PENN BIOETHICS JOURNAL

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A Search for Meaning: Classical to Contemporary psychedelic enhancement and end-of-life care 2 Penn Bioethics Journal Volume XVI, Issue I Penn Journal Bioethics niche field inthe of bioethics. information, Penn the Journal Bioethics occupies aunique scholars field inthe the to broader publicseeking unbiased Journal. With an audience ranging from undergraduates to collaborative,the rigorous and review preparation of the opportunity peer-review the process to experience through Authors and editorial the staffalike have aunique with eminentinterviews figuresthe field. in features briefs news summarizing current issues and amongethics, other disciplines. The biannual issue also technology, philosophy, public policy, law, theology, and and publishes work original addressing debates inmedicine, Embracing interdisciplinarity the of PBJ bioethics, reviews make contributions to field the of bioethics. Journal2004, the provides a venue for undergraduates to undergraduatereviewed journal. bioethics Established in The Penn Bioethics Journal (PBJ)the is premierpeer- EVENTS COORDINATOR Harald Schmidt, MA,PhD NEWS BRIEF AUTHORS MANAGING EDITORS FACULTY ADVISOR EDITORS-IN-CHIEF Hope Hawthorne Humphrey Shen Shreya Parchure Sophie Roling Emma Keeler Millie HuangMillie Miles Meline PUBLISHER Robert Chen Robert David Hong Aditya Rao Amy Chen Jordan Liu Jordan reserved. Copyright © 2020 Penn Journal, Bioethics rights all derived from open-source images. The cover artwork this of issue is by Emily Guo and is gmail.com. information should addressed to be pbjeditorinchief@ or for resale. Requests for permissions these or further promotional creating purposes, collective works, new such as copying for general distribution, advertising, or Permission must requested be for any kind of copying, bioethicsjournal.com. submissionthe process found can be on our website: www. Archived editions of Journal the and information about ASSOCIATE EDITORS Ayotzin Bravo Ponce Pallavi Jonnalagadda Taylor Cunningham Nicholas Anderson INTERVIEWERS Ella AtsavapraneeElla Hope Hawthorne Humphrey Shen Renee Osagiede Renee Aimen Shaadab Mae Mouritsen Thriaksh Rajan Thriaksh Mehek Dedhia Jillian Neuner Emma Keeler Miles Meline William Han William Emily Sheng Megha Nair Bethany So Savan Patel Emily Guo Jordan Liu Jordan Penn Bioethics Journal Volume XVI, Issue I 3 11 16 Christina Stankey University Yale Confronting Death: End of Life Life of End Death: Confronting in Classical Antiquity Care Shaan Bhandarkar University Yale of Implications Ethical Enhancement Psychedelic Articles 4 6 5 8

Harald Schmidt Harald Interview Dr. with A Conversation Bioethics-in-Brief Letter from the Editors Letter from Microdosing: What We Know Know We What Microdosing: to Need We What and Now Out Find Keeler Emma Coronavirus Vaccine Trials Vaccine Coronavirus Hawthorne Hope Psychedelic of Status The Ethical Concerns About About Concerns Ethical Editors-in-Chief Shreya Parchure and Aditya Rao Aditya and Parchure Shreya Content 4 Penn Bioethics Journal Volume XVI, Issue I Letter from Editors the comments, or for ideas collaboration at [email protected]. increases visibility the of among bioethics undergraduates. contact Please us with any questions, has supported capacity the at of large society to adapt to fluctuating the circumstances. express our gratitude to healthcare workers, and other remarkable essential whose service dedication microdosing, an interesting supplement article. to second the full-length of ethics the context inthe COVID-19 vaccine trials, of current the pandemic, and of psychedelic ventilators, tests, and vaccines, and national healthcare coverage. Finally, issue’s this briefs news discuss pandemic, including disparate and impacts socioeconomic groups, on racial particular allocation of and Health Policy at University the of Pennsylvania, implications on bioethical the of COVID-19 the neatly deploying object-end-circumstance the framework expounded by Thomas Aquinas. defends of good the natural human limitations that psychedelic enhancement to undermine, seeks psychedelics toward moral enhancement Author is unethical. Stankey, Christina of also Yale University, modernity. University findsthat theoriestheof legacy classical and practices of end-of-lifecare abideseven in exploring notions the of palliative care and euthanasia inparticular. Author Shaan Bandarkar of Yale conceptthe of end-of-life care from its origins inHippocratic medicine to contemporary allopathy, offer its readershipthe following articles. relevant to pandemic. the Urged by same the attention to intellectual diversity and rigor, PBJ is proud to University of Pennsylvania from June 19–21,featured aflourishing discussion overissues bioethical order to mitigate circumstances such The as these. WorldCongress hostedof virtually theBioethics, by and death rates have become topical challenges. bioethics protecting workers, healthcare and essential service and addressing demographic disparities ininfection ventilators, balancing lockdown enforcement against economic repercussions and individual autonomy, importance of as handmaidbioethics the has of become increasingly policy health apparent. Rationing Meaning: to Contemporary.” Classical Readers, Dear Thank you for thislatestreading issue the of Penn Bioethics Journal. It is our thathope this issue We members thank all of PBJ the team for flexibility their unprecedentedthese in times. also We had pleasure the PBJ also of Dr. interviewing Harald Schmidt, Assistant Professor of Medical Ethics “Ethical Implications of Psychedelic Enhancement,” second the article, argues that of use the This issue’s firstarticle, titled“Confronting Death: End-of-Life CareClassical in Antiquity,” traces We note necessity the of discourse inenabling bioethical constant and vigilance preparation in course the ofOver COVID-19 the pandemic, is which ongoing at of time the writing, this the It is our pleasure to present Volume XVI, Issue iof Penn the Journal, Bioethics “A titled Search for Shreya Parchure and Aditya Rao Editors-in-Chief Penn Bioethics Journal Volume XVI, Issue I 5 There are four major ethical principles that are are that ethicalprinciples major four are There There is a chance that a challenge study would would study challenge a that chance is a There supporting released guidelines WHO 6, The On May

challenge studies as long as eight conditions are met, but if but met, are conditions eight as long as studies challenge want companies biotechnology American other or Moderna approval receive they must studies challenge conduct to the that is conditions the WHO’s of One the FDA. from study challenge of a One the benefit risks. outweigh benefits clinical trial three be phase typical a shorter a than would of losing is a risk There lives. more trial, save which could Working the WHO trial, why whichis thein challenge lives in Studies Challenge Human on Guidance for Group risks. minimizing for suggestions outlined has COVID-19 not gain approval from the FDA because there is not a cure cure a not is because there the FDA from approval gain not never has FDA The group. in the control participants for a treatment a virus without for study a challenge approved are medicalsome professionals a result, 2020). As (Bellamy Myron example, For study. a challenge about concerned diseases infectious expert and at Levine, a physician “Mike” a challenge about concerned is Maryland, of the University effective any yet not are because there COVID-19 for study thus the coronavirus, from death preventing for treatments (Branswell participants study to risk posingsignificant a 2020). non- autonomy, trials: vaccine to beneficence, applicable would be vaccine A coronavirus justice. and maleficence, of thousands hundreds prevent would beneficialit because be trial respected in a vaccine would Autonomy deaths. of and risks about information comprehensive providing by decisions informed make can participants so benefits that major is the non-maleficence However, participating. about that the possibility to due study in a challenge concern refers Justice the coronavirus. die from could participants of hardships and the benefits of the equal distribution to of in distribution the significant most which is research, 2017). (Molyneux vaccines conducting a challenge study because it could potentially potentially could because it study a challenge conducting of the members 35 are There development. speed vaccine up the FDA to written have that Representatives of House U.S. major 2020). The (Branswell study a challenge of in support a coronavirus to develop is study challenge of a benefit death the of risk is concern the major but quicker, vaccine rescue treatment. no is because there Scientists have proposed other ideas that would would ideas that other proposed have Scientists There is another vaccine candidate developed developed candidate vaccine another is There The role of the WHO is to create guidelines for for guidelines to create is of WHO the role The As of August 11, there were 49 vaccines that the that vaccines 49 were there 11, August of As

With the rush to find a coronavirus vaccine, scientists, scientists, vaccine, coronavirus a find the rush to With (Branswell 2020). There has been increased support for for has support been increased 2020). There (Branswell studies” to replace normal phase three studies in thein studies three phase normal replace to studies” Diseases 2020). The et al. (Eyal Infectious of Journal exposingall intentionally involve would study challenge group the control including the coronavirus, to volunteers the though participants Even a placebo. receives only that death still is of a risk there healthy and be young would ready in September with emergency authorization from from authorization emergency with September in ready Excellence Care and Health for Institute National the UK’s (Goldhill 2020). sizes. On March sample large on the vaccine test rapidly “challenge human the idea for proposed bioethicists 31, a combined phase two and phase three study, meant meant study, three phase and two phase a combined This timeline. development the vaccine accelerate to development the vaccine typical of some changed study trial 1,000 one enrolled the phase example, For procedures. the sample than larger significantly whichis participants, trial. could be vaccine This one phase a normal size for term effectiveness and continues to examine side effects to examine continues and term effectiveness volunteers of thousands on tested is three Phase safety. and trials (CDCcontrol efficacyrandomized in long-term for 2018). in is AstraZeneca that and Oxford of the University by vaccines that are distributed and may use WHO guidelines guidelines use WHO may and distributed are that vaccines requires FDA The 2020). (Bellamy decisions make to for be to approved phases three in beto tested vaccines between 100 20 to on tested is use one in the US. Phase Phase safety. focuses on mostly and individuals healthy short- for test to people of the hundreds drugs tests on two vaccine candidates is being made by Moderna, an American American an Moderna, by being made is candidates vaccine received 7, Moderna On May company. biotechnology Drug Administration and Food the U.S. from approval having yet not despite begin testing, to two phase (FDA) 2020). (Weise results one phase complete the approves the FDA the U.S., In development. vaccine humans. The urgency of the situation has led researchers researchers ledhas of situation the urgency The humans. time the same at studies human and run to studies mice (Goldhill 2020). in monitoring was (WHO) Organization Health World these of One 2020). clinical trials (Kommenda human the ethics of clinical trials. The normal time it takes to it clinicaltakes trials.the ethics normal time of The are researchers and 20 years 15 to is a vaccine create a or in a year vaccine a coronavirus make to attempting in typical the changes require This will a half. and year (Boodman process 2020). Normally, production vaccine in beingtested before animals in be tested would vaccines Hope Hawthorne Hope about posed policymakers questions have and physicians, Ethical Concerns About Coronavirus Vaccine Trials Vaccine Coronavirus About Concerns Ethical Bioethics-in-Brief 6 Penn Bioethics Journal Volume XVI, Issue I fairly distribute vaccines. require governments and WHO the to develop plans to going to individuals the that can pay most. the Thiswill justice is important to ensure that vaccines are not just framework for vaccine allocation. Here, principle the of limited supply means that an to need be ethical there will once there is one approved (Higgins-Dunn 2020).The not able be to demand the meet for acoronavirus vaccine Bancel, CEO of the Moderna, said that one producer will individualswhich should receive vaccine the first. Stephane questions ethical be tostill address, decide as policymakers contracting coronavirus the (WHO 2020). a low risk of dying from coronavirus, the but risk of ahigh These suggestions includeparticipants selecting that have Bioethics-in-Brief this practice,this resulting in areliance on variable highly and research surrounding short the and long-term effects of microdosing. This largelyis thedue lack to of empirical a uniform and definitive consensus the on specifics of popularity, scientific the community has not yet reached Kumar 2016;Waldman 2017).Despite recent this spike in publicly 2017;has been (Cruz books addressed inseveral 2019). Furthermore, topic the of psychedelic microdosing microdosing and praising its cognitive benefits (Ian studyingbeen psychedelics for over 50years, endorsing like Dr. James Fadiman, psychologist alicensed has who CEO and co-founder of Apple, and professionals medical years, with prominent figures such as Steve theJobs,late This has garneredpractice increasing attention in recent occasionally cannabis and ketamine (Leonard 2015). mushrooms), N,N-dimethyltryptamine (i.e. DMT), and (i.e. LSD), psilocybin-containing mushrooms (i.e. psychedelic substance, such as lysergic aciddiethylamide consuming low, very sub-hallucinogenic amounts of a Emma Keeler Eyal, Nir, Marc Lipsitch, and Peter G.Smith. 2020.“Human Challenge Brandwell, Helen. 2020.“Infect Volunteers with AProposal Covid-19? 2020.“Researchers Eric. Boodman, Rush to Test Coronavirus Vaccine Bellamy, J. 2020.“Coronavirus Vaccine 14KVolunteer Race: for Human References Now and What We Need to Find Out The Status of Psychedelic Microdosing: What We Know When acoronavirus vaccine is approved, there will Microdosing psychedelics is practiceof the lays-bare-a-minefield-of-issues/. volunteers-with-covid-19-in-the-name-of-research-a-proposal- www-statnews-com.proxy.library.upenn.edu/2020/05/01/infect- Lays Bare aMinefield of Issues.” STAT News. May 1,2020. https:// vaccine-trial-without-usual-animal-testing/. edu/2020/03/11/researchers-rush-to-start-moderna-coronavirus- News. 2020.https://www-statnews-com.proxy.library.upenn. in People without Knowing How Well It Works inAnimals.” STAT lege-trials/85-d9a5b66a-4b66-4426-a330-81174195c6eb. com/article/news/health/coronavirus/coronavirus-human-chal Challenge Trial |11alive.Com.” 11Alive. 2020.https://www.11alive. - “The “The Journey of YourChild’s Vaccine.”Centers 2018. for Disease Molyneux, Malcolm. 2017.“New Ethical Considerations inVaccine Tri Kommenda, Niko, and Frank Hulley-Jones. 2020.“Covid Vaccine Track “Key Criteria for Ethical the Acceptability of COVID-19 Human Chal Higgins-Dunn, Noah. 2020.“Moderna CEOSays No Single Drugmaker Olivia. 2020.“FDAGoldhill, Would Consider Releasing an Unap microdosing (Fadiman 2011). Fadiman claims treated can be through psychedelic depression, and common the sicknesses coldthat — all associated such with illnesses as asthma, allergies, possibility that microdosing may suffering alleviate the productivity and creativity. areOthers attracted to the multifold. Some are drawn to promise the of increased anecdotal from evidence microdosers. Weise, 2020.“Latest Elizabeth. on Search Global for Coronavirus Vac Finfographics%2Fjourney-of-child-vaccine-text.html. refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fparents%2 infographics/journey-of-child-vaccine.html?CDC_AA_ and Prevention. 2018.https://www.cdc.gov/vaccines/parents/ Inc. https://doi.org/10.1080/21645515.2016.1272744. als.” Human Vaccines and Immunotherapeutics. Taylor and Francis tracker-when-will-a-coronavirus-vaccine-be-ready. theguardian.com/world/ng-interactive/2020/nov/10/covid-vaccine- The Guardian.” TheGuardian . November 10,2020. https://www. When Willer: aCoronavirus Vaccine |World Ready? Be News | priority-diseases/key-action/novel-coronavirus-landscape-ncov.pdf. lenge Studies 6May 2020.” 2020.https://www.who.int/blueprint/ vaccine-doses-for-the-planet.html. says-no-single-drugmaker-can-produce-enough-coronavirus- 2020.https://www.cnbc.com/2020/05/12/moderna-ceo-CNBC. Can Produce Enough Coronavirus Vaccine for Doses Planet.” the coronavirus-vaccine/. qz.com/1852835/fda-would-consider-releasing-an-unapproved- proved Coronavirus Vaccine —Quartz.” 2020.https:// Quartz. infdis/jiaa152. of Infectious 221(11):1752–56.https://doi.org/10.1093/ Diseases Studies to Accelerate Coronavirus Vaccine Licensure.” The Journal The amount of apsychedelic substancethat The motivationbehind microdosing psychedelics is testing/5179665002/. com/story/news/health/2020/05/09/coronavirus-vaccine-race-us- Pfizer Tests in Humans.” USA Todat. 2020. https://www.usatoday. cine: 1st USCandidate for Set Phase 2;WHO Tracks 8Efforts; - - - - - Penn Bioethics Journal Volume XVI, Issue I 7 Bioethics-in-Brief

ijnp/pyz029. - Kumar GoogleCreateSpace EfficiencywithBooks. ... - N. and Platform. Publishing Independent 20, 2015. November Stone. Rolling Stone.” - Rolling Trip Business https://www.rollingstone.com/culture/culture-news/how-lsd- microdosing-became-the-hot-new-business-trip-64961/. G. - Barry David H. Rumack, Treatment and Diagnosis Poisoning: - GoogleSpoerke Books. Press. CRC Drugs 8 (2): 167–69. https://doi.org/10.1080/02791072.1976.10471 846. PsilocybinTime on Varied of Doses of 2008. “Effects Vollenweider. Letters Neuroscience Subjects.” in Human Reproduction Interval 435 (1): 51–55. https://doi.org/10.1016/j.neulet.2008.02.006. Group. of Psychedelic Microdosing - as Reported by Microdosers - Microdosers Reported - as by Microdosing Psychedelic of 2019. https://blogs. 12, August Central. BioMed On Health.” biomedcentral.com/on-health/2019/08/12/benefits-and-challenges- of-psychedelic-microdosing-as-reported-by-microdosersutm_ sourcebmc_blogsutm_mediumreferralutm_contentnullutm_ campaignblog_2019_on-health/. Registries. OSF Survey.” Community Microdosing of “Demography https://osf.io/ke49d. 17, 2017. August Cruz - Google W. - Ruben Productivity and Creativity Increased Published. Books. Independently Traditions/Bear. 2019. https://fherehab. 10, February FHE Health. Psychedelics?” com/learning/benefits-in-microdosing-psychedelics/. Physiological and Psychological 2004. “Acute X. Vollenweider. Placebo- A Double-Blind, Humans: PsilocybinHealthy of in Effects 172 (2): Psychopharmacology Dose-EffectStudy.” Controlled 145–56. https://doi.org/10.1007/s00213-003-1640-6. Microdosing of Side-Effects and 2019. “Motives Kuypers. P.C. of Journal International Users.” among Psychedelics with (7): 426–34. https://doi.org/10.1093/ Neuropsychopharmacology22 Kumar, N. 2016. Microdosing: Enhance Your Vitality, Temperament Temperament Vitality, Your Enhance N. 2016. Microdosing: Kumar, New Became the Hot Microdosing LSD 2015. “How Andrew. Leonard, Mushroom of 1994. Handbook Barry G. Spoerke. David Rumack, H., and Psychoactive of Journal & TMA-2.” 1976. “DMT T. Alexander Shulgin, X. Franz and Hasler, Felix Wittmann, Marc Jiří, Wackermann, Publishing 2017. A Really Doubleday Good . knopf Day Ayelet. Waldman, References andChallenges “Benefits 2019. Petranker. Rotem and Thomas, Anderson, 2017. and Le-Anh Dinh-Williams. Petranker, Rotem Thomas, Anderson, to Guide The Definitive LSD: 2017. Microdosing W. Cruz, Ruben Inner Guide . Explorer’s Psychedelic 2011. The James. Fadiman, Microdosing in There Benefits Are in Drug Use: Chris. 2019. “Trends Foy, Franz and Huber, A. Benz, Theo Marco Grimberg, Ulrike Felix, Hasler, Kim and C. Dolder, Patrick L. Mason, Natasha R.P.W., Nadia Hutten, Given the increasing prevalence of microdosing microdosing of prevalence the increasing Given The majority of the few studies that have assessed the have that fewstudies of the majority The These discrepancies continue when comparing comparing when continue These discrepancies concentration, creativity, and productivity, as well as as well as productivity, and creativity, concentration, Others pain. addiction, and depression, anxiety, reduced experience, detailing different described a much have cognitive overstimulation, anxiety, discomfort, physical 2018). (Anderson difficulty emotional and interference, group. One of the few placebo-controlled studies found no no found studies the placebo-controlled few of One group. participants between differences physiological significant psilocybina a placebo microdose versus whoreceived of psilocybin effects the psychological However, microdose. whousers, have by been online reported have microdosing mood, cognition, in energy, both improvements reported half of the respondents who microdose devised their own the respondents half of 2019). specific (Hutten schedule various exhibited have microdosing of psychedelic effects a placebo of the lack notably methodical most issues, accepted routine has been dubbed ‘weekday’ dosing, with with dosing, been has ‘weekday’ dubbed routine accepted substance psychedelic a given consuming microdosers elect dose to individuals other Finally, weekdays. on only to week one from regimes range These everyday. other the many of a few only they are and in duration, years two that survey found A recent microdose. people that ways there are three distinct regimes that are widely practiced. practiced. widely are that distinct regimes three are there by outlined was of which popular mostand first The Guide: Explorer’s Psychedelic book in his The Fadiman 2011). (Fadiman Journeys Sacred and Therapeutic, Safe, consecutive two involves protocol microdosing This Another days. non-dosing two by followed days dosing of what a microdose was considered to be in Rolling Stone be Stone to in Rolling a microdose considered was what of of a microdose, definition the clinically-accepted and of a microdose. definition the variable illustrating reviewing After schedules. microdosing published that appears it protocols, microdosing published different studies have characterized a microdose for mushrooms mushrooms a microdosefor characterized have studies 2004; Wackermann (Hasler grams <0.001 as DMT and For 1976), respectively. (Shulgin grams 0.006 2008) and is mushrooms dose of a hallucinogenic comparison, 1994). & Spoerke (Rumack be to 3–5 grams considered upper threshold betweenthe difference 500-fold a is There example, an article in Rolling Stone defined a microdose defined a microdose Stone in Rolling article an example, 0.2–0.5 grams or LSD, of 0.001 grams approximately as 2015), while psychologists (Leonard dried mushrooms of as Central BioMed it in defined Petranker and Anderson mushrooms of 0.1–0.3 grams or LSD of 0.005–0.02 grams 2019). Clinical preclinical and & Petranker (Anderson constitutes a microdose is the first area of disunity of disunity area a microdose the first is constitutes majority vast The field. microdosing the nascent within entails microdosing that agrees literature published of one- to one-tenth approximately of the consumption a psychedelic dose of the recreational of twentieth For specific doses vary greatly. however, substance, 8 Penn Bioethics Journal Volume XVI, Issue I Could you alittle introduce yourself, talk bitCould about your not just on with problemsdealing the here in the and now, are about. all And that’s we where really Ithink have to focus, 1 interms of illustrating determinants what social of health particular, is organized. Sadly, as exhibit COVID seen can be underlyingthe structure of how and healthcare, society in us—many would emphasize: again—major problems with a pandemic of poverty. In clarity, cruel COVID is showing vulnerable communities, inmany ways, is more this about noted inarecent LDI seminar on of meeting needs the are facing apandemic. But as my colleague Shreya Kangovi whites died, insome states up to as sixtimes many. True, we average, more thanas many twice blacks compared with differences in hospitalizations and deaths across races.On hardvery to comprehend. Then, we have astoundingthese workers—who to save we expect then our lives—is just really preparation and utter disregard for safety the of healthcare as getting protective gear to hospital workers. Thatlack of we were evidently not able to get things basic done, such matters? are implications your of thoughts on these thebioethical income, disparities. What and racial to socioeconomic, States preparedness and response to COVID-19 inregards Therelot a have been of critiques towards the United have at Penn for such work is hard to beat! or establish where them, The interdisciplinarity needed. we important, to make constructive proposals trying to improve at justification ethical the lawsof policies,and and, just as are empty’—and much of my work is concerned with looking Asin ethics. you know, Penn’s motto is ‘laws without morals well I’m because very measure in equal interested as in policy DepartmentThe of Medical Ethics and Health me Policy fits responsibility for and health priority setting inhealthcare. committee.ethics My main research interests are personal UKthat inthe tank functions inmany ways like anational on for Bioethics 7years, anonpartisan think bioethics Iwas Assistantacademia, Director of Nuffield the Council philosophy and aPhD inpublic policy. Before working in atPenn? professional background, and share usyour with role here This interview was conductedThis interview by Jordan Liu, Miles Meline, and Humphrey Shen. Ethics Task Force. of International the on Priorities Society inHealth Care, and amember of UNESCO’s Health Incentives and Behavioral Economics, a member of Management the Committee Policy at University the of Pennsylvania. He aResearch is also Associate at Center the for Dr. Harald Schmidt, MA,PhD is an Assistant Professor of Medical Ethics and Health A Conversation with Dr. Harald Schmidt Interview It how is striking inone of richest the countries on earth, I joined as at faculty Penn in2013.Ihave an MAin way support? that we structure social and the after in pandemic carepolicy the terms of health ofwhat transformations sort see you we do could think Given stark these disparities, that is revealing the pandemic seize. will It’s aunique and opportunity, critical and one hopefully we firesthat be to putneed out, or at least controlled,right now. but longer-term, also what we’re doing once we fought the about lockdown measures, and possibility the of waves new gets who decide avaccine not when can. all that’s where third the challenge comes in, as we to need rationing, be there will as demand outstrip will supply. And making and packaging band-aids. over So extended periods, are major bottlenecks inproduction, as isn’t this same the as of year. the second The is producing vaccines scale. There at administrationthe that thinks happen it will before end the vaccines. Thatwhere is currentthe of focus attention is, and comes to vaccine access. The first is, obviously,developing made available fairly and quickly! today about vaccine strategy and stated vaccines would be FDA? approved gets if and avaccine when reoccurring by the and feelings same challenges those youthe US.Do see ventilatorsallocating and initial COVID-19 testing in We’ve alot of and related anxieties challenges seen to lot more sympathetic to existential the for need healthcare. affordable insurance a health everyone makehopefully will importancethe of having meaningfully comprehensive and of fear of hospitalization and death, and appreciation the of to next the elections, that and personal lasting experience patchy coverage, or none it at when to comes with. start So all of worse the off have lost insurancewiththeir work, only have likely appreciate will value the of insurance. health But many worried about suddenly contracting COVID.better-off The lining inCOVID here. is Literally country inthe everyone and concrete priority. And maybe there’s a silver actually towards universal coverage health like looks most the urgent Working determinants on social aside, moving closer The impatiencethat manypeople understandably have There are lots, threeand main challengeswhen it A pretty topical question given that President the spoke Photo courtesy of Dr. Schmidt Penn Bioethics Journal Volume XVI, Issue I 9 A Conversation with Dr. Harald Schmidt Harald Dr. with A Conversation One way where it shows is probably my take on how how take on my probably is shows it where way One You raised another really important point here, which is here, point important really raised another You

we celebrate heroism here. Don’t get me wrong, there are, are, there wrong, me get Don’t here. heroism celebrate we it— of also outside in healthcare—and people of a lot indeed, them endlessly, admire I things. truly heroic doing whoare all the spirit, can-do in the American a lot I admire and this. But through get to and rise the to challenge, to appeals safety European to alien benchmarked resident a humble as in all swimmingly everything of that going is (not nets how by aback taken just also I am often course!), of Europe, local governments or evenlocal individual or physicians? governments basic liberties social and around the issues though even that couldn’t vaccines or ventilators arise in rationing that justice national uniform binding have don’t glaring, we bemore individual to up completely is rationing Ventilator guidelines. other or state on draw not may or who may, hospitals, flu a for guidelines draft do have we vaccines, For guidance. this will like something be adapted. hopefully, and pandemic, will decide who gets states like looks again it in practice, But situation. bizarre a quite really it’s the stakes, Given what. a makes it aside, transparency and Social leadership, justice, theserules the be have practical set to sense me of at to lot really don’t you on, everything else going With level. national thein hope borders state cross to people incentivize to want a scarce accessing of their chances increase could that that resource. unique. experience I think has been your Harald, pretty in the UK, research done you’ve German, but are You think do this sort you How US. in the you’re now and view has colored background your different of how on see Do you COVID-19? certain approaching are countries why? if so, and, others than better faring countries keeping society functioning, which ones are super spreaders, spreaders, super are society whichones functioning, keeping how example, For different. that’s ventilators, For so on. and vaccines, For differ. can workers essential think about you they clear it’s others, with they have the contacts because of less is priority ventilators, for But be prioritized. should do others, as Pennsylvania, and Michigan like States clear. do. all states not But workers. healthcare front-line prioritize not is impact COVID’s Given doesn’t. York New example, For health workers, enough have not to fear must we that such the health care risk of recognition some or reciprocity York New that But them priority. giving drives take, workers see these risks—but they mean don’t thisdo doesn’t doesn’t deserving them more makes that something this isn’t that just which the risks to trivial the extent assess to not it’s (plus, those to of or nurses, those to of take relate physicians that workers, transport public or workers, check-out supermarket then bewho equally deserving). might should be theseWho crafting ethicalto guidelines allocate like vaccines? be resources Should it the federal and level, be should the lower like it or on state government I don’t think the ethical principles are different at all. But But at all. different are think the ethical principles I don’t

When it comes to the general population (as opposed to opposed (as population the general to comes it When My take on who should get priority for vaccines is vaccines for priority get who should take on My about epidemiology, which people or groups are essential for for essential are groups or which people epidemiology, about about vaccines that might warrant some sort of a different sort some a different might of warrant vaccines that about allocation? require and facts differ can health care-related the medical or need think to a lot you in vaccines, So, close consideration. Thinking the about ethical and frameworksguidelines are think use, do the underlying we principles you that or tests, allocatingventilators, we’re when for different guide to vaccines? principles the same be Should we using special something allocation think do there’s that you or generations, it’s critical to avoid a Tuskegee-like impact—and impact—and a Tuskegee-like critical avoid to it’s generations, in disparities concerning the extremely again note I’ll just months. seen in recent we’ve that deaths and hospitalizations can’t social you about justice, trust and about care if you So, a level everyone starts from pretending by vaccines allocate field. playing the feeling of being passed over in healthcare encounters is encounters in healthcare being passed over of the feeling Vaccines African Americans. especially, for, one a common it If value. as symbolic well as health benefits, major have races in across discrepancies huge have we that out turns be could hard the social vaccines, damage accessing justice will define that COVID-19 like something With fathom. to that’s the epidemiological side of things. The economic The economic things. side of the epidemiological that’s are ones who the are off the worse as related, closely is one working engineers losses. job The software by hit hardest a out it sitting fine, will do just now Florida from remotely to attention pay to have really we ethically, And longer! bit in all structural this.plays racism that role thesignificant structural disadvantage, ongoing and Because historical of able to leave the city and simply can’t afford to not work. work. not to afford can’t simply and the city leave to able over health their prioritize to able are Sopeople off better both simultaneously), pursue (or opportunities income with contact more into come They less so. far off worse and situations, housing and commuting in their work, people the virus— in spreading role a larger alsowhich can play say, essential workers) what ticks both boxes is to prioritize prioritize to is both ticks boxes what workers) essential say, and ethical, for economic, groups, population off worse it When City. York in New I live reasons. epidemiological holiday to their went people off the better of a lot started, not poor were people of lots But out. things sit to homes about who gets vaccines arguably comes right after having a having after right comes arguably vaccines who gets about problem. a place. So the in that’s first vaccine is what – now and both the here consider to have we that the as well — as the spread controlling of in terms important societal implications. longer-term of infection make this all the more urgent. While theNIH has While urgent. thisall make infection the more of while now we and January, since vaccines on been working to responding in urgency stressing the administration have Speed, Warp Operation the initiative in naming COVID-19 towards anything have yet don’t we that concerning really it’s clarity importance, of terms In plan. allocation a vaccine 10 Penn Bioethics Journal Volume XVI, Issue I say much interms of how it should shift, either.Except to moving inplay balls at moment. the And I’m not sure Ican opinion? currentshift the state governance, health global in your of controversial the pandemic How the amid pandemic. will The World Organization’sHealth actions havebeen fundamental human connectedness and vulnerability. that many so other countries are better at appreciating our it means with to others be as you clap at one, it’s striking it recognizingcall right the to or health understanding what coverage and equitable support systems. social Whether you to affordtheircare, it just comesback to universal health toneed wonder ambulance person inthe ifthe able be will that moment we’re when at all one inclapping, but still also asked just now other whether countries dothings better, in hear analso Ambulance siren of middle inthe it. When you open the and G string resonate. see then Sometimes you as you when pluck, say, aGon aD-string of an instrument, is that you’re doing. Almost mechanical, same in the sense moving connection to others as you clap, holler, whatever it And that, underneath all there’s and basic really quite avery jubilantbeing for a moment. Whatever you Rorschach in. essentialthe workers. But there’s defiance. also Anger. Just manyhas so differentthings going on. Yes, we arethanking with Why this. are we doing What’s this? happening here? It just to figure people. night Every out Itry what is going on silhouettes. No white people, brown people, black people, more20 times people than you And see. you mostly just see and a bit that sense in the freaky it sounds as if there are about clapping thing going on here night. It’s at every seven loud for outrage here? lambs sent being to slaughter—did Imention there is aplace as Anna rightly puts it, many workers health feel more like planning. But to need wepay also attention that, to fact the fails to protect through needs basic their appropriate heroic for going to work inasetting where government the excellent piece Boston inthe about Globe Yes, this. nurses are appeals to heroism. My colleague Anna Wexler wrote an heroic efforts necessary. pay alot of attention to underlying the structures that make and celebrate individuals’ against deeds We odds. the to need other scenes every disaster final in the of Hollywood movie, slow clap Tom the of care health Cruises into stardom like aroundrally flag. the Butthe end herecan’t thatbe we just how is this hard, and that of intimes crisis it’s important to outrage, but relentlessly focused, constructive outrage. Iget conditionsthe that Notsurfaces. Covid-19 blind-rage style but there has aplace to for—frankly—outrage also be at are just for taken granted. Yes, we should celebrate heroes, much conditions the that heroic make these necessary deeds A Conversation with Dr. Harald Schmidt How shift it will it, I have Thereno idea. are a lotof Finally, Imentioned Ilive inNew York City. We have this A related point is expectations the that are with raised far more important lessons to me to seem come from seeing omitted could actions reasonably they have But taken. the toand need include these holding leadersaccountable for pandemics.with new So, there are many process lessons, many such things before, to again and need dothem will that. is unprecedented, While scale the had we to also do implement distancing, testing, social contact tracing, and all how to develop treatments and vaccines, how to allocate PPE, directly COVID-related. We had to figure out infection rates, you lessons theworld learn? think should some key When we emerge what from are theCOVID-19 pandemic, function. WHO,the instead of working constructively to improve its a national level alone is as naïve as it is to cut funding for don’tviruses borders. respect at them to tackle So, trying national level. As is oftensaid, and as we’ve just experienced, is an urgent for need governance health global at supra- the say that clear what is that seem does COVID shows us there differences often tracking income and racial groups. in cities like New York or Chicago of up to 30years, with these countries on planet, the we have differences inlife expectancy groups.racial It’s just outrageous that inone of richest the causes,the and attention pay particular to differences across factors: we to beyond need look causes, the to causes the of worse offpeople are less healthybecause risk of higher on We agrand scale. just can’t go on and on to lament that science, and politics isis nothing asocial more than medicine ishealth Rudolf Virchow, made point who the that medicine justice implications. One of my heroes personal inpublic And third, and closely related, also are broader the social genuine engagement determinants with social the of health. andhealth place is just as and critical, that requires robust and lessonsthe that COVID is revealing about connection the of lost insurance health with jobs. Secondly, their understanding doesn’t break down way the it didhere for many people who insurance,health with asystem that, among other things, there’s importance the of andmeaningful affordable universal areunequally both distributed US.So, inthe number one, intricate connection andhealth between wealth, and how COVID-19 as aheuristic. There seem to be two types twoTherebe types of lessons.seem to The first is one What COVID-19 has made irrefutably clear is the Penn Bioethics Journal Volume XVI, Issue I 11 , Socrates hypothesized the state of death death of the state hypothesized Socrates , Apology Greek philosophers typically offered views in favor views in favor offered typically philosophers Greek of the senses to achieve pleasure. While Epicurus based his Epicurus While pleasure. the senses achieve to of Socrates pleasure, of acquisition and goals life on argument purview his societal from death of and utility. life analyzed Plato’s In sleep”) (a “dreamless consciousness of a cessation either as judges” with “just afterlife impartial in an participation as or necessary for palliative care and euthanasia may not have have not may euthanasia and care necessarypalliative for the Greeks but been fully in Classical developed antiquity, their of the limitations embrace still to had Romans and the for to care a way find the time and at medical knowledge stemming of death, conceptualizations unique Their dying. greatly religion, and in philosophy ideas rooted diverse from would that medicalof strategies development the influenced and care to palliative predecessors notable be the first euthanasia. Death of Conceptions Cultural I. Greco-Roman philosophers These death. about fears public assuaging of experience and a “bad” not was itself death that agreed this sentiment. explain to consolations unique extended the soul, of believed in the transmigration Pythagoras some with a set point to end death, the body at from released (Bradley et personal identity of preservation for potential also the soul left believed the body that 2012). Epicurus al. of being state defined the explicitly more he but death, at pleasure nor pain involving neither us,” to dead “nothing as the true cited vice of (Bradley 2012). Epicureans et al. the which detracted pain, as from overall life of and dying ideals His in their perspective: life pleasure. goodchief of thesocial life to of benefits sensitivity a greater embraced stimulation a greater and etc.) friendships, (relationships, active euthanasia (direct administration of lethal drugs) of administration (direct euthanasia active life-sustaining of (withdrawal euthanasia passive or medical knowledge relevant and ideals The treatment).

Medicine has long averted a thorough and transparent transparent and a thorough averted long has Medicine From the ambitious Hippocratics to the highly- to Hippocratics the ambitious From medications can manage. Physicians throughout history throughout Physicians manage. can medications patients allow to euthanasia to resorted controversially have use either may practitioners they Such die. choose to how any time of diagnosis as it is more of a style of healthcare. The healthcare. a style of of more is it as diagnosis time of any life a patient’s of the end close to care palliative of prominence However, be understated. still cannot hospices like in places terminal pain, of alleviation an promises while care palliative overwhelming more far pain endure likely could patients pain-relief other or morphine dose non-lethal of any than has always been a prominent consideration in the field. in the field. consideration been a prominent always has been the most in modern have medicine approaches Two care palliative cultures: across care end-of-life to relevant pain of the alleviation entails care Palliative euthanasia. and occurs, while naturally death until symptoms other and curtail to death further suffering. and pain hastens euthanasia at care actually palliative practice may physicians Modern that would retract the gift of life from anyone; nobody, nobody, anyone; of life from the retract gift would that from be spared would social morality, of or class regardless a mere transcending Far Ages”). through (“Death clutches its a sociocultural is death construct clinical pronouncement, centuries. for life perspective on humanity’s shaped has that care end-of-life but death, dialogue about physician-patient had to grapple with the eventuality of death regardless. Some regardless. death of the eventuality with grapple to had merely viewed as Egyptians death the ancient like cultures a serene of the potential by consoled the journey, a part of such Others, After Death”). (“Life experience in the afterlife of reality faced a harsher societiesas Europe, in Medieval plague. the bubonic of outbreaks during death indiscriminate to be a constant proved social “Black Death” This personified specialized physicians of the modern world, confronting confronting the modern of world, specialized physicians conundrum been age-old has an death of theimplications present even may very death its By definition, in medicine. While the purpose medicine. of of the veryas itself antithesis have civilizations hesitation, of be a source thus may thetopic to the curative purpose of medicine and has thus not reached a true level of transparency. Nevertheless, since death is a is death since Nevertheless, transparency. a true of reached level not thus has purpose and medicine of the curative to formal first The has. medicine the of practice as long as for existed have processes these decision-making societal constant, Classical world in the ancient materialized euthanasia, and care palliative of the analogs as care, end-of-life of precursors the first for a framework formed philosophy and laws, medicine, A synergy Hippocratic of Romans. and the Greeks of these very that we find institutions further tabooed Through investigation, topic. a previously of considerations public considerations. end-of-life on stillmodern left a legacydiscourse influences that have The advent of novel medical technology such as CRISPR-Cas9 gene therapies has emboldened the resolve of medicine of resolve the emboldened has gene therapies medical as CRISPR-Cas9 technology such novel of advent The not has day that process, the aging reverse to be able might we day one that hopes the fanatic Despite life. prolong to to having binary as ideas, life Our with death society death. views and mostly life remains: reality harsh one and arrived from the transition of the precipice at right happens what However, death. inevitable an the fullest to before be enjoyed quality the to ensure how of deciding stigmatized task often but face a paramount, ones loved and Physicians death? to life antithesis as the understandably) seemcan (and care end-of-life Yet, around dialoguethe final days. in a patient’s life of ShaanBhandarkar* *Shaan Bhandarkar is a sophomore at Yale University studying Psychology and Medical History. He can be reached at at be can reached He History. Medical and Psychology studying University Yale at a sophomore is Bhandarkar *Shaan [email protected].

Confronting Death: End-Of-Life Care in Classical Care End-Of-Life Death: Confronting Antiquity Article 12 Penn Bioethics Journal Volume XVI, Issue I Horace his famous scribed “carpe diem” day) the (seize line present it.” to experience In Poem 11of his Natura death. Lucretius, Epicurean, as atrue wrote inhis and status socioeconomic affectedculturalperceptions of source for additional insight into how factors like race Romans later inherited. on how to live best life before death, asentiment that the makesthat sense Greek philosophers and public the focused avoiding death presented itself as acultural taboo. It then of For healing. or of mortal alike, beings idea the immortal to resurrect with he hiswhen tried dead divine the powers vaporized Asclepius Zeus tree, while with alightning bolt gods sentenced Sisyphus to Tartarus for tying Hades to a chastised ambitionsmythology strictly to cheat death. The satisfaction during life to hold on to. Furthermore, Greek would only have lone this consolation of pleasure and self- continued. Clearly, Achilles and other the souls of dead the motivationfurther to strive for pleasure long so as lives their well have interpreted Epicurean inthe idea this as view outlookthis may Greek the pessimistic, seem public may achievements and absolutely sacrifices meaningless. While Underworld.the The Underworld rendered all of Achilles’s tolead areduction of person to the an insubstantial shade of pursuitsthe of materialistic pleasures could still and glory overall arc story of Achilles showed how with alife filled inevitability of death. 11of In Homer’s Book Greek religion depicted and overall the mythology further due to popular fears of death, inany era. care decisions oftentranscend philosophy and objectivity institutionsmodern of advance directives, active end-of-life our actions. Regardless of various their consolations and life as opposed to permitting inevitable death to dictate Epicurus, and Pythagoras delineated all on afocus living faith of promoting patient autonomy and comfort. Socrates, clamoredboth for such “advance directives” good inthe end-of-life care. community The medical patientsand have physicians gridlock frustrates ethical the mustfurther facein (Novotney exactly wishes observed 2010).This elasticity 10% of that wanted surveyors asserted they end-of-life their In a2005study published in around apatient’s capacity to complicates decide matters. designate aproxy for resuscitation decisions, ambiguity the patientthe insuch of cases death anxiety. Even wills when Physicians commonly question mental the competency of faceimpendingminds they when death inan emergency. (Novotney 2010). Patients change could with also wills their preferences medical their of incases incapacitation 25% of Americans have created living to communicate wills is asensitive matter that not does evoke objectivity. Only not fear death. reasonphilosophers, to Greek the every people possessed (Harten 2011).From persuasion the of eminent these from death the anxiety that paralyzed his fellow Greeks accepted his death as ablessing and declared his freedom impending death upon sentenced being by ajury, Socrates etal. 2012).With(Bradley Confronting Death The heavy stratification of societyRoman a offers Juxtaposed with influence the of insights,philosophical However, despite our attempts to defer to reason, death that “it is irrational to fear death not as we will be Apology The Gerontologist The ’s setting of Socrates’s own Odes Odyssey , fewer than De Rerum De Book 1, 1, Book , the the , their dyingtheir enemies and compiled his own list of remedies that Greek physicians took an oath to never properly treat known anti-Hellene, Cato Elder, the would his son instruct elementfurther of tension. racial Reputed statesman and Roman families as physicians,served introduced which a majority of Greek Hippocratic doctors slaves being who skepticism merits inthe of medicine. This resulted the in (Michels Romans the 1955).Overall, displayed also far more provide aconsolation, at least more than medicine so could Romans clearly remembrance the believed of life could impoverished Romans. When grappling with death, the hundreds of acres, luxuries that would inaccessible be to his entire and will aspirations for his tombstone to span your mind!” At his lavish dinner, Trimalchio later revealed a doctor’s not for good anything except for aconsolation to doctors did away with him, or rather, his hadtime come, for mentioned passing the of and his friend that “too many Satyricon celebrationin this on status. socioeconomic based In the authors like Petronius have mocked inherent the disparities of celebrating life by enjoying present, the other Roman to our inability aguaranteed to see tomorrow. In idea this with an Epicurean of view makingmost the of today due holistic of palliative aspects care that are to practiced this II. Palliative Care: Pain Enemy istheReal strategies. would prove advantageous to be for future end-of-life care nevertheless forged with advances ahead inmedicine that counterparts,as modern their Greek and Roman healers parameters with conceptions of death and disparities incare a discriminatory foregoing of curative care. Facing similar given thatespecially hospice care conflated could be with past injustices like Tuskegee exacerbates situation, this 2013). Mistrust American inthe healthcare system for and quality of care in minority neighborhoods (Johnson significant discrepancies inaccess to opioid-based medicines backgrounds. Unfortunately, researchers have cited more accessible to patients and of racial socioeconomic all patients, current advocates to make are hospice trying care for dying patients. To match diverse the culturalof beliefs care now commonly incorporates spiritual counseling comfortthe and emotional of needs patient. the Hospice from ancient Greek philosophical of ideas attending to day.this In other end-of-life cases, care commonly draws 2017), areality community medical the is considering to influence on end-of-lifecare decisions al. et (Chakraborty in medicine. However, religious have still beliefs astrong considerationstheological could compromise objectivity 2010). In Flexner argued fact, that philosophical and that religion should have no place in medicine (Puchalski document development in the of medicine, dictated modern medicine today. The 1910 Flexner a report, formative for citizens, religion bearsacomplicated relationship with proved unanimous to be inits day-to-day implications end-of-lifedo persist inmodern care. While Greek religion for his family members. Greek spiritual exemplified healing methods the Religious, and racial, disparities socioeconomic still , Petronius’s pretentious character of Trimalchio Penn Bioethics Journal Volume XVI, Issue I 13 treatise treatise treatise treatise Dreams Decorum Confronting Death Confronting The Science of Medicine Medicine of Science The treatise, Hippocrates pointed pointed Hippocrates treatise, and Decorum treatise of the Hippocratic corpus prioritizes the prioritizes corpus the Hippocratic of treatise While both the Hippocratics and Asclepian priest priest Asclepian and both the Hippocratics While In addition to the spiritual precedents for palliative care, care, palliative for precedents the spiritual to addition In Airs, Waters, and Places and Waters, Airs, physicians also used prognoses as prophylactics against against also prophylactics as used prognoses physicians their care, under die probably would that patients treating The their reputation. damaging prevent to patients trust their healthy not to even advised physicians with cases, in case cooperate in non-terminal they did not misattributed was the blame and instructions the physician’s the physician-priests, the vaunted for As the physician. to anyone Cos and forbade Epidaurus at Asclepius of temples a reinforcing again the temple, of in the vicinity dying from presence the inevitable acknowledging taboo cultural around mental or emotional output of their patients to develop develop to their patients of output emotional or mental Hippocratics’ The regimens. treatment diagnosesbetter or physical dietary for and regimens physical of proposition an to athletes, also points physical especiallyfor benefits, modern physical and regimens betweenanalog Hippocratic the sync to still attempts care end-of-life Modern therapy. death. impending to the patient attune to mind body and Galen relief, clinical pain to analog ancient an to Alluding in transdermal treatment opioid-based an alsomentioned inscriptum,” Olympionico the “Fuscum commentaries, his athletes for pain used relieve to the Hippocratics that is transdermal administration 2006). While et al. (Bartels palliative in terminal patients, relief pain quick ideal for not opioid-based subcutaneous still use strong physicians care physician 2020). In et al. (Harman morphine like treatments terminal sedation offer to opt physicians (PAD), aid-in-dying in their painlessly away pass may patients so that opioids with repurposed the medical have physicians so, doing In sleep. of psychosocial event the delicate to the Greeks of insights dying. active palliative to relevant strategies treatment healersforwarded being used in end- strategies such the frequency of care, authors Hippocratic The the dubious. time is at care of-life the treatises of prognosis accurate an as a prognosis, thevalued idea of Hippocratic However, the physician. to credibility provided patients through relief of pain, aching muscles, and stiff limbs limbs stiff and muscles, aching pain, of relief through patients has therapy physical on emphasis Ancient (“Hydrotherapy”). both healthcare, aspectcurrent of a major into also translated purposes. palliative and preventative for medical insights relevant alsocontributed the Hippocratics methods. healing The be Asclepian to with used in union Decorum cost. whatever at the patient of cooperation and comfort the that suggested the author this end, to Unfortunately, attention, and solicitude with [the patient] “console physician condition,” present or future his of nothing revealing in disclosing face physicians turmoil the emotional mirroring the Hippocratics this hesitation, terminal diagnoses. Despite between the patient harmony natural a creating emphasized In comfort. ensure to environment their surrounding and the discomfort for catalysts as changes climate seasonalto and 1983). The et al. (Hippocrates sickness and claiming by extent an further to well-being legitimized mental physiological on influence some retain processes mental that body” healthy mind, in the believers “healthy As conditions. the of became vigilant thus doctors Hippocratic mantra, . Two thermae while the abaton abaton of the theater complex, further implicating the further implicating complex, the theater of skene Modern hospices have also adopted these approaches these approaches also adopted have hospices Modern While Apellas noted his vision of Asclepius to be to the Asclepius of vision his noted Apellas While 1997). Hydrotherapy claims an even richer history of use history of even richer an claims 1997). Hydrotherapy Roosevelt Delano Franklin in modern President medicine. his polio after believer in hydrotherapy became a staunch center relief pain a hydrotherapy created and diagnosis Georgia. Hospice Springs, Well in polio patients young for assisting in benefits its for hydrotherapy adopted has care patients, hospices aim to help patients achieve self- achieve patients help to aim hospices patients, 2014). (Richardson in life meaning find and actualization art and that suggests modulation pain into research Hospice their to attention be the can patient’s used divert to music themes life with music art and ways, profound more In pain. be to at and relief pain in their own invest to patients enable Higachi and (Trauger-Querry death peace impending with of Ascelpius’s legitimacy into the minds of the visitors, some some the visitors, of the minds legitimacy into Ascelpius’s of the time in the a belief at to even pointed have historians tragedies. watching of potential cathartic therapy music/art and hydrotherapy, therapy, physical of as healing. Just of ambience positive a similarly setto up Asclepian for the experience healing transcendental was near the further is that known It the theater. of relevance therapeutic the with coincided Epidaurus the peak at medical tourism of Menander, and Euripides, Sophocles, like dramatists rise of his and Ascelpius of mentions included whom all of three 1978). (Robinson in their scripts ailment heal to any ability the idea further to implant attempt an this indicates While temperature and pressure of water for bathing patients patients bathing for water of pressure and temperature methods which hydrotherapy, of form early some suggest be public furtherwould in the developed Roman a theater Epidaurus, In Greece”). in Ancient Healing (“Faith the from a mile away of a quarter stood only excavated were Hygeia and Asclepius resembling statues the theatricality and apparent divinity of these methods. of divinity apparent the and theatricality the experiencecrux healing a (when of the god suggested experience overall health), his his regain to him for regimen A nearby there. gymnasium finish did not Epidaurus at regimen physical whatever follow to patients allowed the of Alterations prescribed. have may Asclepius temple at first. The patient would first have to be cleansed and to have be cleansed first would patient The first. at temple Asclepian Then, the well. in a sacred bathed ceremoniously the at a ritual with proceed would priests sleepthe in crowded to thepatients enticed incense fumesof their dreams arrival into Asclepius’s await eagerly and temple ofuse additional The Greece”). in Ancient Healing (“Faith bolstered this event during the physician-priests by snakes spectacle of anatomical votives spread out over the walls over out spread votives spectacle anatomical of of Temple of the foot at the clustered offerings other and the to serving a testament as visitors, greet would Asclepius Healing the experience of (“Faith success divinely-ordained a tablet of the account to according Yet, Greece”). in Ancient at Apellas Julius Marcus as known a patient to belonging the to be fully not admitted would the patient Epidaurus, day. Striving for a more comfortable patient experience, patient comfortable a more for Striving day. encourage modern hospices at care palliative of proponents physical psychosocial support, support, spiritual for outlets the healing methods. Similarly, other among therapy, advertised Greece ancient throughout Asclepius of temples experience. A visual a life-changing as the process healing 14 Penn Bioethics Journal Volume XVI, Issue I in ofwith cases insurmountable pain. Aeschylus’s character However, most authors and philosophers didempathize ofbetrayal gods the and disturbance natural inthe order. Greeks condemned suicide inmost circumstances as a allusions point to atolerance of practice. the Generally, about euthanasia, but various and literary philosophical III. Euthanasia: to Death” Right the“Good falloutthe of aloved one’s passing. and support that Greek and Roman from families needed medicine as afield of objectivity by offering the connection end-of-life care pushes boundaries the of Flexner’s vision of bereavement far beyond apatient’s services death. Current Hospiceservices. care treats also families as units and offers and commonly facilitate accomodations for funeral In era,hospices modern the prioritize patient autonomy unique of needs apatient and family their inend-of-life care. thataspect was missing in ancient medicine, expressing the time.the Greek and Roman culture unravelled human the distrust for field’s the ability to helpsensitive ina manner at objectivity of medicine fromrites final probably due to For Greeks the both and Romans, public the divorced the preparation the lead then for of body the Underworld. the sameThis relative eyes thewouldand the deceased close of kiss dying their loved one to “catch soul” their (Smith 1870). at body the death and some Romans would relatives elect to days. final The ( the Romans soul believed also moments and gather around dying their loved ones intheir Similar to Greeks, the Roman families would share tender themselvesto trust end-of-life to undertake preparations. probably contributed to Roman families only able being atmosphere distrust towards of societal medicine also and regimens than on palliative functions. The overall likely corresponded to acultural emphasis on hygiene adapted for Roman baths. Yet, Roman hydrotherapy more thatsprings ideas all for as beneficial were diseases, skin (inaccordance body the with humoral and sulfurous theory) hot water springs as key to balancing natural the fluids of in “restorative bathing” and many of works their proposed for sharedexperience Romans. social Hippocratics believed as astaple fordid serve public care health and as a also citizens.terminally-ill The publicbaths ( far more resources to aiding injured the as opposedto frequently on battlefield, the theand government allocated medicine. Roman medicine found its application far more palliative care didnot feature as prominently inRoman havethrough body thethe left mouth. once of ( soul the disposal bodies, the 1870). Greek families would individually then arrange for prayers to Hades for safe passage Underworld inthe (Smith to afamily member, heartfelt farewells to loved ones, and “settle affairs,” their which included entrustingtheir children According to Socrates, Greeks about to die would have to in presiding overdays final the their of dying relatives. Greece, families of patients the great thus reserved autonomy of death explicitly environment inthe of In healing. Ancient Confronting Death Prometheus Bound Prometheus The ancient Greeks did not dictate any specific laws Healing temple practices and other precursors to claimed that “it was better to die psyche thermae ) was thought to anima ), however, ) left physicians were not obligated to continue treatment for an to anybodydrug requested who it, Hippocratic the while oath forbade provision of adeadly euthanizedthe citizens buriedinunmarked be graves. Even such that cases presiding the physicians put be to death and (Papadimitriou etal. 2007).In directly administering poisons to patients wishing to die in other of parts happy perpetually to be and from free pain. At same the time, argued that should ajust allow society an individual citizen state.the Using argument ajustice-based in euthanasia of became less to if they use themselves and to citizens were allowed (and evenobligated) to undertake Plato, of view utility, Socratic the levying that believed disparities inseparating euthanasia from murder or suicide. dramatists. Philosophical insights reflect such further physician aid-in-dying) to seems incite hesitation inthese of an accomplice to active euthanasia (similar to modern murder (Papadimitriou et al. 2007). The more active role father Heracles dieto himfrom free pain as equivalent to at time, the portrayed Hyllus’s consideration of helping his anguish.” But, Sophocles, aknown religious conservative once and for than to all drag out my lingering days in autonomy and rejections of intervention medical like with repercussions. However, physicians patient respect also to patients, terminal drug lethal due to fears of professional opinions about physician aid-in-dying, aprescription of a Modern physicians often shyalso awayfrombold asserting an unwritten and privately accepted way to to die. choose to dieimplies that poisoning hemlock could have been Hippocrates’s subtle suggestions of honoring patients’ wishes Despite publicly the expressed hesitations, Plato’s and rather than individual volition, with rare private exceptions. on acceptability justifying euthanasia on societal based people. Greco-Roman alot placed of societies emphasis suicide or shame face the else of and his supervisors his situation,this pressuring also while to soldier the commit wouldgrant self-sacrifice honorsoldier in to a glory and an enemy on battlefield. the The Homeric trope of heroic soldiers to consume poison hemlock ifeversurrounded by Romansthe and Greek the city-states encouraged both in most as of betrayal cases commonwealth. the However, of case the soldiers, Roman the scoffed military at euthanasia applied to Senate the and received approval (Hayes 2008).In werethey aslave, soldier, or aperpetrator of acapital crime) by poisoning hemlock as long as ailing the citizen (unless Libri overwhelming pain. According in to Livy existence, derived from whether shameful allegations or death by poisoning hemlock insuch of cases intolerable shame of his allegations with dignity. The Greeks accepted executioner as apitiful consolation for himto the escape Athenian youth.Socrates named Theas his jury own as agent the of Socrates’s execution for “corrupting” the justicethe system. The hemlock prescribed Athenian jury Greek public about knew poison hemlock and its in use acceptable outactual of methods euthanasia, carrying the euthanasia (Papadimitriou etal. 2007). andincurable could disease have thus engaged inpassive While most Greek writers never explicitly discussed , the Romans, the explicitly accepted passive euthanasia Laws , Plato didnot condone physicians Phaedo The Art The , Plato in evenadvised Ab Urbe Condita suggested that Laws IV , Plato Plato , Penn Bioethics Journal Volume XVI, Issue I 15 Confronting Death Confronting

modified 1870. 29, 2019. November Hastings Center, The Conditions.” Psychiatric Symptom and Pain Control for Therapy Music Artthe Focus: and 12, 1997. April & Francis, Taylor Care.” in Hospice Management 57 (2011): 165-83. Journal Classical 41C7)." The Cambridge Overview. Accessed December 8, 2019. Accessed Overview. (1898): 1606-07. 2008. Group, & Francis Press/Taylor CRC Raton: Haven New Yale UpToDate. of Life.” and Days Hours The Last Care: 2020. April System, Health UK, 1983. 451. Penguin Vol. writings. Hippocratic Pakistan Turkey." from example An medical education: during 5 (2017): 1177. medical sciencesjournal of 33, no. 16,11 (2013): 1329-34. vol. medicine palliative of Journal 86 (1955): Philological the Association American of Proceedings 160-79. October 2010. Association, Psychological American Psychology. Kyriaki and Papadimitriou, J. Dimitris Polimeropoulos, Vassilis of Viewpoint in Antiquity: Suicide and "Euthanasia Papacostas. J. Society the Royal of of Journal Philosophers." and the Dramatists 1 (2007): 25-28. 100, no. Medicine Prev J Cancer Pac Asian do." we what and know don’t we what know, 1 (2010): 45-9. Suppl 11, no. 3 (2014): 150-159. 3, no. Medicine Palliative 4 (1978): 530-42. no. 30, Journal Theatre Greek Pain Remedy for Athletes." PAIN Practice 6, no. 3 (2006): Practice 6, no. PAIN Athletes." for Remedy Pain Greek December 6, 2019. 212-18. Accessed of Handbook Oxford Review Death." The of of Philosophy Last Online. modified Handbooks Oxford Death. of Philosophy December 2012. December 5, 2019. Accessed Religion. religions.” world major in the five issues end-of-life major about 15,5 (2017): 609-622. vol. care & supportive Palliative Smith, William. "Asclepius." Asclepius | Encyclopedia Mythica. Last Encyclopedia | Mythica. Asclepius "Asclepius." William. Smith, to Death Physician-Assisted Bonnie. “The Steinbock, Expanding for Case “Balancing Haghighi. Ryan Katherine and Barbara, Trauger-Querry, 40C5– Apology (Plato, Death and Life on "Socrates Alice. Harten, Van "Faith-Healing in Ancient Greece." The British Medical Journal 1, no. 1955 no. 1, Journal Medical British The Greece." in Ancient "Faith-Healing 5th Boca ed. Toxicology. of Methods and Principles Wallace. A. Hayes, “Palliative M Walling. Anne and Bailey, M, Amos Stephanie Harman, , 2020. Hospice Children's Rainbows “Hydrotherapy.” eds. Mann, W. N. and Chadwick, John Geoffrey Ernest Richard, Lloyd, in empathy Sahin. "Changes Kursat Mustafa Artiran, and Fusun Igde, care.” in palliative ethnic S. “Racial disparities and Kimberly Johnson, and Transactions Poets." Two and "Death Kirsopp. Agnes Michels, on Monitor Needs Resuscitation.” Will “The Living Amy. Novotney, S. Mavrantonis, Skiadas, Constantinos Panayiotis D., John Papadimitriou, we what spirituality: and medicine "Religion, Christina Maria. Puchalski, of Annals care." palliative and religion "Spirituality, Patrice. Richardson, Educational Theatre." and the Asklepius of Cult Alice M. "The Robinson, the patient’s social narrative, essentially defined by by their defined essentially social narrative, thepatient’s to given date an expiration by confined and pathologies their favor seems bodies. medicine to Flexnerian Modern empathetic less become that depersonalized practitioners of display daily to in their education tolerant more and adapt needs to Sahin 2017). Medicine and (Igde morbidity for death of tackle psychosocialto challenges the unique the “care” hopefully put can We their families. and patients personal and the humanistic adopting by healthcare into back considerations future our Classical into healing of attributes care. end-of-life of References Ancient "An Harrison. P. Adrian and Swaddling, EliseBartels, M., Judith "Introduction: Johannson. Jens and Feldman, Ben, Fred Bradley, Egyptian Civilization, Death." after "Life History. of Museum Canadian beliefs religious review of systematic “A et al. Rajshekhar Chakraborty, Brief Ages: through Death Ages." through "Death Encyclopedia.com. In other words, physicians have become more cognizant cognizant more become have physicians words, other In Palliative care and euthanasia persist in current medicine in current persist euthanasia and care Palliative misconceptions and novel insights into palliative care and and care palliative into insights novel and misconceptions widely are healing Greek of methods holistic The euthanasia. the like countries many and these days, used in hospices and volition of arguments Platonian using are Netherlands treats medicine Current legal euthanasia. regulate to justice for regard less with symptoms of a list as terminalpatients the medical community has not achieved transparent and and transparent achieved not has the medical community in end- specialization with death of communication sensitive inherited have centers such other and Hospices care. of-life not “it’s that claiming of spirit Epicurean an with this mission and the Greeks While live.” you how but die, you how about truly to trust intervene enough medicine did not Romans both their learn from can we death, impending in cases of gene therapies, medicine will continue to bear limitations. bear to limitations. will medicine continue therapies, gene good in certain than pain inflictmore can Medicine palliative death, inevitable the idea of With circumstances. but in alleviating pain, stance active taking an represents care between the timeline for arbiter being an the physician with accountability this same transfers Euthanasia death. and life both cases, In their family. or the free will theto patient of of-life care today are more urgent than philosophical; real philosophical; than urgent more are today care of-life given be answered must these questions and stake at are lives knowledge. current our of the extent just field, in the overall their knowledge of the limitations of with. terms to come to had physicians the Hippocratic as breakthrough of witnessed the advent has era that in an Even questionable state of consciousness actually qualifiedas consciousness of state questionable of definition The death. brain whole clinical, as or living be could circulation or activity brain of a cessation as death which could in neuroscience, developments to due evolving However, in the future. question into call judgements such in end- make must physicians that decisions the day-to-day her husband and her parents, regarding withdrawal of her of withdrawal regarding parents, her and husband her expanded state, vegetative persistent her to due tube feeding Schiavo’s apply. could euthanasia casesthe scope where of members in which family case the highlighted ambiguity overall as well as in decision-making, be the surrogate would the case, to Especially relevant accountability. of questions whether Schiavo’s on agree not could the medical community the ethical core of what it meant to be a doctor. Kevorkian Kevorkian be to a doctor. meant it what of the ethical core claiming movement, the initial “right-to-die” launched their death of control much as retain should patients that to argument used a Platonian-like Kevorkian their life. as a patient preclude could rejecting euthanasia that claim in their end-of-life autonomy and happiness acheiving from between legaland the dispute Teri Schiavo of case The care. as the two most prominent features of end-of-life care, but with but care, end-of-life of features prominent most the two as in the early movements Right-to-die varying controversy. of the issue of the urgency century especially21st illuminated conviction chilling activism and Kevorkian’s Dr. euthanasia. struck all physicians of the duty constituted euthanasia that “do not resuscitate” orders. PAD is legal in nine US states and and states legal US is in nine PAD orders. resuscitate” not “do the public that surveys and show Columbia, the District of PAD in certain of the support use officials healthcare and 2019). (Steinbock suffering” “unrelenting cases of Echoes Modern Thoughts Final and IV. 16 Penn Bioethics Journal Volume XVI, Issue I Ethical Implications of Psychedelic Enhancement Article [email protected]. *Christina Stankey is a2019graduate of Yale University inMolecular, Cellular, and Developmental Biology. She reached can be at Christina Stankey*Christina issues such as violence, poverty, and climate change pose enhancement by pointing to grave the dangers which 2008, anumber of bioethicists have argued for moral recent years. After Thomas Douglas the coined term in of promoting harmony social has gained in traction Arguments for Psychedelic Moral Enhancement aim of human striving. insofar undercuts as use their process the both and the that psychedelics ought not for used to be enhancement implications of practice. this In paper, this argue I will to consider psychological the risks and philosophical endorsements of psychedelic enhancement often fail spiritual, and moral enhancement. However, enthusiastic have suggested of use the psychedelics for cognitive, traits (Griffiths 2006). some scholarsthese effects, With alterations tolead beneficial personality in and character induce neurogenesis, occasion mystical and experiences, carefully controlled conditions, psychedelics appear to therapeutic realm; instudies of healthy volunteers under disorders (Nichols extendbeyond 2016).Benefits the for addictionand anxiety, among other psychiatric psychotherapy has proven effective ahighly intervention has ended. Harnessing psychedelic-assisted effects, these connectivity that persist long afterthe psychedelic trip inducing formation of patterns new of activity and Psychedelic profoundly drugs alter functioning, neural akey to secretsof the unlocking drugs life.these growing extent, mainstream the culture –have proclaimed consciousness. Members of counterculture the –and, to a psychedelicsheralded as akey to secretsof the unlocking psychedelic. Members of scientific the community have Its name is lysergic aciddiethylamide (LSD), and it is a ofsense interconnectedness to others and to world. the influence creativity,transcendence, peace, and adeep ImplicationsEthical of Psychedelic Enhancement psychedelic moral enhancement is not compatible fully with agenuinely human anthropology. exclude undermines conditions them the that foster human flourishing and make moral choice meaningful. Therefore, such as physicality and relationality. As features these provide backdrop the of for and purpose moral development, to enhancement donot account for ways the psychedelic inwhich circumvents experience central features of human life, given to cooperation the addressnecessary necessary grave issues insociety. However, arguments for psychedelic moral disposition. Proponents of moral enhancement argue that it on is possible recent based evidence scientific and Psychedelic moral enhancement refers of to use the psychedelic guided to improve experience an individual’s moral The idea The idea of moral bioenhancement as a means There exists acompoundthat offers underthose its is biological in nature and hasthat biological (2) effects; bioenhancer worthy of name: the (1)that intervention the 2018). He instead provides three conditions for a of brain the and world the that humans navigate (Earp of behavior failing while to consider complexity the are unrealistic insofar propose as they to alter one aspect literature techniques of describes bioenhancement that scholar, Brian that Earp, much observes of current the cooperation to2008).One (Douglas remedy evils these world,to modern the and by noting for need the global psychiatry in the past leading inthe to twopsychiatry decades, aspate of hold of researchers fields inthe of neuroscience and little. Aresurgence of interest inpsychedelics has taken may regard enhancing the power of psychedelics as too anything, on current based scholarsevidence, scientific psychedelics can deliver promised the benefits. If and morally defensible means to improvement. personal similarly cited psychedelic as an experience efficacious scientists,Other philosophers, and popular writers have works with an individual’s rather will than superseding it. psychedelics to bolster human inaway goodness that thusEarp paints picture a powerful of promise the of into fabric the of an individual’s character 2018). (Earp bring insight deeper into human life and are integrated at moral improvement, facilitating that experiences psychedelics should treated be only as adjuncts to efforts individuals inproperly controlled settings, and (2)that are administered only to autonomous, consenting psychedelics inbioenhancement: (1)that psychedelics suppliesit. Earp two additional conditions for of use individuals evaluate world the and roles their within can transform experiences these ways the inwhich including psychedelics which those occasion, because make room for spiritually induced chemical experiences, cognitive enhancement” conditions 2018).These (Earp ofsort way, without simply collapsing into Ritalin-style ina“robust,acts sustained, flexible-across-contexts from interconnected ones; and (3)that intervention the interventionthe not does treat one capacity inisolation The question naturally whetheras to arises Penn Bioethics Journal Volume XVI, Issue I 17 The man who comes back through the Door in the in the Door the back through comes who man The who the man as the same will be never quite Wall happier will cocksure, less be wiser He but out. went in acknowledging humbled self-satisfied, less but understand to equipped better yet ignorance his systematic of things, to words of the relationship tries, which it Mystery the unfathomable to reasoning 1954) (Huxley comprehend. to vainly, forever Just as psychedelic drugs generate neurological neurological drugs generate psychedelic as Just Aldous Huxley writes in The Doors of Perception, of in The Doors writes Huxley Aldous and “resets” circuits of connectivity both pathological and and bothpathological connectivity of circuits “resets” and psychiatric some of cause the root treat which may normal, of the glimpse unfiltered an the mind grant and disorders functional resonance magnetic In 2018). (Pollan world psychedelics by induced the changes studies, imaging intense by those prompted from indistinguishable appear in a state seem the brain place and to meditation or prayer in which the default brain, a child’s of that resembling 2018). (Pollan developed incompletely is mode network drugs induce psychedelic theory that holds current Thus, imposed bythe default the filter removing by their effects horizon a broader to openness facilitating modenetwork, of reality. mimic those observed so that too in mystics, states in certain trips settings psychedelic on individuals may a encountering emphasize Some insight. mystical gain transcendent once at is their that trips during presence flooded was love, with awareness personal: “My and known I ever had peace anything and beyond beauty, a now Bill Richards, wrote be to imagined possible,” or psilocybin first his of researcher, psychedelic preeminent the 2018). Others describe vastness glimpsing (Pollan trip profound its while alsothe intuiting world of mystery and author The nature. providential and interconnectedness chooses psychedelic experience to reach the end of of the end experience reach chooses to psychedelic here relevant is Neurobiology enhancement. moral use. psychedelic the full of import in understanding ofthe activity altering These drugs by exert effects their interconnects nodes that of a web mode network, default mode default 2016). The (Nichols neural systems many paradigms into stimuli fit the brain helps network that experiences, such previous through established filtered indirectly, only each new experience perceived is role its 2018). With (Pollan the past the of sieve through network mode default the traffic, mental in directing to her allows and self-image a person’s construct helps (i.e., consciousness of dualities “fundamental understand vs. external)” internal vs. object and subject self vs. other, drugs reduce 2014). Psychedelic (Carhart-Harris the serotonin binding by activity mode network default cortex, in the cerebral 2A receptor 5-hydroxytryptamine that thought of patterns ingrained the deeply disrupting her and the world of understanding a person’s underpin this organizing 2014). With (Carhart-Harris in it place unleashed is neural activity of a torrent removed, principle Ethical Implications of Psychedelic Enhancement Psychedelic of Implications Ethical The object of psychedelic moral enhancement enhancement moral of psychedelic object The At its heart, this raises questions of object, end, and and object,end, of heart, questions this raises its At is, most simply, psychedelic experience, for a user a user experience, for psychedelic simply, most is, psychedelic enhancement, proposing that the conditions the conditions that proposing enhancement, psychedelic social undermine cohesion. distribution of PsychedelicThe Object: Experience daily lives to foster moral improvement. I will argue instead instead I will argue improvement. moral foster to lives daily the end experience) both and the object (psychedelic that suspect insofar prove this intervention of (enhancement) limitations human overcome to a desire theyas represent may these the good limitations that considering without of circumstances the I will address alsohold. briefly insofar as it promotes the cooperation necessary build the cooperation to promotes it as insofar to and relationships meaningful interpersonal more use of societal that and global or issues, pressing address occurs it as this purposeso long moral is for psychedelics to constructed in environments individuals in consenting their into be integrated may that insight gain users help chosen, the intention of this choice, and the conditions the conditions and this choice, of thechosen, intention a comprise together and chosen, is which it under action (CCC an the 1749). ethics of evaluate to framework electfor to that argue would of psychedelics Those in favor mindsetconducive a foster to is enhancement psychedelic desirable is this decision that ethically, behaving to of themselves and to evaluate information necessary for necessary for information evaluate to and themselves of kinder, become – to this promise With judgment. prudent is what to attuned more and free, intellectually more enhancement? psychedelic refuse – whosacred could act being to immediate the refer terms These circumstance. (MacLean 2011; Pokorney 2017; Kuypers 2016; Romano 2016; Romano 2017; Kuypers 2011; Pokorney (MacLean as act psychedelics that confirm 2010). These findings the drugs biochemical, nature by valid bioenhancers; than More capacities. human of range a broad augment thought of patterns support to appear psychedelics that, disposing by character moral of growth with consistent outside principles or identify individuals with their to users experiences can enhance social empathy and facilitate facilitate and social experiences enhance can empathy that openness, of trait in the personality increases lasting thinking style vital the divergent augment can ayahuasca patterns while solving decreasing problem creative to for thinking responsible convergent conventional of learning accelerate can LSD and that functionalfixedness, more than two thirds of participants ranked the single thesingle ranked participants of thirds two than more significant most their five psilocybin of one as session both and experiences, self-reports and spiritual lifetime the experience that suggested evaluations behavioral peace inner and compassion as such measures increased psilocybinthat indicated studies Further 2006). (Griffiths striking findings. In 2006, Roland Griffiths published a published Griffiths In 2006, Roland striking findings. psilocybinthat reliably could showing piece landmark volunteers, experiences in healthy “mystical-type” induce at awe described sense whom of extreme of an many in union and the world with one at themselves feeling later, months Six 2006). (Griffiths the transcendent with 18 Penn Bioethics Journal Volume XVI, Issue I interpersonal interactions for because purposes altruistic goal, is which to create individuals better able to engage in directly faceof inthe psychedelic moral enhancement’s research findings. in Cruel its irony,this outcome flies since it is widely reported, although rarely quantified in secrets of life (Pollanrisk 2018). This appears appreciable knowledgein the that have they gained insight into the from psychedelic trips with massively inflated egos, smug more outcome pernicious is that individuals often return of adevastating car crash. Amore common and perhaps even awholesome family road with it trip carries danger the risk for ends of pleasure, enjoyment, or purposes; cosmetic environments, and individuals often legitimately assume quite psychedelic when are small drugs incontrolled used reasoning is flawed insofarthe as chance this of outcome is that of maintaining (Nicholshealth 2016). However, this woulddrugs introduce risk for a benefitthat beyond goes unjustifiableuse for enhancementthe since purposes, psychedelics induce will long-term psychosis makes their may that be significant, the though rare, hazardthat forshould used be enhancement One response purposes. question the destructive, remains as to they whether (Nichols 2016).Yet are drugs the not while physically not addictive, and have multiple therapeutic applications haveincorrect: drugs the aremarkably low toxicity, are (Pollan use medical 2018).This rationalescientifically is considereddrugs to have abuse high potential and no anduse counterculture, the with them classifying other and self-proclaimed the connection psychedelic between Substances Act inreaction to well-publicized trips bad declared psychedelics under 1970Controlled the illegal present public inthe mind; legislators United inthe States and relationships. their This concern has longbeen negative psychological alterations that harm individuals made inarguments for form this of moral enhancement. psychedelic and use upon examining presuppositions the growth becomes apparent upon considering risks of the enhancement is incommensurable with genuinely human make humanity. meaningful: them That psychedelic chemicals –are feature lacking very inthe that would demand, and encounters with divine the mediated by And promises yet, these –prayer inapill, insight on functional, and more able transcendence. to experience rewire brain the to astate that happier, is seemingly more neither an analgesic nor acheap Rather, thrill. drugs these promise to foster acharmed life of mental harmony that is (Griffiths meaningful then, psychedelicsOverall, 2006). canthrough find experience the be it to remarkably profoundly or deeply unnerving but painful, after working consumewho ego often death drugs as describe these phenomenon “ego termed death” (Nichols 2016).Those thatpersonal defines reality temporarily disintegrates, a that psychedelic can engender experiences “I” the when Ethical Implications of Psychedelic Enhancement First among risks of the psychedelics is that of accountsThese conveythe humility and centeredness effects effects by disruptingfunctionthe this system,of they (Carhart-Harris 2014).When psychedelics their exert understanding of themselves and place their world inthe and engage in“reality testing,” thus promoting acoherent advantage, allowing individuals to develop paradigms evolutionarily favored it because provided an adaptive into human the psyche. The default network mode was balance amongthe brain systems that wired has been fromarises upset manner the drugs these inwhich drugs. these arguewho for enhancement cohesiveness of social with fromarises psychedelic ought use to give pause to those by loneliness,already pervaded risk of the isolation that incommensurate with hoped-for the benefits. In a world irrational assertions or stubborn rejection of help –appear and placing obstacles way in the of future ones as a result of to cause –destroying an individual’s present relationships that effects personal this ego expansion been observed has interconnected whole of universe. the The devastating havethey unique the glimpsed value of of eachpart the through interpersonal relationships and communal values, andguided checked by formation of behavior patterns that individuals natural experience desires that must be solution is more human fully insofar as it acknowledges of and of food good are the health Thelatter preserved. and moderation is encouraged, such that enjoyment both would prefer aworld delicious inwhich is savored food relatively healthy to dampen desires, their most individuals ondependence biomedical interventions healthy inthe or obesity. While grotesque the outcome imagined of can be are they when readily available, potentially resulting in cravings for large amounts of nutrients these continue even present environment, trait this is maladaptive because and nutrients these salt because are to vital In health. the evolutionarily conditioned to favor infat, high foods sugar, humanmeaningful For experiences. instance, humans are maladaptation through biochemical means would diminish therapeutic intervention, to to overcome seek every practices can become pathological and thereby merit remedied biochemically.be While many maladaptive However, it maladaptation is untrue that every should desirable it because may able be to patterns. correct these to maladaptive patterns of thought, psychedelic is use and that environmentssocieties these may conducive be metropolitanin the environments typical of industrialized point that to fact the since humans didnot evolve to live faceofthe fixedness functional (Pollan also 2018). They resilient individuals and engenders creative solutions in resemble patterns of connectivity typical of brains the of laud way the process in this which rewires brain the to Harris 2014).Psychedelic researchers and enthusiasts assessing against them backdrop the of reality (Carhart- consciousness, piecing together stories or without ideas rummagedrunkenly through contents the of their foster “magical thinking” inits place, individuals inwhich A second risk-founded argument against psychedelics Penn Bioethics Journal Volume XVI, Issue I 19 The end of psychedelic moral enhancement naturally naturally enhancement moral psychedelic of end The knowledge, to be to perfected personal knowledge, through gradually belief is hand, the other evidence; on of accumulation it evidence, because mere than richer humanly often into brings and relationship interpersonal an involves also the but know to capacity a person’s only not play enter to others, to oneself entrust to deeper capacity and intimate them which with is a relationship into II 1998) Paul (John enduring. life human to central a doubt without is Mystery traditional human limitations. Some bioethicists bioethicists Some limitations. human traditional forms as academiceducation and describelife family have these institutions that note and enhancement of to respond who adequately individuals form failedto does not this argument However, modern challenges. psychedelic for justification moral a legitimate provide the acknowledge does not it as insofar enhancement in pharmaceutical kind structural between and difference children certainly improves Education interventions. of newa generation equipping by the community and trips happen within the confines of an individual’s mind mind an individual’s of the confines within happen trips felt noetic a quality, described having often as are and as than rather intuition incommunicable of the level at but is guidance 2018). There truth (Pollan intelligible guides journeys; typically, on goalthese lonely fixed no “trust, to of psychedelics advise those the influence under moral of vision 2018). This (Pollan be open” and let go, journeyer a lone as the individual paints formation In society. from truth apart discovering for responsible – a education moral of image the conventional contrast, and character her forming a person of gradual process in immersion beliefs her through articulate to learning purpose of questions to answers express that traditions the – places the past of the wisest minds by given in life acknowledging community, within squarely individual human to intrinsic are physicality and relationality that morality up seeks build to enhancement Psychedelic life. starting The gnostic insight. of ground the hollow atop Neither scrutiny. to up stand does this scheme not of point end. does its The End: Enhancement overcome methods to novel the use of enhancement, is and relationships; suffering and death generate profound profound generate death and suffering relationships; and fully be answered, cannot that meaning of questions and the beauty at joy spark friendship and love as just at Thesetheir fullest experiences another. of complexity in the a deep rootedness and life of a sharing prompt Paul John Saint that relationships interpersonal of fabric psychedelic many – as insist to II describes. contrast, In feature a fundamental is mysticism do – that enthusiasts reasoning moral for a foundation and existence human of meaningful most individual’s an that presupposes Psychedelic society. experiencesfrom occur in isolation Ethical Implications of Psychedelic Enhancement Psychedelic of Implications Ethical through belief can seem an imperfect form of of seem belief form imperfect can through an In believing, we entrust ourselves to the knowledge the knowledge to ourselves believing, entrust we In an important suggests This people. other by acquired acquired the knowledge hand, On the one tension. access to the primary religious experience by means means experience by the primary to access religious be to a psychoactive which happens the sacrament, of 2018) (Pollan superfluous. rendered is molecule. Faith provides it as appealing insofar proves proposal This everyone coming after, there is the comparatively thin thin is comparatively the there after, everyone coming the sacrament, of the symbolism thegruel stories, of it of the original power attenuates History faith. and But the priests. by be mediated must all, which now in the Church offer on promise the extraordinary gain timemay any at anyone that is Psychedelics of If this is a religion, it’s one with a significant difference. difference. a significant with one it’s this a religion, is If a perhaps and a religion of the founder only Typically, authority the kind of to claim lay can acolytes early few For of experience a direct the sacred. from flows that Use of psychedelics to achieve the end of moral moral of the end achieve to psychedelics of Use it acknowledges the necessary and meaningful place of the necessary of meaningful place acknowledges and it belief, writing, experience and by extension in human life, suggesting that that suggesting life, in human extension by experience and denial This is be irrelevant. made should and belief can that given anthropology, a fully with human inconsistent for others on dependent and finite nature by are humans Paul John Saint fulfillment. instruction, and knowledge, as insofar accurate more is that a position II articulates limited in their access to encounters with the divine based the divine with encounters to in their access limited circumstances. cultural or geographical, historical, on reality the fundamental ignores thisargument However, and geographic, the historical, by shaped are humans that now being and in which into they came context cultural in spiritual faith of the role seeks deny to it Moreover, live. equality in religious experience: no longer are individuals individuals are experience: longer no religious in equality Alfred Hofmann, the chemist who discovered LSD, as the the as LSD, who discovered the chemist Alfred Hofmann, notes, Pollan yet, And a new religion. of founder goods. goods. on judgment moral grounds also wrongly enhancement praise psychedelics of advocates experience. Many mystical experience in which these drugs mystical the way make compare to as goes so far Pollan all. Michael to accessible circuits but from their correlates in the external world, a a in the external world, their correlates from but circuits An purpose or life. in connection human authentic of lack real for solutions real requires instead response adequate dignified promote that institutions supporting problems, seeking than rather relationships and lives human these by occasioned states mimic the brain that chemicals rather than suggesting that these desires ought to be be to ought these desires that suggesting than rather Similarly, manipulation. biochemical through suppressed necessary is to enhancement neurological the idea that in modern society individuals of simply happiness foster in modernbecausethey the fact society live that ignores neurological improper from just arises not unhappiness 20 Penn Bioethics Journal Volume XVI, Issue I towards by goodness fostering formation of neurological forneed choice, but individuals to it purport dispose does Psychedelic enhancement clearly not does obviate the and love what and is good, thus it to choose habitually. examplethe and counsel of others, comes to recognize decision bydecision difficult person, asa guided by soul. (Kass 2003) flow intentionallyfrom knowing, hiswilling, embodied of and an agent self-experiencing alert making his deeds of character good against hardship, but manifestations the meaning inhuman terms…the point is less exertions the can at feelwithout best effects their understandingtheir iswho not merely passive but plays who no role at He all. andbody mind to bring about effects their on a subject result of choice. To end this Kass states, as amatter of technological manipulation rather than as a drama disappears from daily life and character is treated day, it may of to lead asense complacency also as moral attention outwards to combat dramatic the of crises the may insociety allow individualsadequacy to turn their possibilitythe for moral greatness. While fostering moral to probability the lessen of moral depravity increase will Similarly, it is unclear that altering neurological processes have inmany ways narrowed and flattened dialogue. to enhance relationships through of ease communication platforms media it is empirically social meant observable; diminishment of human life is counterintuitive evenwhile 2003). That enhancement would lead to mediocrity or a of genuine freedom, individuality, and greatness” (Kass ceiling of human possibility, and reducing likelihood the – perhaps raisingsociety floor the butgreatly loweringthe way that to leads “still greater homogenization of human permitted and may widely used become mandatory” ina bioethicist and humanist Kass Leon notes that “what is result ingenuine moral improvement is unclear. The mayuse become coercive. However, would this whether morally enhanced individuals, pressure for psychedelic ofgoal requires ills remedying mass acritical social of challengethe to human freedom. Given that proposed the enhanced individuals smacks of dystopia. loving world built on backs of the pharmacologically in human life. This promise of a more just,peaceful, and propensity towards selfishness thator cruelty evident is reshape themselves as more moral and less immune to the consenting individuals rely on abiochemical means to In contrast, psychedelic enhancement proposes that giving shape to children morally as well as physically. as older generationstheir duty the fulfill to next one, natural unfolding of individuals’ lives within society interventions, “enhancement” the through occurs the betterment. However, ineducation and similar structural individuals to contribute maintenance to societal and Ethical Implications of Psychedelic Enhancement Traditionally, excellence of character is built Biomedical interventions directly on act human the Among most the evident dangers of enhancement is The Circumstances:The LifeHuman destroys head the human life. empty decisions these of from heart meaning. the Severing instinct may ensure more reliable decisions, may too so it minor moral matters; though transforming choice into psychedelic enhancement mark missesthe by minimizing as stepping stones on path the life. to a good Therefore, neurological enhancement fails to capture meaning their actions should circumvented be or improved through and moral lives of involved. those To insist that these arethey in and good of themselves and shape physical the harmony or rationally must completed, be but because are not performed foster merely they socially because orneeds, devoting but oneself to work necessary thankless wholehearted attention totending afriend, to achild’s routinein the moments of daily life. The acts givingof behavior ignores that that fact morality manifests itself repeated moral decisions. This pathproposed to moral patterns fashioned that be through would small, otherwise including utilitarianism, deontology, and ethics. virtue other lensesofthe common several frameworks, ethical examine consequences the of moral enhancement through circumstancesthese provide acommon starting point to prove source of a fruitful future discussion insofar as examination of circumstances the of psychedelic may use enhancement with risk to them society. carry Further distribution of psychedelics for of moral purpose the become shortcomings. Thus,both limited andwidespread touted as solution the to society’s problems, mistakes of through solace solidarity. When enhancement is in crushing responsibility and removing possibility the of humanity engenders a lack of humility, culminating on individuals, pursuing enhancement without asense 2004). Sandel suggests that rather than easing burden the Michael Sandel refers to as “ethic the of giftedness” (Sandel enhancement favors of destruction what scholar the interpersonal, means. more,Still fostering an of ethos insight and pharmaceutical, rather than and personal would remain of founding moral growth upon mystical If distribution were aforementioned the equalized, issues that allow one group to with identify another dwindle. will disadvantaged, structurally the shared the features of life different lives materially, cognitively, culturallyandfrom chasms: as enhanced the come to live more and more into dividessocioeconomic could deepen unbridgeable level of views, political education, and like, the current propensitythe of individuals to favor like in them those among able those to affordthe expensive Given drugs. benefits the because of enhancement be distributedwould to an acceptable would level, risk toremain society distribution. Even ifrisk to individuals lowered could be raise cause for concern. Most is problem the striking of groundsthe of its and object doits end, too so circumstance While psychedelic enhancement may on rejected be Penn Bioethics Journal Volume XVI, Issue I 21 Ethical Implications of Psychedelic Enhancement Psychedelic of Implications Ethical

By proposing to rewire the brains of individuals individuals of the brains rewire to proposing By Psychopharmacology 212, no. 3 (2010): 441-448. 212, no. Psychopharmacology on the Church of the Catholic bishops to the II: Paul John Pontiff Books MA: Pauline Boston, reason. and between faith relationship & Media. by Michael Pollan; Blue Dreams: The Science and the Story of Story the and the The Science Dreams: Blue Pollan; Michael by Review London Slater." Lauren by Our Minds Changed Drugs that 18 (2018): 31-33. Booksof 40, no. John and Aloyo, J. Vincent A. Schindler, Emmanuelle Dave, and learning accelerates LSD "Intrahippocampal A. Harvey. et al." Romano in the rabbit, the 5-HT 2A receptor desensitizes lead to increases in the personality domain of openness." Journal of of Journal openness." of domain in the personality lead increases to 11 (2011): 1453-1461. 25, no. Psychopharmacology (2016): 264-355. of psilocybin "Effect on X. Vollenweider. Franz and Dziobek, of Journal International decision-making." moral and empathy 9 (2017): 747-757. 20, no. Neuropsychopharmacology of perfection." The New Atlantis 1 (2003): 9-28. Atlantis New perfection." The of creative enhances "Ayahuasca J. G. Ramaekers. and Theunissen, convergent thinking conventional while decreasing divergent 3395-3403. 18 (2016): no. 233, thinking." Psychopharmacology psilocybin the hallucinogen experiences by occasioned "Mystical tobacco addiction." Current drug abuse reviews 7, no. 3 (2014): reviews drug 7, no. abuse Current addiction." tobacco 157-164. experiences mystical-type occasion "Psilocybin can Jesse. spiritual and personal meaning sustained and substantial having 3 (2006): 268-283. no. 187, Psychopharmacology significance." Publishers. HarperCollins informed by neuroimaging research with psychedelic drugs." psychedelic with research neuroimaging by informed 8 (2014): 20. neuroscience in human Frontiers 2000. Conference, Catholic States 83 (2018): 415-439. Supplements Philosophy of experiences in the treatment mystical "Psilocybin-occasioned Shanahan, Amanda Feilding, Enzo Tagliazucchi, Dante R. Chialvo, R. Chialvo, Dante Enzo Tagliazucchi, Feilding, Amanda Shanahan, states a theorybrain: of conscious entropic "The Nutt. David and Saint John Paul II. 1998. Encyclical letter, fides et ratio, of the Supreme Supreme of the fides et ratio, II. 1998. Encyclical letter, Paul John Saint April 01, 2004. Atlantic. The “The perfection.” caseagainst M. J. Sandel, Jay, Mike. "How to Change Your Mind: The New Science of Psychedelics Psychedelics Newof Science The Mind: Your Change to "How Mike. Jay, D. Kuldip Li, L. Quinn, Luchuan G., Jennifer Anthony Romano, Nichols, David E. "Psychedelics." Pharmacological reviews 68, no. 2 reviews 68, no. Pharmacological E. "Psychedelics." David Nichols, Isabel Kometer, Michael Preller, H. Katrin Thomas, Pokorny, Kass, Leon R. "Ageless bodies, happy souls: biotechnology and the pursuit the pursuit and biotechnology souls: bodies, Leon R. happy "Ageless Kass, E. L. S. Barker, Revenga, Riba,De M. La Fuente C., J. K. P. Kuypers, R. Roland Griffiths. and Johnson, W. A., Matthew Katherine MacLean, Griffiths, Roland R., William A. Richards, Una McCann, and Robertand McCann, Una A.William Richards, Roland R., Griffiths, NY: City, York New 2009. of perception. doors A. The Huxley, Catechism of the Catholic Church, 2nd ed. Washington, DC: United DC: United Washington, ed. 2nd Church, the Catholic of Catechism of Institute Royal enhancement." moral "Psychedelic D. Brian Earp, Johnson. W Matthew and Albert, R Griffiths, Roland Garcia-Romeu, than are strictly sought after. It would be wise not to barter to barter would be wisenot It after. strictly sought are than goods. human of snippets for life human of the fabric away References Murray Hellyer, John Robert Leech, Peter Lester, Robin Carhart-Harris, that is fundamentally isolating: suggesting mystical mystical suggesting isolating: fundamentally is that and judgment moral for experience a foundation as to fails character bedrock as for patterns neurological in the physical life human of the rootedness acknowledge enhancement of Every form in relationships. and world experience, natural the sacrificeof carriessome it with changes in more results every enhancement and of form Conclusion supporters enhancement, thepurpose moral of for implicit an propose enhancement psychedelic of form a takes reorganization The society. of restructuring Call for papers

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