Doctor Who and Philosophy

Doctor Who and Philosophy is the 55th title in the Popular Culture and Philosophy series

The new series of Doctor Who is underway, the sixth in the 21st Century reincarnation of the classic science fiction drama. The current two-parter The Rebel Flesh and The Almost People is raising some interesting ethical questions which I hope to discuss here in the near future. If you are interested in ethical and philosophical questions raised by the Timelord’s adventures you may be interested in Doctor Who and Philosophy: Bigger on the inside.

A recent addition to the Popular Culture and Philosophy series, this multi-author work has been edited by Courtland Lewis and Paula Smithka.  Topics covered include questions of personal identity, existence, science and ethics. My former colleague Bonnie Green and I have a chapter Ain’t we all the same? Underneath, ain’t we all kin? on the notion of species. This actually started life as a post here on Bioethicsbytes (see The Meaning of Humanity). I am delighted that the publishers have allowed us to include a pre-publication edition of our chapter in the Leicester Research Archive. It can therefore be accessed via this link. If you like the look of it, why not buy the book!

Sister (book review)

 

Sister is Rosamund Lupton's first novel

 

(Warning: contains minor spoilers!) Not to be confused with Jodie Picoult’s My Sister’s Keeper, which is about Preimplantation Genetic Diagnosis, Rosamund Lupton’s 2010 novel called simply Sister centres on a gene therapy trial.

The Hemming family know that they harbour the gene for cystic fibrosis (CF); Beatrice – the narrator of the story – has seen her younger brother Leo die of the disease and her pregnant sister Tess has been told that her child will also be a sufferer.

At the start of the book Tess has gone missing and Beatrice flies back from the USA to look for her. As Beatrice recounts the events that follow her search for her sister, it is clear that Tess’s decision to participate in a clinical trial of a gene therapy cure for CF lies at the heart of the story.

In terms of bioethics education and an explanation of some of the ethical tensions associated with gene therapy, the stand-out passage begins on p231 when Beatrice goes to visit Chrom-Med, the company behind the official trial. Chrom-Med use of an artificial chromosome to deliver a working copy of the CFTR gene, which codes for the Cystic fibrosis transmembrane conductance regulator protein.

The passage could be read to a class to introduce some of the issues. I would suggest starting with “At just before 9.30 a.m. I arrived at the Chrom-Med building…” on p231 and running through to “When will you be testing it on humans? You’ll make a killing then, wont you?” on p233. Reading this section aloud takes about three and a half minutes.

Alternatively – the novel was adopted as the Radio 4 Book at Bedtime for ten weekday nights (24th Sept to 1st Oct 2010) and was cited in Quentin Cooper’s Material World on 27th September 2010, so there may be valuable audio extracts there. Unfortunately these shows are no longer on iPlayer but I am investigating availability of audio recordings.

BBC Radio 4 – Cancer Tales

Listen again to Cancer Tales via the BBC iPlayer (available until Monday 2nd February 2009)

On Monday 26th January 2009 BBC Radio 4 broadcast Cancer Tales as the Afternoon Play (aired at 2.15pm). This interesting and emotional radio adaptation was based on the play of the same name written by Nell Dunn (first published in the UK in 2002 by Amber Lane Press) which provides fictional accounts of experiences of cancer diagnosis and treatment. The accounts are very emotional and moving, and include the perspectives of the patients themselves, their family members and, occasionally, members of their clinical care teams. Dunn’s narratives are based upon the real-life experiences of cancer patients and offer a true-to-life snapshot of their experience of cancer diagnosis and treatment. Thus, Cancer Tales provides an opportunity to see many aspects of medical care and services from the patients perspective. This is particularly the case with the recent Radio 4 adaptation, which, within it 45minute running time, focusses on three of the narratives contained in the original script. These are all female experiences and explicitly dealt with experiences of clinical services (as opposed to wider social and psychological themes connected to cancer diagnosis).

Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer – Bazell (1998)

Bazell, R. (1998). "Her-2: The Making of Herceptin". New York: Random House.

In his interesting and insightful account of “the making” of Herceptin, Robert Bazell, shows how the creation of a new drug is not only a scientific process, but also a social endeavour involving patients, doctors, regulators, funders, politicians, activists and the media. This is particularly so when it comes to clinical trials for a new product, and Bazell’s description of this procedure for Herceptin (Trastuzumab) is detailed and would form an excellent resource for illustrating its complexities and/or discussing its complications.

While the book deals with much more than the clinical trials of Herceptin – including the sources of early interest in the Her-2/neu receptor in breast cancer and the collaborations that eventually brought the potential of this monoclonal antibody to the attention of Genentech’s management – this post focusses on the clinical trials that formed the basis for its licensing by the FDA (Food and Drug Administration) in the US and subsequent worldwide use as an adjuvant therapy in advanced (metastatic) breast cancer.

This post is accompanied by a BioethicsBytes Extended Commentary on the making of herceptin (available here), which discusses some additional bioethical issues raised in this post.

Faking it for real – A Paper Mask (Collee, 1987)

	Paul McGann plays Martin Harris/Dr Simon Hennessey in Paper Mask (1990, [VHS], High Fliers Video Distribution)

(Warning: contains plot spoilers!) In his novel A Paper Mask John Collee explores the issue of bogus doctors – that is, people who fraudulently gain employment as doctors and practice medicine within conventional hospital settings or as general practitioners without formal qualifications. Through the actions of his character Matthew Harris, a hospital porter who adopts the identity of Dr Simon Hennessey following the latter’s death, he offers an account of the basis of medical expertise which jarrs sharply with a conventional view of the importance of formal medical education.

Author John Collee is both a doctor and writer of TV medical scripts (see Henry III, W.A. “Going Beyond Brand Names”, Time, Monday 3rd April 1989, pg. 2), including the screenplay for the 1990 film Paper Mask. While both book and film may be considered quite ‘lightweight’ they nevertheless succinctly highlight some of the less frequently discussed bioethical issues implicit in medical practice, though also provide an interesting set of observations on the true nature of medical skill and its acquisition.

Artifical Evolution – Prey (Crichton, 2002)

(Warning: contains plot spoilers!) Published in 2002, Michael Crichton’s novel Prey explores some of his concerns around the convergence of “genetics, nanotechnology, and distributed intelligence” (p.525), within the contemporary market for new healthcare technologies. The story revolves around the creation of a “swarm” of nanobots designed to work together as an artificial imaging system for use inside the human body. These molecular scale “cameras” are manufactured from organic biomolecules, which are assembled automatically. When injected into the body the cameras “distributed agent” programming enables them to work together and coalesce to form a minature eye, such that creator company Xymos can ‘see’ any organ within the human body. However, one camera swarm escapes the company’s fabrication plant and is allowed to roam free in the Nevada desert. Within days the swarm begins to evolve in ways its creators never imagined. Drawing on its programming and sources of biomolecules present in the environment the swarm multiplies, develops predatory capabilities, and eventually turns on its creators.

Crichton (2002). Prey. HarperCollins, London.

As in his more recent novel, Next, Crichton’s explicit intention is to highlight some of the more troubling aspects of contemporary biotechnological developments (this is expressed in a short introduction to Prey). While much of the action is quite fantastic, the technology is – as Crichton’s bibliography demonstrates – not unrealistic. At present, bioethical concerns associated with developments in nanobiotechnology, including artificial life forms capable of autonomy and evolution, rarely make the headlines. However, as these technologies become more widely discussed (see for example Science, 16 November 2007. Vol. 318, no. 5853 and Phoenix, 2003), this seems likely to change.

A number of bioethically-relevant themes arise in Prey. They include:

• Issues around machine “mimicry” and enhancement (for example, see pages 85-88 concerning the appearance of Julia, a Xymos employee)
• Non-rule based conceptions of intelligence, specifically distributed intelligence and self-organising behaviour in animals and machines (see pages 96-97 and 177-181)
• The commercial environment within which new biotechnologies are developed, specifically in relation to the involvement of venture capital and the military (as on pages 174-176, for example)
• Issues around our ability to control the technologies we create (the theme of “technology-out-of-control” in bioethical thought)

Overall, Crichton’s novel raises interesting questions about both, the direction of contemporary research in nanobiotechnology, and the environment within which it is conducted. However, as a basis for discussing the bioethical questions posed by this technology, the lack of short sections dealing with key themes (as in Next) and the narrative’s later focus on the ‘battle’ with the nanobot swarms, unfortunately makes it unwieldy as a teaching tool.

Prey was written by Michael Crichton, and published in the UK in 2002 by HarperCollins, London. ISBN: 9780007229734.

More than human? – ‘I, Cyborg’ (Warwick, 2002)

Kevin Warwick’s 2002 book I, Cyborg opens with the line “this book is all about me” (pg. vii). For the reader, this appears true in at least two senses. Firstly, its pages detail Warwick’s journey to become professor of cybernetics at Reading University, and explore the origins, ambitions and actualisation of his drive “to become a cyborg” (pg. 1). Secondly, it can also be read as an expression of his belief that science, in this case robotics, should be made accessible to the public “in a straightforward way” (pg. 189) – a sentiment that has led some to accuse him of deliberately courting media attention (see, for example, this article in Wired magazine published in 2000).

I, Cyborg cover photo

While Warwick does address various bioethical issues implicit within his projects (most notably in terms of applying for ethics committee approval for experimental procedures, as on page 156, for example), I, Cyborg‘s primary bioethical utility is as an opportunity to examine in detail how one of the key scientific figures in the area of human-machine interaction sees the future of this technology. Is its use to “upgrade the human form” (pg. 1) a morally legitimate goal; or should cyborg technology be used only in the treatment of disease and disability?

In both bioethics and philosophy of medicine these two uses correspond to the distinction between ‘therapy’ and ‘enhancement’. In I, Cyborg, Warwick does effectively make a distinction of this kind, particularly when distinguishing between his own “projects on two fronts” (pg. 40). However, in Chapter 8, where he catalogues some of the research that informed his second cyborg experiment, the ambiguity implicit in the therapy/enhancement distinction is exposed (this is discussed at length in the accompanying BioethicsBytes Extended Commentary that will shortly appear here).

However, where bioethical debates have centred on the use and validity of the therapy/enhancement distinction as a way to describe a moral boundary between ‘good’ and ‘bad’ research and intervention (for example, where breast reconstruction following mastectomy might be viewed as intrinsically ‘good’, breast enhancement for cosmetic purposes might be more morally questionable), this is largely neglected in Warwick’s book. It may be his ‘post-‘ or ‘trans-humanist’ orientation to the ethics of enhancement that is responsible for this, though it also provides for a different perspective on this issue.

In this way, I, Cyborg provides a rich source of provocative quotes on the ethics and implications of the technological enhancement of humans. These would form a suitable basis for any discussion of this issue. Some key quotes include:

• “humans will be able to evolve by harnessing the super-intelligence and extra abilities offered by the machines of the future, by joining with them. All this points to the development of a new human species, known in the science-fiction world as ‘cyborgs’.” (pg. 4)
• “it doesn’t mean that everyone has to become a cyborg. If you are happy with your state as a human then so be it, you can remain as you are. But be warned – just as we humans split from our chimpanzee cousins years ago, so cyborgs will split from humans. Those who remain as humans are likely to become a sub-species. They will, effectively, be the chimpanzees of the future.” (pg. 4)
• “My own definition of a cyborg is something that is part-animal, part-machine, and whose capabilities are extended beyond normal limits. … it allows for metal upgrades as well as physical upgrades and allows the extension to go beyond the normal limits of either the animal or the machine.” (pg. 61)
• “As a result of the experiment, I received several communications from companies, government bodies, military and police forces about … what it might mean for the future. Would we as a society want implants like this to be generally available? Who would control the situation? The technology was now available, so such questions had to be raised, rather than just discussed as a mere futuristic concept that might never happen.” (pg. 89)

Finally, in Chapter 17 of I, Cyborg Warwick speculates on what a future populated by (superior) cyborgs and (inferior) humans might look like. What he describes is a global, networked society with deep divisions and huge potential for exploitation, discrimination and abuse. While this might also be said of our contemporary society, Warwick’s vision suggests that in the future the lines of division might be drawn in very different places and with different effects. Though the darker aspects of this chapter resonate with the sentiments of another of Warwick’s popular science books In the Mind of the Machine (1997), and also reflect their author’s provocative style, this epilogue does raise an important question. As Warwick himself suggests: “this really is the crux of the whole moral and ethical dilemma. Using implants to help a person with a disability is one thing, but using them to upgrade a perfectly healthy individual is something else” (pg. 293). For posthumanists, as Warwick appears to be, the “ultimate upgrade” (The Rise of the Cybermen, Doctor Who series 2, 2006. [TV]. BBC1, 13th May 2006. time in: 00:24:15) is something to be desired. However, for the rest of us, is Warwick’s future one we really want to inhabit?

I, Cyborg was written by Kevin Warwick, and published in the UK in 2002 by Century, London. ISBN: 0712669884.

Introducing our “Extended commentaries”

As the number of resources on BioethicsBytes continues to grow, so too does the range and diversity of the materials we are offering.  We have recently launched a new genre, the BioethicsBytes Extended Commentaries.  As the name implies, these articles pick up on one or more theme arising from a book, film or programme but discuss the issue(s) in a broader context. The Extended Commentaries draw on a wider range of academic texts than would be usual for a standard BioethicBytes review. They will normally be linked to a shorter post on the main blog.

At present there are four Extended Commentaries on:

Transgenics and a world of “limitless possibilities” – concerning issues arising from the first documentary in the Animal Farm series (Channel 4, March and April 2007), including medical v non-medical applications of transgenic organisms, connections with the debate about genetically-modified (GM) food, and a consideration of what is ‘natural’

The “pharmaceutical farm” – discusses speciesism, identity and the ethical treatment of experimental animals, as prompted by the second episode of Animal Farm

Making “creatures that work for us” –  looks at the medical benefits from transgenic animals, the modification of animals for our pleasure (specifically the transgenic GloFish) and the development of animals specifically to counter mankind’s impact on the environment, all of which were issues arising in the third programme of the Animal Farm series

The future of our families? – a consideration of some of the ethical concerns about saviour siblings, including illustrations drawn from Jodi Picoult’s novel My Sister’s Keeper

Further Extended Commentaries will follow in due course.

The Future of Our Families? – ‘My Sister’s Keeper’ (Picoult, 2004)

To date only a handful of, so called, ‘saviour siblings’ have been born worldwide. These children (the oldest is now 8 years old) were conceived by IVF and have been specially selected to be tissue matches for an existing, ailing sibling. In general, these siblings suffer from incurable – though often treatable – anaemias or leukaemias, some of which have a genetic component. Their newborn siblings, as the term saviour suggests, are ‘designed’ to save their lives. This is the background to American author Jodi Picoult’s 2004 novel My Sister’s Keeper. The story follows sisters’ Kate and Anna Fitzgerald as they, and their family, confront extraordinary circumstances.

Picoult (2004). “My Sister’s Keeper”. Hodder and Stoughton: London.

Kate, 16, who suffers from Acute Promyelocytic Leukemia (APL) – a rare and aggressive form of cancer – is dying. Her younger sister, Anna, 13, was born to be her ‘saviour’. Anna is an human leukocyte antigen (HLA) matched donor for Kate, and while in real cases it is only umbilical cord blood that has been donated, Picoult’s novel imagines a situation in which much more is required. As Picoult’s story progresses we learn that Kate did indeed receive a transfusion of cells taken from Anna’s umbilical cord blood. This blood, rich in compatible stem cells, was intended to repopulate her bone marrow and effectively cure her leukaemia – a treatment which apparently worked. However, as is obvious from what, in the book, constitutes the current situation, this was only a temporary phenomenon. Picoult’s Kate suffers a relapse, which, following initial treatment with Anna’s compatible platelets and ultimately her donated bone marrow, locks them both into a seemingly endless cycle of, not only, operations and hospital visits, but also, responsibility, guilt, love and resentment.

Over the years Picoult describes the numerous procedures the character Anna goes through in her unchosen efforts to fulfil the role of ‘saviour’. This culminates in the prospect of kidney donation – the book’s present day. Faced with this Anna hires a lawyer, Campbell, and takes her parents to court in order to “petition for medical emancipation” (Picoult, 2004: 49). The book follows the build up to, conduct and aftermath of this action, through which Anna fights for the right to refuse this donation – an outcome, both she, and her family, know Kate will die without.

As with many works of fiction, Picoult takes current science, imagines ‘what could be’, and explores some of the social, psychological, emotional and – in this case legal – consequences that might follow. As a work of fiction My Sister’s Keeper seems a scarily realistic, though also, moving picture of a normal family under extreme pressure. However, as a source of insight into the ethical dilemmas presented by the creation of ‘saviour siblings’ it also has its value. While not presenting arguments according to philosophical principles, this book functions as a very effective exploration of possible social implications and potential endpoints of the use of HLA typing in this way. Below are just some of the common bioethical concerns about the creation of saviour siblings that My Sisters Keeper addresses (the page numbers given here refer to episodes, conversations or interactions within the book that highlight each issue particularly well):

• The welfare and best interests of the child to be born – pages 286-289 illustrate how the donation of umbilical cord blood may turn into a succession of more invasive and therefore more ethically problematic donations, also how, in practice, the best interests of the saviour sibling may be balanced against those of the child to be saved
• The instrumentalisation of the child – pages 64-65 and the bathroom scene on page 25 show the Fitzgeralds as a complete family with Anna as an addition only to save Kate, while pages 53-54, 196-197 and 405-407 show her as a loved and valued family member, just like any other
• Consent – pages 20-21 and 292-296 provide a good illustration of how consent to non-therapeutic medical treatment (e.g. bone marrow or blood donation) is handled currently for minors
• The long-term experience of the child – pages 1-2 and 89-90 are short but powerful examples of how Anna, at 13, experiences being a saviour sibling, and how that knowledge has become a part of her identity.

These themes are explored in greater depth in the BioethicsBytes Extended Commentary that accompanies this post. The commentary also highlights how Picoult’s story emerged from ethical arguments around the creation of saviour siblings in reality, and how My Sister’s Keeper elaborates some of these arguments through the multiple viewpoints of the characters and their interactions.

My Sister’s Keeper was written by Jodi Picoult, and published in the UK in 2005 by Hodder and Stoughton, London. ISBN: 9780340835463.

Update 4th April 2015: The film adaptation of My Sister’s Keeper is now available to members of subscribing institutions via Box of Broadcasts.

If you like BioethicsBytes…

If you have been using the BioethicsBytes website to find out information about multimedia resources for teaching about bioethics, you may also like to take a look at the Literature, Film and Genetics site. Although their “about us” section is not currently very informative, it is fair to say that the site does exactly what it says on the tin. There are reviews and ratings of a variety of books and films where genetic themes are raised.  The material in their database can be browsed by Author/Director, Fiction (i.e. book), Film, Topic (Adaptation, Biological Determinism,… [through to]…, Vivisection and Young Adult).  There is also an interesting section on Criticisms, listing publications by their team.