Building a 21st-Century Surgical College for Future Generations

Inaugural speech of the 32nd President of the West African College of Surgeons..

Comparative ethical evaluation of epigenome editing and genome editing in medicine: first steps and future directions

Targeted modifications of the human epigenome, epigenome editing (EE), are around the corner. For EE, techniques similar to genome editing (GE) techniques are used. While in GE the genetic information is changed by directly modifying DNA, intervening in the epigenome requires modifying the configuration of DNA, for example, how it is folded. This does not come with alterations in the base sequence ('genetic code'). To date, there is almost no ethical debate about EE, whereas the discussions about GE are voluminous. Our article introduces EE into bioethics by translating knowledge from science to ethics and by comparing the risks of EE with those of GE. We, first (I), make the case that a broader ethical debate on EE is due, provide scientific background on EE, compile potential use-cases and recap previous debates. We then (II) compare EE and GE and suggest that the severity of risks of novel gene technologies depends on three factors: (i) the choice of an ex vivo versus an in vivo editing approach, (ii) the time of intervention and intervention windows and (iii) the targeted diseases. Moreover, we show why germline EE is not effective and reject the position of strong epigenetic determinism. We conclude that EE is not always ethically preferable to GE in terms of risks, and end with suggestions for next steps in the current ethical debate on EE by briefly introducing ethical challenges of new areas of preventive applications of EE (III).

Promoting Equality in the Governance of Heritable Human Genome Editing through Ubuntu: Reflecting on a South African Public Engagement Study

In a recent public engagement study on heritable human genome editing (HHGE) conducted among South Africans, participants approved of using HHGE for serious health conditions-viewing it as a means of bringing about valuable social goods-and proposed that the government should actively invest resources to ensure everyone has equal access to the technology for these purposes. This position was animated by the view that future generations have a claim to these social goods, and this entitlement justified making HHGE available in the present. This claim can be ethically justified in the Ubuntu ethic (deriving from South Africa) as it (a) emphasizes the interests of the community, and (b) espouses a metaphysical conception of the community that transcends the present generation and includes past and future generations. On this basis, a compelling claim can be made on behalf of prospective persons in favor of equal access to HHGE.

Positive reputation for altruism toward future generations regardless of the cost for current others

Recently, altruism toward future generations (future altruism) has become a hot research topic. Although future altruism has been observed in several previous experiments, it is not yet clear when and why people are more likely to engage in future altruism. Drawing upon the empirical literature of reputation and cooperation, we predicted that future altruism brings reputational disadvantages. Accordingly, we investigated whether future altruism was evaluated positively or negatively by others in the current generation in two vignette studies (total N = 1,237). Contrary to our initial prediction, we found that future altruism was positively evaluated even when it decreased the payoff of the members of the current generation. The difference in the evaluation of future altruism, as opposed to unsustainable current-generation focused behavior, was most pronounced when people do not know how a future altruist allocates rewards among individuals in the current generation. However, the positive evaluation of future altruism did not stem from the expectation that future altruists would also be altruistic toward the current generation. These results indicated that reputational benefits (i.e., positive reputation from others in the current generation) promote future altruism.

To be or not to be: Future lives in economic evaluation

Sometimes healthcare will affect the health of people living in the future, or their chance of coming into existence. Should such outcomes be valued in health-economic evaluation? Guidelines implicitly recommend their inclusion but this rule has counterintuitive implications and is not consistently applied in practice. We suggest making a distinction between "necessary" and "potential" future lives in Health Technology Assessment. Necessary lives will exist independent of our healthcare choices and should be included. Potential lives are choice-dependent and should be excluded. This rule offers intuitive solutions within the HTA framework, and it changes the cost-effectiveness of several interventions where necessary future lives are affected.

Future minds and a new challenge to anti-natalism

Some futurists and philosophers have urged that recent developments in biotechnology promise advancements that challenge standard accepted views of human nature, the self, and ethical obligation. Additionally, some have urged that developments in artificial intelligence similarly raise interesting new challenges to our conceptions of the mind, morality, and the future direction for conscious entities generally. Some have even gone so far as to argue in defense of "artificial replacement," which is the view that humanity should be prepared to "hand over the keys," so to speak, to a new sort of intelligent collection of entities and that we should go extinct gracefully. These views suggest a new challenge to the anti-natalist view that people should stop procreating: perhaps humanity is obligated to not allow itself to go extinct quite yet, at least until we have ensured that these next stages of intelligent entity have emerged. When we take into consideration some possibilities for entities with minds relevantly different from our own, we confront a challenge to the asymmetry argument that concerns human-like minds. Call this the "future minds challenge to anti-natalism." I will examine some assumptions that underlie such a challenge, and I will argue that some famous articulations of the anti-natalist stance should be revised in light of such technological advancements.

Meaning of Ambiguity: A Japanese Survey on Synthetic Biology and Genome Editing

Synthetic biology and genome editing have become increasingly controversial issues, necessitating careful attention and engagement with the public. Our study examined ambiguity in public perception about emerging biotechnologies through the use of several intermediate response options in a survey. To understand the relationship between respondents' thoughts and attitudes, we also examined how respondents' indecision is related to their cognitive concept of "self" as well as their interpretation of "future generations." An online survey of 994 respondents living in Japan revealed that around 80% hold intermediate attitudes (two-sided, non-judgmental, or reserved attitudes) toward synthetic biology and genome editing. These results revealed that respondents who have a narrow self-concept tend to postpone decisions about the application of emerging technologies. In contrast, those with a broad self-concept tend to adopt an ambivalent attitude and are more short-sighted, but make judgments based on the impact of their decisions on current and future generations. This study thus demonstrates that public views are more diverse and nuanced than those obtained from conventional public surveys for policy making.

The Impact of Changing Norms on Creativity in Psychological Science

The open science or credibility revolution has divided psychologists on whether and how the "policy" change of preregistration and similar requirements will affect the quality and creativity of future research. We provide a brief history of how norms have rapidly changed and how news and social media are beginning to "disrupt" academic science. We note a variety of benefits, including more confidence in research findings, but there are possible costs as well, including a reduction in the number of studies conducted because of an increased workload required by new policies. We begin to craft a study to evaluate the short- and long-term impacts of these changing norms on creativity in psychological science, run into some possible roadblocks, and hope others will build on this idea. This policy change can be evaluated in the short term but will ultimately need to be evaluated decades from now. Long-term evaluations are rare, yet this is the ultimate measure of creative scientific advance. Our conclusion supports the goals and procedures for creating a more open science.

Mitigation gambles: uncertainty, urgency and the last gamble possible

A rejection by current generations of more ambitious mitigation of carbon emissions inflicts on future generations inherently objectionable risks about which they have no choice. Any gains through savings from less ambitious mitigation, which are relatively minor, would accrue to current generations, and all losses, which are relatively major, would fall on future generations. This mitigation gamble is especially unjustifiable because it imposes a risk of unlimited losses until carbon emissions cease. Ultimate physical collapses remain possible. Much more ominous is prior social collapse from political struggles over conflicting responses to threatened physical collapse. The two most plausible objections to the thesis that less ambitious mitigation is unjustifiable rely, respectively, on the claim that negative emissions will allow a later recovery from a temporary overshoot in emissions and on the claim that ambitious mitigation is incompatible with poverty alleviation that depends on inexpensive fossil fuels. Neither objection stands up. Reliance on negative emissions later instead of ambitious mitigation now permits the passing of tipping points for irreversible change meanwhile, and non-carbon energy is rapidly becoming price competitive in developing countries like India that are committed to poverty alleviation.This article is part of the themed issue 'The Paris Agreement: understanding the physical and social challenges for a warming world of 1.5°C above pre-industrial levels'.

To recycle or not to recycle? An intergenerational approach to nuclear fuel cycles

This paper approaches the choice between the open and closed nuclear fuel cycles as a matter of intergenerational justice, by revealing the value conflicts in the production of nuclear energy. The closed fuel cycle improve sustainability in terms of the supply certainty of uranium and involves less long-term radiological risks and proliferation concerns. However, it compromises short-term public health and safety and security, due to the separation of plutonium. The trade-offs in nuclear energy are reducible to a chief trade-off between the present and the future. To what extent should we take care of our produced nuclear waste and to what extent should we accept additional risks to the present generation, in order to diminish the exposure of future generation to those risks? The advocates of the open fuel cycle should explain why they are willing to transfer all the risks for a very long period of time (200,000 years) to future generations. In addition, supporters of the closed fuel cycle should underpin their acceptance of additional risks to the present generation and make the actual reduction of risk to the future plausible.