No One Is Sovereign Over Genetic Sequences

Most of the time the sanctity of national sovereignty is invoked in international law, it’s covering for something bad. The debates about the interpretation of the Nagoya Protocol, a 2010 supplement to the Convention on Biological Diversity, are no exception.

A number of states party to the Protocol, a cryptic document designed to ensure the “fair and equitable sharing of benefits arising from the utilization of genetic resources,” enshrines a principle of state sovereignty over the genetic sequences of all life—including those of pathogens—within state territory.

This interpretation is not obvious on the face of the treaty. But neither is it foreclosed. The resolution of this question has profound implications for global public health: if the states that espouse this position are right, global genetic research will be impeded, possibly dramatically, and epidemics will be harder to fight. Read More

The bottom half of a robotic face, featuring nose and mouth in blue lighting

Sex Robots are Here, But Can the Law Keep Up The With Ethics and Privacy Issues?

The robots are here. Are the “sexbots” close behind?

From the Drudge Report to The New York Times, sex robots are rapidly becoming a part of the national conversation about the future of sex and relationships. Behind the headlines, a number of companies are currently developing robots designed to provide humans with companionship and sexual pleasure – with a few already on the market.

Unlike sex toys and dolls, which are typically sold in off-the-radar shops and hidden in closets, sexbots may become mainstream. A 2017 survey suggested almost half of Americans think that having sex with robots will become a common practice within 50 years.

As a scholar of artificial intelligence, neuroscience and the law, I’m interested in the legal and policy questions that sex robots pose. How do we ensure they are safe? How will intimacy with a sex robot affect the human brain? Would sex with a childlike robot be ethical? And what exactly is a sexbot anyway? Read More

Repayment for Training as an Optimal Solution to Medical Brain Drain

In an earlier post I offered two arguments for why wealthy nations have a moral obligation to address medical professional brain drain from resource-scarce developing nations. But once one acknowledges that wealthy nations have this obligation, a question remains as to what the best way to fulfill that obligation is.

Some have suggested that the solution is for wealthy nations to train an ample amount of doctors in their home countries so that they no longer need to take talent from developing nations to make up for the gap. This idea has intuitive appeal. After all, it allows more medical doctors to be trained in wealthy nations like the U.S. and results in more doctors being trained overall (assuming that developing nations would continue to train the same amount of doctors under such a model). Read More

Reality star Kim Kardashian at the CFDA Awards at the Brooklyn Museum on June 4, 2018.

Can Kim Kardashian Help Bioethics? Celebrity Data Breaches and Software for Moral Reflection

In 2013, Kim Kardashian entered Cedars-Sinai Medical Center in Los Angeles.

During her hospitalization, unauthorized hospital personnel accessed Kardashian’s medical record more than fourteen times. Secret “leaks” of celebrities’ medical information had, unfortunately, become de rigueur. Similar problems befell Prince, Farah Fawcett, and perhaps most notably, Michael Jackson, whose death stoked a swelling media frenzy around his health. While these breaches may seem minor, patient privacy is ethically important, even for the likes of the Kardashians.

Since 2013, however, a strange thing has happened.

Across hospitals both in the U.S. and beyond, snooping staff now encounter something curious. Through software, staff must now “Break the Glass” (BTG) to access the records of patients that are outside their circle of care, and so physicians unassociated with Kim Kardashian’s care of must BTG to access her files.

As part of the BTG process, users are prompted to provide a reason why they want to access a file. Read More

Don’t miss today’s Health Law Workshop with S. Matthew Liao

October 1, 2018 5:00 PM
Hauser Hall, Room 104
Harvard Law School, 1575 Massachusetts Ave., Cambridge, MA

Presentation: “The Moral Status and Rights of Artificial Intelligence”

To request a copy of the paper in preparation for the workshop, please contact Jennifer Minnich at jminnich at

S. Matthew Liao is Director of Center for Bioethics and Arthur Zitrin Professor of Bioethics at the NYU College of Global Public Health. He uses the tools of philosophy to study and examine the ramifications of novel biomedical innovations.

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From bioethics to medical anthropology to humanities and back: A year in review

I thought I would take this opportunity to reflect on the past year, where I will be in the future, and how the student fellowship has impacted me. I still hope to contribute to the Bill of Health blog going forward, but as my last official post as a Petrie-Flom Student Fellow, I would be remiss if I did not express my sincere gratitude to everyone at the Petrie-Flom Center, the faculty and staff, the other student fellows, and especially my mentors: Professors I. Glenn Cohen, Carmel Shachar, and Intisar A. Rabb.

My own project took a few different turns this year. My original proposal was to explore the ways in which bioethics and biomedical issues will play a significant role in reviving the dialectic between secular scholars and religious authority. Ayman Shabana rightly argues that respect for Islamic religious norms is essential for the legitimacy of bioethical standards in the Muslim context, wherein he attributes the legitimating power of these norms—as well as their religious and spiritual underpinnings—to their moral, legal, and communal dimensions. Building off of Shabana’s work, my initial argument held that the relationship between the secular and religious worlds is important because the discourse between the two, although often presumed to be dichotomous, is not necessarily antithetical nor is it impassable. This led me back to the arguments of the venerable philosophers Alasdair MacIntyre and Charles Taylor whereby, in critiquing the concept of secularism itself along with its historical contexts, furthered my argument and helped me to clarify the significant role that religion plays vis-à-vis categorical issues such as fundamental beliefs and metaphysics. I still maintain this, and it is something I continue to work on, although I decided to take my project in another direction.

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What can an 11th century Islamic philosopher teach us about 21st century neuroscience?

There is a lot of fascinating research about the brain coming out of Stanford University, with some exciting, cutting-edge work being done there. Early last month I reported on the findings made by neuroscientists at Stanford in understanding how mental rehearsal prepares our minds for real-world action. Today, I’ll outline the recent advances made by a team led by Sergiu Pasca, MD, assistant professor of psychiatry and behavioral sciences at Stanford University, and discuss some of the ethical implications of this research.

Pasca’s method enables him to culture cells in order to form brain organoids with robust structures that are not compromised by cells from other parts of the body, thereby allowing him to more accurately replicate distinct brain regions. Doing so provides greater structural organization and also allows him and his team of researchers to better study and understand pathological mechanisms and perhaps one day to examine the molecular, cellular, and circuit levels of a person’s neurons. This is a promising method and a big step toward greater understanding of psychiatric and neurological disease, leading Pasca to declare, “This is our doorway into personalized psychiatry.” At the same time—although these “brain balls” are not brains, nor do they receive sensory inputs from the outside world—it is clear that as scientists progress in both the techniques and complexity of replication, major ethical questions and dilemmas will arise.

Chief among these will undoubtedly be the perennial ethical debate about the ontology of a human being. Is it only physical, material, social—in which case we might think of ourselves as technicians—or is it spiritual, religious, metaphysical—in which case we would more likely consider ourselves custodians? When we speak about attributing rights to animals or consciousness to AI, it is because at bottom we hold some fundamental belief: about dignity, a soul, being, or about what life might mean in a relational or social and emotional sense. This is no different with Pasca’s brain balls; in fact, it is an even more pressing quandary. As Bruce Goldman notes in his article, “One of the most amazing things about their brain balls was that, with not much chemical guidance, they tended to take on a default structure that’s a facsimile of the most evolutionarily advanced part of the brain: the human cerebral cortex, with all six layers you find in a living human brain.” The ethics of growing human organs are one thing, but the ethics of growing brain balls, which might eventually lead to more and more complex synaptic connections followed by even more elaborate renditions of an actual brain, will become especially contentious given the meaning and significance that we associate with the brain—both biologically and existentially.

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Orcas, Dolphins, and Whales: non-human persons and animal rights

With few exceptions, most cultures put homo sapiens at the center or the apex of creation. Humans, it is generally believed, are distinguished from other animals by our self-awareness and our ability to use tools, to think, reason, and construct meaning and representations about life. The Abrahamic religious traditions are most notable in their anthropocentric vision of human purpose in creation; and although the metaphysics and teleology are sometimes challenged by advances in science and technology, the fact remains that human beings remain the paradigmatic case against which other animals or even artificial intelligence is measured. As a Muslim and a theist, I avow my belief in the unique status of humans; however, as someone who also believes in science and is keenly attuned to the environment, I have a great love for nature and the animal world, and a great desire to protect them.

It is with this, then, that I want to propose to put ethics before metaphysics in considering the moral status of what legal scholars and ethicists call “non-human persons.” In particular, I want to look at cetacean intelligence of orcas, dolphins, and whales to understand the way in which we might classify them as non-human persons which would be given certain rights and protections. Doing so, I argue, would enable us to collapse the bifurcations that influences much of Western thought thereby ushering in a more holistic, ecological and relational approach to ethics and being.

To begin with, I would like to make a distinction clear: I am not claiming that orcas, for example, are morally equivalent to humans, but I am suggesting that we ought to be more cautious with regard to understanding our place in the animal world as a whole, particularly as it relates to the precariousness of life itself. My argument below follows philosophical and ethical reasoning, though this might also be understood in the context of religious texts. The story of Yunus (aka Jonah) and the whale is found in both the Bible and the Qur’an. In short, Yunus felt discouraged that the people of Nineveh did not heed his call to worship God, and so he left in anger. Being cast into the sea, followed by being swallowed by the whale, was ostensibly punishment for his loss of hope and leaving the city without God’s permission; though on another level the exegetical scholars point to the fact of his supplication “O Lord! There is no god but you: Glory to you: I was indeed wrong” (Qur’an 21:87) as instructive of submitting to God’s will and the significance of humility. Indeed, the Qur’an goes on to say elsewhere: “Had he not been of those who exalt God, he would certainly have remained inside the whale until the Day of Resurrection.” (Qur’an 37:143-144). The whale, on this reading, is integral to the Abrahamic worldview insofar as it is the manifestation of God’s power and dominion over creation, as well as his lesson to human beings to remain humble. Read More

Illness, Disability, and Dignity

By Yusuf Lenfest

Medicine is meant to heal our ailments and treat our illnesses. Our deep knowledge of the body and the numerous mechanisms that contribute or correlate to good health is considered a triumph of the medical sciences. We can now perform transplants with relative ease, offer prosthetics to those who require them, and even cure some forms of blindness. But so much of modern medicine today is built around quantitative data—family histories, success and morbidity rates, pathologization, statistical analyses—without much conscious consideration of how one understands, copes, or derives meaning from their experience. True, such data is gathered for the purposes of more accurate diagnoses and as the first defense against an illness or medical condition; but physicians are taught to concentrate on the cure, and while few would dispute that that is certainly a good thing, we also ought to keep in mind that excessive focus on a default measure of “normal” does not necessarily allow us to express the diverse ways of being in the world nor adequately account for the ways in which people embrace their conditions.

Some autistic individuals, for example, believe that autism should be accepted as a difference and not as a disorder. That the autism spectrum is precisely that—a spectrum—is important: on the one hand, statistical analysis may reveal that these individuals are in the minority versus the average population, only 1%; but on the other hand, to take a different perspective, it means merely that the characteristics of these individuals manifest in a way that is atypical with how the institution and culture of medicine classifies them. Lest we forget, medicine is part of the dynamic structure of society and social norms—in the background and the foreground—of knowledge-making, and it is imbedded in place and society, as part of the structures existing in institutions. It is not possible to consider theoretical or epistemological claims apart from practical knowledge and applied sciences. Read More

Islam and the Beginning of Human Life

When does human life begin?

One of the more contentious bioethical and legal issues is about the beginning of human life. Nor is it difficult grasp why, for beyond political rhetoric it is a subject of considerable philosophical and legal debate and raises a number of questions which are profoundly difficult to answer. Biomedicine can roughly differentiate when life becomes viable, that is, at which point a fetus could survive as an infant if a mother gave birth prematurely; it can likewise recognize potential complications either in the development of the fetus or the health of the pregnant woman. Yet other questions are not as easy to answer, precisely because they tend to fall more in the spectrum of philosophy or personal belief: what constitutes a human being? What is a person? Is a potential life accorded the same rights as an actual life? For that matter, are there rights to begin with automatically, or are there criteria that must be met in order to procure rights? In short, questions that strike at the very core of who we are.

A number of these questions were debated by Muslim theologians and legal scholars in the pre-modern world when considering contexts of abortion or issues surrounding paternity. In the modern world, these questions have grown to include in vitro fertilization and surrogacy amongst others. Muslim scholars continue to grapple with these bioethical questions as the medical sciences grow more advanced and technology allows us to have ever more control over the basic aspects of reproduction, growth, and development. Per the question, When does human life begin? for example, Mohammed Ghaly analyses in an important article, “The Beginnings of Human Life: Islamic Bioethical Perspectives” some of the newer discussions and positions Muslim scholars have taken vis-à-vis contemporary bioethics and independent legal reasoning (ijtihad). Complementing this discussion is also a seminal article by Ayman Shabana, “Paternity Between Law and Biology: The Reconstruction of the Islamic Law of Paternity in the Wake of DNA Testing.” Shabana shows how classical rulings pertaining to paternity issues continue to hold higher authority, even despite the advent and availability of modern technology that would ostensibly challenge that authority. This is interesting for a number of reasons, not least of which is the possible change in perspective with regard to how religious authority is derived and its relationship to the medical sciences. Read More