Timothy Krahn

The Extreme Male Brain Theory of Autism and the Potential Adverse Effects for Boys and Girls with Autism

Autism, typically described as a spectrum neurodevelopmental disorder characterized by impairments in verbal ability and social reciprocity as well as obsessive or repetitious behaviours, is currently thought to markedly affect more males than females. Not surprisingly, this encourages a gendered understanding of the Autism Spectrum. Simon Baron-Cohen, a prominent authority in the field of autism research, characterizes the male brain type as biased toward systemizing. In contrast, the female brain type is understood to be biased toward empathizing. Since persons with autism are characterized as hyper-systemizers and hypo-empathizers, Baron-Cohen suggests that, whether they are male or female, most possess an “extreme male brain profile.” We argue that Baron-Cohen is misled by an unpersuasive gendering of certain capacities or aptitudes in the human population. Moreover, we suggest that this may inadvertently favour boys in diagnosing children with Autism Spectrum Disorders. If this is correct, it could also have rather serious consequences for treatment and services for girls (and women) on the Autism Spectrum.

Preimplantation genetic diagnosis: does age of onset matter (anymore)?

The identification and avoidance of disease susceptibility in embryos is the most common goal of preimplantation genetic diagnosis (PGD). Most jurisdictions that accept but regulate the availability of PGD restrict it to what are characterized as ‘serious’ conditions. Line-drawing around seriousness is not determined solely by the identification of a genetic mutation. Other factors seen to be relevant include: impact on health or severity of symptoms; degree of penetrance (probability of genotype being expressed as a genetic disorder); potential for therapy; rate of progression; heritability; and age of onset. In the original applications of PGD, most, if not all of these factors were seen as necessary but none was seen as sufficient for determining whether a genetic condition was labelled ‘serious’. This, however, is changing as impact on health or severity of symptoms is coming to eclipse the other considerations. This paper investigates how age of onset (primarily in the context of the United Kingdom (UK)) has become considerably less significant as a criterion for determining ethically acceptable applications of PGD. Having moved off the threshold of permitting PGD testing for only fatal (or seriously debilitating), early-onset diseases, I will investigate reasons for why age of onset will not do any work to discriminate between which adult-onset diseases should be considered serious or not. First I will explain the rationale underpinning age of onset as a factor to be weighed in making determinations of seriousness. Next I will challenge the view that later-onset conditions are less serious for being later than earlier-onset conditions. The final section of the paper will discuss some of the broader disability concerns at stake in limiting access to PGD based upon determinations of the ‘seriousness’ of genetic conditions. Instead of advocating a return to limiting PGD to only early-onset conditions, I conclude that the whole enterprise of trying to draw lines of what is to count as a ‘serious’ condition is itself problematic and in certain ways morally misleading.

Care ethics for guiding the process of multiple sclerosis diagnosis

Multiple sclerosis (MS) is a chronic neurological disorder for which there is no definitive diagnostic test. Uncertainty characterises most of its features with diagnosis reached through a process of elimination. Coping with uncertainty has been recognised as a significant problem for MS patients. Discussions in the literature concerning the ethics of MS diagnosis have focused on an ethics of duty emphasising the rules for disclosure and healthcare professionals’ obligations to provide information to patients. This narrow construal of the ethics at stake with MS diagnosis may be driven by a common misperception that diagnosis is an event, or series of events, rather than a process. Scant attention has been given to the dynamic, situated relational space between patient and physician as they journey potentially together (or apart) through the process of diagnosis. The healthcare provider cannot properly judge ‘the how, what and when’ of MS disclosure merely by applying rules pertaining to general professional duties to tell the truth and patients’ rights to know their medical status. Proper disclosure and effective communication require the practice of flexible, caring responsibility and sustained, ongoing attention to the particular relational needs of ‘this’ patient in her own situational context. Accordingly, this article argues that care ethics is especially useful (but not without certain limitations) for attending to a broader swath of responsibilities (different from minimal duties) and affective components implicated in meeting patients’ overall needs for care as the patient and physician cope with uncertainty through the process of establishing an MS diagnosis.

REGULATING PREIMPLANTATION GENETIC DIAGNOSIS: THE CASE OF DOWN'S SYNDROME

Preimplantation genetic diagnosis (PGD) involves the testing of embryos produced through in vitro fertilisation (IVF) or intracytoplasmic sperm injection. One or two blastomeres are excised from the embryo at the 6to 8-cell stage, and a genetic analysis is conducted with probes to detect heritable genetic conditions. Most commonly, only ‘unaffected’ embryos will then be transferred to the uterus in the hope of initiating a pregnancy that in all likelihood will not be affected by the familial disorder or chromosomal anomaly tested for. PGD was originally developed in the late 1980s as an alternative to prenatal diagnosis (PND) for couples wishing to produce a genetically related child free of an undesired, heritable, genetic condition where at least one of the prospective parents is a known carrier. Given that it is possible, and in the opinion of some desirable to utilise PGD to select against Down’s syndrome embryos in the context of IVF, is it appropriate for health care professionals to offer, and society to permit, the use of this technology for this purpose? What makes this condition so ‘serious’—in contradistinction to other ‘not-serious-enough’ conditions—that PGD testing for it is deemed an appropriate intervention.

Interrogating the Boundary of Human-Level and T Moral Status

As our development of neuroenhancement technologies continues apace, John Basl’s (2010) paper is a welcome addition to the discussion of appropriate state policy concerning the use of nonhuman animals in cognitive enhancement research. In this commentary we challenge the author to better interrogate and explicate the boundary of what he christens “human-level moral status” and “T moral status” (41). It is Basl’s contention that, within liberal states, policy is to be determined in part by the principle of neutrality of justification (PNJ). A policy accords with the PNJ “with respect to justification just in case that policy is consistent with all reasonable conceptions of the good embedded in liberal society” (41). In Basl’s view, the PNJ does not seek to offer substantive reasons for or against any particular policy; rather, it provides the necessary conditions for determining which ends are appropriate objects of state policy or which reasons are legitimately used by a state to justify its policies. Legitimate ends are those that can be sanctioned by the plu-

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Ethical Analyses of Predictive Brain Implants Should Be Consistent With Feminist Interpretations of Autonomy

The ethical concern, which is the focus of this article, is whether a technologically self-controlled individual may experience a sense of autonomy while being fully under the influence of predictive and advisory functionalities. The potential threat to her or his autonomy is that implanted individuals have no control over the predictions and advice produced by these devices while choosing to act in accordance with these predictions and advice. Consequently, the threat to autonomy is not external but rather internal to the individual. (6)