technology can be a grand shaper of cultural norms and expectations, and de‐extinction should be looked at in relation to a number of emerging technologies. This paper will examine the degree to which de‐extinction is part of a more widespread restructuring of ethical relationships to the surrounding world that are under way at the hands of emerging technologies. This restructuring is part of an ongoing shift in how to think about conservation in the new epoch of the Anthropocene. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Human Gene TherapyMary Carrington Coutts (bio)On September 14, 1990, researchers at the U.S. National Institutes of Health (NIH) performed the first approved gene therapy procedure on a four-year-old girl named Ashanti DeSilva. Born with a rare genetic disease, severe combined immune deficiency (SCID), Ashanti lacked a healthy immune system and was extremely vulnerable to infection. Children with SCID usually develop overwhelming infections and rarely survive to adulthood; even (...) a common childhood illness like chicken pox is life-threatening. Ashanti led a cloistered existence, avoiding contact with people outside her family, remaining in the sterile environment of her home, and battling frequent illnesses with massive amounts of antibiotics.In Ashanti's gene therapy procedure, her own white blood cells were genetically modified and then infused back into her bloodstream. Laboratory tests show that the therapy has strengthened Ashanti's immune system. She no longer has recurrent colds, has been allowed to attend school, and has been immunized against whooping cough. This gene therapy procedure is not a cure, however. The genetically-treated white blood cells only survive for a few months and must then be replaced, but Ashanti's future is much brighter because of the new therapy (VI, Thompson [The First] 1993).Although this simplified description of Ashanti's gene therapy procedure sounds like a happy ending, it is little more than an optimistic chapter in a long story. The road to the first approved gene therapy procedure was rocky and fraught with controversy. The biology of human gene therapy is very complex, and there are still many techniques that need to be developed and diseases that need to be understood more fully before gene therapy is well established. The public policy debate surrounding the possible use of genetically engineered material in human subjects is equally complex. Major participants in the debate come from the fields of biology, government, law, medicine, philosophy, politics, and religion, each bringing different views to the discussion.In studying the ethics of gene therapy, one should draw a distinction between [End Page 63] therapy on somatic (non-reproductive) cells and germ (reproductive) cells. Only the germ cells carry the genes that will be passed on to the next generation. Reactions to gene therapy have varied widely. Some commentators on gene therapy object to any form of genetic manipulation, no matter how well-intentioned (VI, Rifkin 1983). Another reaction is to allow the use of somatic-cell therapy, but not to approve the use of germ-line therapy, which could have unforeseeable effects on future generations. A different stance is that, with proper regulation and safeguards, germ-line gene therapy is a logical extension of the progress made to date and that it is an ethically acceptable procedure.TechniquesTo date, 43 research protocols have been approved for somatic-cell gene therapy in the United States. The techniques employed in each protocol vary, but in general a virus is used as a "vector" to insert the desired gene into the DNA of the patient's cells, in order to compensate for a defective gene. For Ashanti's gene therapy, this technique involved obtaining white blood cells and introducing properly functioning genes into as many of the cells as possible. The normal genes were delivered through the use of a specially-engineered virus.Although similar techniques are used in germ-line gene therapy, the procedure is more difficult. There are two basic ways to perform germ-line gene therapy: (1) to treat a preimplantation embryo that carries a serious genetic defect before its implantation in the mother, which necessitates the use of in vitro fertilization techniques; or (2) to treat the germ cells (sperm or egg cells) of afflicted adults so that the genetic defects would not be passed on to their offspring, which requires the technical expertise to delete the defective gene and insert a properly functioning replacement. Because of the complexity of the procedures involved and the attendant ethical controversy, germ-line therapy is not currently performed.Candidate Diseases for Gene TherapyAt present, gene therapy is likely to be most successful in treating diseases that are caused by single-gene defects and has been approved for treating diseases such... (shrink)

It may be unethical to deny children with cystic fibrosis access to ethically approved clinical trials from which they might benefitDespite advances in nutritional management, aggressive antibiotic usage, and physiotherapy, cystic fibrosis remains a life limiting illness with high morbidity that imposes considerable burdens on children and families.1 Although survival to 40 years is predicted for children born in 1990s, the median age of death in 2003 was 24.2 years .The pathophysiological features of CF are produced by a defective gene (...) on chromosome 7, resulting in the defective production of a protein that regulates cellular ion transport. Defective ion transport is thought to lead to increased mucus viscosity , with poor airway clearance, recurrent bacterial infection, lung damage, and death.Gene therapy , the insertion of a normally functioning gene into deficient host cells using a suitable vector, is a potential treatment or cure for diseases produced by single gene defects—for example, CF. Gene therapy does, however, have potential or actual risks, leading many to suggest that evidence of efficacy in adults should be demonstrated before trials are conducted in children. Many serious diseases in adults such as CF have their onset in childhood. If early treatment provides greater hopes of benefit, children may be more appropriate targets for GT in CF than adults. It may be unethical to deny them access to properly constructed, ethically approved clinical trials from which they might benefit.Since research in children should be scientifically valid, in the child’s best interests, and the subject of valid consent, this article will consider these parameters in relation to trials of GT in children with CF. Because of the importance of consumer participation in the design of research we present the results of a questionnaire about GT trials delivered …. (shrink)

The following is excerpted from Sean Gurd’s translation of Euripides’ Hippolytus published with Uitgeverij this year. Though he was judged “most tragic” in the generation after his death, though more copies and fragments of his plays have survived than of any other tragedian, and though his Orestes became the most widely performed tragedy in Greco-Roman Antiquity, during his lifetime his success was only moderate, and to him his career may have felt more like a failure. He was regularly selected to (...) have his plays performed in the annual festival of Dionysus at Athens. But the plays were performed in a competition, and in the competitions he lost and lost, winning first place only five times in a career that spanned more than forty years. His corpus reads like the remains of a life spent trying to get a few things right and never being quite satisfied: scenes and schematized combinations of elements recur again and again, each time slightly changed. Hippolytus itself is an example: it contains two scenes in which a sick or dying character lies on a couch or a stretcher and is surrounded by silence and grief; he had experimented with such scenes in Alcestis, and would work with them again in Herakles and Orestes. Nor, judging from appearances, was he immune to the desire to score a hit, or to satisfy the audiences and the judges at the competition. Hippolytus is a rewrite of another Hippolytus, performed several years earlier, which scandalized the audience and certainly did not take first place. In that earlier Hippolytus (called by later writers Hippolytus Veiled), Euripides fashioned a Phaedra who was neither ashamed of loving her stepson nor incapable of taking steps to satisfy her desire. The forwardness of her approach to Hippolytus so outraged him that he covered his head with a robe (hence the play’s later title). Euripides liked to write energetic and self-confident women like this. He staged his Medea in 431, just three years before he revised Hippolytus, and in it the jilted title character murders her children in revenge for Jason’s new marriage to a more politically advantageous wife. Another flop: the play came in third of three. Evidently the judges did not like their women showing agency, especially when the consequences were transgressive. “The ornament of women,” wrote another great Athenian a little earlier, “is silence.”i Euripides’ Medea and his first Phaedra had other decorations. So three years after Medea crashed and burned and some time after the first Hippolytus suffered the same fate, he produced another Hippolytus play with a different setting and story. How could this one not have been a reaction to the failure of the first? “Second thoughts are always better,” he has one of his characters say, as though he were offering an apology for his first thoughts on the same story. In this new version, Phaedra is suicidally ashamed of her love, choosing to die rather than have it discovered, and willing to bring down her beloved Hippolytus in the service of the same end. Now it is Phaedra herself who covers her head in shock and horror at her desire. Only an intermediary, a slave of the house and an old crone with her fingers in all sorts of illicit pots, communicates Phaedra’s secret – against orders – and in consequence brings about the demise of two resolutely moral figures. It worked. For his tale of two well-born nobles with an unswerving commitment to moral action, destroyed by the meddling of a slave (and by the hostility of some particularly uncaring divinities), the judges crowned Euripides winner. It was the first time he had won, after almost thirty years of work. *** What Hippolytus wants more than anything else, as he protests with outrage just before leaving Trozen for the last time, is the benefit of due process – oaths, witnesses, an investigation that would reveal who really lusted after whom. Ironic, given that in the first Hippolytus, as far as we can make out, he did get a trial – but too late, and Theseus’ successful processing of Hippolytus failed to prevent his death. I cannot help hearing in the second Hippolytus’ complaints the anger of his authorial semblable who lost year after year by a process of judging that might have seemed brutal to him. Judges took no cognizance of how he worked, how long or hard or why; they just voted, and Euripides lost. But then I hear, in the fate of the first Hippolytus, an even grimmer commentary. Processed or not, we lose. We run aground. At the very least, this might cast a darker shadow on the business of watching or reading a play: in that twilight, things move too fast to make a fair assessment and, in any case, the reasonably high definition of what you see and hear belies the truth of indistinction, the multiplicities just below the surface. Watching is a constrained activity, a form of captivity, but reading is plastic. This translation was begun to supply the script for an audio version of the play, recorded in the spring of 2012, and here and there it sacrifices literalness for sayability and the voices and passions of the actors on that occasion. But it was finished to be read, and engineered to create a reading caught between the poles of specificity and non-specificity that the play itself conjures and relies on at its generative core. Thus two texts: the one clear, perhaps overprecise, respectably modern in its presentation, and the other ancient, a reasonable approximation of the classical reading process, and indistinct in vital ways. Like early modern dramatic texts, the exact provenance and original function of the scripts that have made it down to us are unknown. We do know that the ultimate survival of Hippolytus was thanks to its wide-spread use as a school text. But its relation to the first performance in 428 BCE is a matter only of speculation. Euripides presumably had a fair copy before production began; it was probably modified during rehearsals. The actors may have had copies, too (probably the young men who served in the chorus did not). The chor?gos, a wealthy Athenian who paid for the production, might have been presented with or just made sure to get his hands on a high-quality text, to commemorate the play’s success. Fans might have been able to buy copies. Any one of these sources might have provided the ultimate progenitor of our text. Several of them might have, in fact, if later editors compared and conflated traditions. The plays toured extensively in the Greek-speaking world, and were restaged as repertoire for centuries afterwards. In the process they were subjected to enough modifications by producers and actors that in the later fourth century the Athenian statesman Lycurgus had a law passed prohibiting performances at Athens from deviating from the official “city” text of the tragedies (which he had commissioned). It is unlikely that the city text was the last word; but it marks an important moment in Athens’ role in their dissemination, since after this the major sites of textual curatorship moved overseas, to Alexandria, Pergamum, Rome, Antioch, Constantinople. Any single text of any single play is thus no more than a moment of clarity and stability, crossed and subtended by multiple vectors of change, including that of textual flux (from Euripides’ first drafts to the latest printed text) and that of Euripides’ life work as a writer, in the light of which the Hippolytus is just one attempt to produce something exactly right, to win the prize or finally satisfy himself or prove to himself that all this longing for perfection was a waste of time. I am intrigued by the possibility that a single text might somehow serve as a lens onto this wider zone of indistinction, representing a small region clearly but nonetheless containing a blurred image of the whole, like a Leibnizian monad. After all, no text is a witness: it is, rather, a perception and a performance, and what every Hippolytus must perform is the awkward overlay of singular and plural, social practise and subliminal drive, that structures the tragedy. Modern critical editions can do this by juxtaposing a (relatively) clean and simple text with a textual apparatus reporting variants and theorizing the relationship between textual instantiations. A translation lacks the resolution to catch the fine variations which feed into the construction of an apparatus. But there are other means to hand. Guessing at the exact words of the original text is always just that – guessing – though Hippolytus is less problematic than plays like Iphigenia at Aulis. But we can make a pretty secure guess at what such a text looked like. Texts read by fifth-century readers were fundamentally different from what is presented in the best medieval MSS and printed in modern publications. The texts of Euripides’ time and for many centuries afterwards did not indicate word division with spaces (or by any other means) and were extremely sparing in punctuation, often avoiding it altogether. There was only one “case” of letters – what we call “capitals.” Musical sections were inscribed as though they were prose, without line endings to reflect their rhythm or their rhetorical structure. There was no indication of the speakers within a dramatic text, either. The earliest surviving dramatic texts, which come from over a century after Euripides’ death and a time which was much more elaborate and precise in its textual culture, indicated speaker-change with a little line or paragraphos below the line and a double-point [:] at its end. This convention almost certainly does not date back to Euripides’ own time; it may not even date to Lycurgus. In any case, such indications were understood to be readers’ marks: they did not have the same authority as the text and they were subject to readers’ revisions. At least ideationally, if not in concrete and distinguishable fact, a dramatic text was understood as containing no indication of speaker-change (and certainly none of who was saying what). The reader had to figure that out for him-/herself. The clear, legible, easy texts we are accustomed to reading are the fabrications of medieval and modern reading cultures. The first text, then, presents the translation as the text would have been in the mid-fourth century, perhaps decades after Euripides’ death. The second text processes Hippolytus, makes sense of it and makes it “readable.” That is: too distinct, dangerously so. It gets in your way, conjures fantoms, tries to make you see. Fragments of the Hippolytus Veiled, otherwise almost entirely lost, are juxtaposed with similar passages in the text – not to suggest a reconstruction, but a dialogue and a complex set of reassessments. I have not tried to represent the full variety of textual variants, but I have signalled where, for one reason or another, the text is soft and different editions propose excisions or changes. The two texts must be read together: you, reader, form the bridge between the distinctly seen and the indistinct invisible. You, in the end, will be its mask. *** illsandhateddiseaseswhatcanidoforyouwhatshouldinotdohereisthelightandthebrightairyoursickbedisnowout s idethehouseyoureverywordwastocomeherebutyouwillrushbacktoyourbedroomagainyoufadequicklyyoudelig htinnothingyoudislikewhatyouhaveyoulovewhatyoudontitsbettertobesickthantendthesickthefirstissimpleto the secondattachesheartspainandhandsworkeveryhumanlifeispainfulthereisnoendtotoildarknesshidesbehindclo udswhateverisdearerthanlifeweproveunhappyloversofwhatshineshereforlackofknowledgeofanotherlifethere isnoproofforthingsbeneaththeearthonlystoriessustainus liftmybodystraightenmyheadthebondsofmylimbsareloosenedtakemyhandsandmypalearmsthishatistooheavy formyheadtoweartakeitoffspreadmyhairovermyshoulders couragechilddonttossandturnsoviolentlyyouwillbearyoursicknessmoreeasilywithpeaceandanoblemindallmort alssuffer aiaiiwanttodrinkpurewaterfromadewyspringiwanttoliebackandrestunderthetreesinsomegrassymeadowchildw hycrydontsaythesethingsnearthecrowdhurlingwordsmountedonmadness sendmetothemountainiwillgototheforestwherebeastkillingdogspressthespotteddeergodsilongtoshouttothedo gstoshootthethessalianjavelinpastmyblondhairtoholdthebarbeddartinmyhandwhythisanxietychildwhatdoyouc areabouthuntingwhydoyoulustforflowingspringstheresahillwithwaterjustnexttothetowerwecangetyouadrinkt h ereartemismistressofthesaltlakeandthecoursethunderingwithhorseshoovesiwishiwereonyourplainsbreakings t uds whythrowthesefrenziedwordsaboutjustnowyouweresettingoutforthemountaintohuntandnowyoulongforhorses onthewavelesssand thesethingsneedanoracletotellwhichgodreinsyouinanddrivesyoufromyoursenseschild whathaveidonehowfarhaveibeendrivenfromgoodthoughtsiwascrazyiwascursedbysomepowerpheupheualasn ursecovermyheadagainimashamedofwhativesaidcovermeatearmovesdownfrommyeyeanditembarrassesm eithurtstostraightenourmindanditisterribletobeinsanebesttodiebeforeyoubecomelucidagain illcoveryoubutwhenwilldeathcovermeimoldivelearnedalotmortalsshoulddrinkoffriendshipmoderatelynotfrom th edeepestmarrowofthesoulamindslovecharmsshouldbeeasytoundoorthrustawayortiemoretightlyitisaverydiffic ultweightforonesoultolaborovertwopeopleasiamwrackedbypainforhertoomuchdisciplinecausesmoreharmthan pleasureandwarswithhealthipraisetoomuchlessthannothinginexcessandthewiseagreewithme *** Scene 1 Enter Phaedra and the Nurse; the former is recumbent on a couch while the latter bustles about her with gestures that might be those of a caregiver or a guard. NURSE Ills and hated diseases! What can I do for you? What should I not do? Here is the light, and the bright air; your sick bed is now outside the house. Your every word was to come here, but you will rush back to your bedroom again. You fade quickly. You delight in nothing. You dislike what you have. You love what you don’t. It’s better to be sick than tend the sick – the first is simple. To the second attaches heart’s pain and hand’s work. Every human life is painful. There is no end to toil. Darkness hides behind clouds whatever is dearer than life. We prove unhappy lovers of what shines here for lack of knowledge of another life. There is no proof for things beneath the earth. Only stories sustain us. PHAEDRA Lift my body, straighten my head: the bonds of my limbs are loosened. Take my hands and my pale arms. This hat is too heavy for my head to wear. Take it off, spread my hair over my shoulders. NURSE Courage, child; don’t toss and turn so violently. You will bear your sickness more easily with peace and a noble mind. All mortals suffer. PHAEDRA Aiai. I want to drink pure water from a dewy spring. I want to lie back and rest under the trees in some grassy meadow. NURSE Child, why cry? Don’t say these things near the crowd, hurling words mounted on madness. PHAEDRA Send me to the mountain. I will go to the forest where beast-killing dogs press the spotted deer. Gods! I long to shout to the dogs, to shoot the Thessalian javelin past my blond hair, to hold the barbed dart in my hand. NURSE Why this anxiety, child? What do you care about hunting? Why do you lust for flowing springs? There’s a hill with water just next to the tower; we can get you a drink there. PHAEDRA Artemis, mistress of the salt lake and the course thundering with horse’s hooves: I wish I were on your plains breaking studs! NURSE Why throw these frenzied words about? Just now you were setting out for the mountain to hunt – and now you long for horses on the waveless sand. These things need an oracle to tell which god reins you in and drives you from your senses, child. PHAEDRA What have I done? How far have I been driven from good thoughts? I was crazy, I was cursed by some power. Pheu pheu. Alas. Nurse, cover my head again. I’m ashamed of what I’ve said. Cover me – a tear moves down from my eye and it embarrasses me. It hurts to straighten your mind and it is terrible to be insane. Best to die before you become lucid again. NURSE I’ll cover you. But when will death cover me? I’m old; I’ve learned a lot. Mortals should drink of friendship moderately, not from the deepest marrow of the soul. A mind’s love-charms should be easy to undo, or thrust away, or tie more tightly. It is a very difficult weight for one soul to labor over two people, as I am wracked by pain for her. Too much discipline causes more harm than pleasure and wars with health. I praise “too much” less than “nothing in excess,” and the wise agree with me. ***. (shrink)

ABSTRACT In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as (...) autonomy and the harm principle, to infectious examples. We argue that this is insufficient, however. Taking infectious disease into account requires understanding the patient as victim and as vector. Infectiousness reminds us that as autonomous agents we are both embodied and vulnerable in our relationships with others. We conclude by applying this reunderstanding of agency to the examples of informed consent and distributive justice in health care. (shrink)

The recently developed CRISPR-Cas9 gene editing technology is transforming basic biomedical research, but it also may have therapeutic applications. This essay examines how the technology works, its possible applications in somatic and germline cell therapy, and the use of gene drives to control disease vectors like mosquito-borne illnesses. While potentially valuable, all of these applications present ethical problems, including the specific risks of unintentional mutations; pre-existing concerns over the relationship between biomedical technology, power, and procreation; and CRISPR’s unintended (...) consequences for the environment. (shrink)

ABSTRACT In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as (...) autonomy and the harm principle, to infectious examples. We argue that this is insufficient, however. Taking infectious disease into account requires understanding the patient as victim and as vector. Infectiousness reminds us that as autonomous agents we are both embodied and vulnerable in our relationships with others. We conclude by applying this reunderstanding of agency to the examples of informed consent and distributive justice in health care. (shrink)

Plants from a handful of species provide the primary source of food for all people, yet this source is vulnerable to multiple stressors, such as disease, drought, and nutrient deficiency. With rapid population growth and climate uncertainty, the need to produce crops that can tolerate or resist plant stressors is more crucial than ever. Traditional plant breeding methods may not be sufficient to overcome this challenge, and methods such as highOthroughput sequencing and automated scoring of phenotypes can provide significant (...) new insights. Ontologies are essential tools for accessing and analysing the large quantities of data that come with these newer methods. As part of a larger project to develop ontologies that describe plant phenotypes and stresses, we are developing a plant disease extension of the Infectious Disease Ontology (IDOPlant). The IDOPlant is envisioned as a reference ontology designed to cover any plant infectious disease. In addition to novel terms for infectious diseases, IDOPlant includes terms imported from other ontologies that describe plants, pathogens, and vectors, the geographic location and ecology of diseases and hosts, and molecular functions and interactions of hosts and pathogens. To encompass this range of data, we are suggesting inOhouse ontology development complemented with reuse of terms from orthogonal ontologies developed as part of the Open Biomedical Ontologies (OBO) Foundry. The study of plant diseases provides an example of how an ontological framework can be used to model complex biological phenomena such as plant disease, and how plant infectious diseases differ from, and are similar to, infectious diseases in other organism. (shrink)

Oncofertility is one of the 9 NIH Roadmap Initiatives, federal grants intended to explore previously intractable questions, and it describes a new field that exists in the liminal space between cancer treatment and its sequelae, IVF clinics and their yearning, and basic research in cell growth, biomaterials, and reproductive science and its tempting promises. Cancer diagnoses, which were once thought universally fatal, now often entail management of a chronic disease. Yet the therapies are rigorous, must start immediately, and in (...) many cases result in premature failure of the body's reproductive ability. In women, this loss is especially poignant; unlike the routine storage of sperm, which is done in men and boys facing similar treatment decisions, freezing oocytes in anticipation of fertility loss is not possible in most cases, and creating an embryo within days of diagnosis raises significant moral, social and medical challenges. Oncofertility is the study of how to harvest ovarian tissue in women facing cancer to preserve their gametes for future use with IVF, thus allowing the decisions about childbearing to be deferred and reproductive choices to be preserved. The research endeavor uses the capacity of the ovarian follicle to produce eggs in vitro . Developing the human follicle to ovulate successfully outside the body is scientifically difficult and ethically challenging. Infertility is linked to long-standing religious and moral traditions, and is intertwined with deeply contentious social narratives about women, families, illness and birth. Is the research morally permissible? Perhaps imperative if understood as a repair from iatrogenic harms? How are considerations of justice central to the work? How will vulnerable subjects be protected? What are the moral implications of the work for women, children and families? What are the implications for society if women could store ovarian tissue as a way of stopping the biological clock? What are the moral possibilities and challenges if eggs can be produced in large quantities from a stored ovarian tissue? (shrink)

The frequency of death from miscarriage is very high, greater than the number of deaths from induced abortion or major diseases.Berg (2017, Philosophical Studies 174:1217–26) argues that, given this, those who contend that personhood begins at conception (PAC) are obliged to reorient their resources accordingly—towards stopping miscarriage, in preference to stopping abortion or diseases. This argument depends on there being a basic moral similarity between these deaths. I argue that, for those that hold to PAC, there are good reasons to (...) think that there is no such similarity. There is a morally relevant difference between preventing killing and letting die, giving PAC supporters reasons to prioritize reducing abortion over reducing miscarriage. And the time-relative interest account provides a morally relevant difference in the badness of death of miscarriages and deaths of born adults, justifying attempts to combat major diseases over attempts to combat miscarriage. I consider recent developments in the literature and contend that these new arguments are unsuccessful in establishing moral similarities between deaths from miscarriage and abortion, and deaths from miscarriage and disease. (shrink)

Alzheimer's Disease is a form of dementia that affects the memory, cognition, and motor skills of patients. Extensive research has been done to develop accessible, cost-effective, and non-invasive techniques for the automatic detection of AD. Previous research has shown that speech can be used to distinguish between healthy patients and afflicted patients. In this paper, the ADReSS dataset, a dataset balanced by gender and age, was used to automatically classify AD from spontaneous speech. The performance of five classifiers, as (...) well as a convolutional neural network and long short-term memory network, was compared when trained on audio features and text features. The same audio and text features were used to train five regression models to predict the Mini-Mental State Examination score for each patient, a score that has a maximum value of 30. The top-performing classification models were the support vector machine and random forest classifiers trained on BERT embeddings, which both achieved an accuracy of 85.4% on the test set. The best-performing regression model was the gradient boosting regression model trained on BERT embeddings and CLAN features, which had a root mean squared error of 4.56 on the test set. The performance on both tasks illustrates the feasibility of using speech to classify AD and predict neuropsychological scores. (shrink)

This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases' powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on (...) humans by foreign micro-organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical-ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community. (shrink)