Cheltenham Day 4: Ethical Issues

Dear All,

Today I was struck by the ethical and moral issues raised in the talk ‘Vegetative state’ where Adrian Owen talked about his latest research.

New research has been carried out using MRI scanners on patients who had been clinically diagnosed as being in a ‘vegetative state’. The MRI scanners can show which parts of the brain are active. A ‘vegetative state’ is defined as wakefulness without awareness. A person in a vegetative state may therefore have their eyes open but do not know about the environment around them. They are unable to follow instructions such as ‘Please raise your hand now’.

It has now been shown that some people who appear to be in this state are aware. In an MRI scanner the patient is asked to think of ‘tennis’ or ‘moving between rooms in their house’. The active parts of the brain are very different when thinking about these two things and the people in an apparently ‘vegetative state’ could switch between them when asked showing them to be aware. They then moved to asking yes and no questions with ‘tennis’ for yes and ‘moving through rooms of the house’ for no.

On the one hand this filled me with a feeling of dread at the thought of some poor people out there, completely aware and unable to move or communicate, without others knowing of their awareness. This feeling amplified when I became aware that when someone is in a vegetative state it is possible for the medical profession to remove feeding tubes if it appears that there is no hope of recovery and the family agrees. They have found that 20% of those previously thought to be in a vegetative state are aware. So perhaps 20% of those allowed to die were aware of it.

Some people voiced the question of whether those with the cost of caring for these people would want to know so that you could let all people in an apparent vegetative state die to save money without the guilt of knowing that they were aware. Some people had the opposite view and felt that it should be the law to use MRI scanning on people in a diagnosed vegetative state before making the decision to remove feeding tubes.

I feel that there is a new tool which can tell whether someone unable to communicate through other means is aware. It would be wrong to dismiss this knowledge and as a positive test we cannot tell whether a person in a diagnosed vegetative state is definitely not aware even if the test appears negative. The use of the tool perhaps still needs to be debated.

‘Are we still evolving?’ by Alice Roberts was another talk that I found engaging and fulfilling because for once the question was answered with a clear yes albeit more slowly and perhaps in different ways than before.

In the last 50,000 years humans that moved from Africa to colder climates have selected for paler skin to make vitamin D better with less light at the expense of the natural sun block melanin needed on the equator. In the last 20,000 years when certain cultures started to farm it was selected for continued lactase production into adulthood to allow milk to be drunk into adulthood without it causing diarrhoea. This is why lactose intolerance is most prevalent in eastern Asians as there has not been a long culture of drinking milk there.

Genetic changes have been seen in a heavily studied population over three generations in the modern day. They got shorter and fatter so this is hopefully thought to be a slight blip. Today we will begin to evolve more slowly in the developed world as we have fewer children and more live to adulthood. Therefore there is less for evolution to work with. We have also got IVF where we can screen out disease and choose sex or eye colour. It has not been used to choose flippant traits such as eye colour as yet. The technology though is there and it raises issues such as whether we know enough about the genome to, for example, eliminate the genes that cause cancer to generate our own next stage in evolution or whether in doing so we may unwittingly cause detrimental effects. Again a tool has been invented but how to use it remains a question.

Until a thought-provoking tomorrow.

Your Computational Chemist