Semio- or Semi-ethics: Semioethics for Animals?

By Matthew Cuffaro 

Semiotics (the study of signification) has a deep tradition for universalism. A deeper tradition in thought is the concession that humans hold a special place among lifeforms as “conscious,” and semiotics is no different. In Sign Crossroads in Global Perspective, the authors Petrilli and Ponzio argue that if humans are conscious of the significance of things, then they are responsible for their signification, curtailing polluting or destructive cultures and practices in favor of “planetary semiosis [process of signification]” (the analogue of the “Spaceship Earth” idea you might have heard about). Petrilli and Ponzio define semioethics for us:

“…1) invent a plurality of possible worlds; 2) to reflect upon signs; 3) to be responsible for one’s actions; 4) to gain conscious awareness of our inevitable involvement, of each and every one of us, in the sign network of life over the entire planet; and 5) to be responsibly involved in the destiny of planetary semiosis.” (3-4, Petrilli and Ponzio).

How does semioethics look in our day? For example, if I say “forest”, I denote the complex of trees that scaffold a rich ecosystem, but I can also expect to connote something in the listener that is met with a response. There might be stress: the listener that is familiar with the films Silent Running, Medicine Man, and Avatar is familiar with the disappearing forest—something invaluable, yet mercilessly exploited, yet something distant. There might be interest: the listener may be a logger who equates the forest with their income, or an ecologist who sees the forest as a complex of interdependent lifeforms. There may be religious or existential feelings to the listener that knows the forest to possess supernal power or sagacity, healing benefits, or the basis of their livelihood. Further still, the Puritan coming to the New World sees the endless forests as ripe with resource to be drawn from systematically through their labors. Through cultural and scientific influence, our example paints the forest as something once a symbol of innumerable economic plenty to something of indispensable ecological value. If we follow these trends, we imagine the forest as a “life support system;” something of personal and functional value, Thus, the forest is represented in a way that alters its significance to the people.

Now I believe Petrilli & Ponzio’s project is bioethical because they are both critical and imperative towards environmental practice, but their focus on the human is uncharacteristic of the contemporary trends in semiotics to extend its essentially pre-linguistic domain to lifeforms. If biosemiotics wishes to construct a basis for extending signification to (all) lifeforms, then can we depart from Petrilli and Ponzio to say that animals are in some way semioethical? Prima facie, this is absurd, because the hare does not have the logging companies, the socioreligious campaigns, NIMBY sieges on civic projects, etc.; what the hare has is grassy flatlands, abundant cellulose, and other “critters” that are supposedly significant to it.

The example I like is the “fable” of the Fox and the Hare. In the introduction to Jesper Hoffmeyer’s Biosemiotics (of which I paraphrase): A hare in a field becomes aware of a fox stalking close by. The hare stands up on its hind legs and the fox, seeing this, aborts its foxing and trots away. An ethologist reporting on this claims that the hare stood as a gesture to the fox that chasing it would be a waste of everyone’s time and energy. The meat behind this claim is that it does not argue that the behavior is instinctual. After all, brains are calorically very expensive so the ethologist believes that the hare’s act is an example of signification, or that standing up is a gesture invented by the hare to communicate.

What is possibly semioethical in this account of the fox and the hare is that the creative status of the hare’s gesture leads us to ask the status of consciousness of the hare, which leaves us with open questions. If the hare is communicating something to the fox, then does it recognize the fox as something that can respond or react to the gesture? Do animals of supposed creativity understand their intercommunicants as “animated threats” (how the heck does the fox appear to the hare)? If so, then can we attribute a variant of the semioethical capacity we attribute ourselves to an animal that is cognizant of the capacities of other animals?

Why is this semioethical account useful to us?

If we adopt a biosemiotic strategy of extending semiotics “globally,” then the ideal common system for describing things semiotically allow us to ‘approximate’ ourselves beyond scientific prejudice of an unchecked human exceptionalism—the notion that all “human” qualities are exclusively “human.” If we form through our inquiries the grounds for suspecting the rudiments of consciousness in other lifeforms, then we not only invite scientific interest to explore and validate these suspicions but confirm the deep intuitions of those who advocate for ecocentric (more like un-anthropocentric) thought.

Notwithstanding, it is problematic already for us in the political arena to attribute animal rights in the very least, but if we can extend an ethical basis to animals first, then we have the philosophical freight to carry these arguments further. We may look at the vegetarian pamphlets thobbing the horrors of factory farms through the animal anecdotes and praising soy diets, perhaps with Ryan Gosling’s testament in there for good measure (I’m looking at you, Vegan Outreach.). In these pamphlets chickens named Kevin, pigs named Emily, and fishes named Calvin are celebrated for their ability to solve puzzles, count, communicate and especially escape, yet the semioethical project underlying this is that these animals are worth something by their apparent human attributes. We should treat these arguments by not evaluating the animals by their humanness, but by the attributes that allows us to understand the intentions of the animal (or plant), at the threat that we continue to think “humanness” is superior to “animalness” and is a standard beyond the niche of our circumstances. In a more fundamental way, the semioethical problem I try to convey would, if realized, mark a step in the scholarly imagination: those who could peer into the eyes of the rabbit peering into the fox, or to surject themselves onto the mind of the plant.

Matthew Cuffaro is a philosophy student at the University of South Florida with a concentration in the philosophies of mathematics and religious studies. 

The Paradox of Government Vaccine Mandates

By Timothy Rubbelke

Few aspects of medicine invoke so much disagreement among people.  Vaccines have fundamentally changed the way we think about illness.  Yet, they are still rejected by a surprisingly large subset of the population.  To ward off potential public health catastrophes we engage in draconian measures, including preventing school registration without proper vaccination.  In spite of this, lack of vaccination has caused a resurgence of diseases thought to be eliminated.  This begs the question: are the mandates working or could they actually be counterproductive?

Public Mistrust of Vaccination

Vaccination is the source of much public mistrust today.  No longer just an issue for fringe groups and religious objections, vaccination bashing has become embedded in popular culture through statements made by celebrities, most famously Jenny McCarthy.  Given that data shows vaccines to be incredibly safe and yet these groups still continue to gain followers, we should look at some of what animates them.

It seems easiest to connect the anti-vaccination movement’s beginnings with the now infamous study by Dr. Andrew Wakefield published in The Lancet in 1993.  A relatively small study, Wakefield concluded that the MMR vaccination caused damage to the intestinal system of growing children, which in turn resulted in more toxins getting into the blood stream, making them more susceptible to developing autism.[1],[2]  Ultimately the Wakefield study would be proven false, the connection between vaccines and autism thoroughly severed by science, and yet this idea remains an incredible concern for many, with some people going so far as to reanalyze CDC data to find a connection.[3]

The theory of dangerous vaccines gained even more traction when the CDC began looking into the possibility that thimerosal, the mercury-based preservative used in many vaccines, was linked to autism.  This potential danger appealed to common sense as well as scientific sense.  After all as Neal Halsey, one of the CDC proponents of removing thimerosal, reasoned: we are cautious about mercury levels in fish, doesn’t it make even more sense to be cautious about the levels in vaccines given to newborns and young children.[4]  Eventually thimerosal would be removed from vaccines, out of precaution, even though the scientific evidence was sparse regarding its effects, if any, on children.  But this resulted in a ripple effect of growing distrust against vaccines.  In turn, this would open the door for groups like the National Vaccine Information Center, an organization that claims to be neutral towards vaccines although it was founded by an anti-vaccination advocate and Generation Rescue, Jenny McCarthy’s charity, to gain credibility as experts on the national stage.[5]

Those with anti-vaccination beliefs are still very much a noticeable group.  Vaccination in some schools in California, for example, has dropped below 50%, with “Personal Belief Exemptions” sometimes outnumbering the number of vaccinated students.[6]  Yet something has to underlie this mistrust for it to continue to maintain a national presence.  I would suggest that the government mandates provide the backdrop which the anti-vaccination uses to gain traction in its fight.

Americans and their Freedom

Before beginning our discussion on vaccines specifically, it may be helpful to first discuss the importance of freedom for Americans.  Freedom, of course, is a broad and somewhat vague word.  When we speak of the American notion of freedom that is of interest here, we are referring to personal liberty, specifically civil liberty.  Civil liberty entails one being free from state interference, except, at the bare minimum, to ensure the public good. Consider as an example the recent pushback against the so-called “individual mandate” included in ACA.  Since the passage of the bill, there has been an outpouring of opposition towards it.  Some 27 states filed lawsuits seeking to have the mandate overturned on constitutional grounds, an argument eventually rejected by the Supreme Court, which declared the mandate a tax.  Ten states have passed various forms of legislation that attempt to overturn the mandate at the state level.  Two of these passed with crushing margins in public elections. One in Ohio passed with a double digit margin.[7],[8]  Similarly, an August 2011 poll of Americans showed that over 80% believed the government should not have this power.[9]  Regardless of one’s individual position on the matter, I think it could be argued it is not well received by the public.  But what does this tell us about perceptions of the government?  It tells us quite a lot.  It is not necessarily that these people are opposed to the idea of purchasing healthcare insurance or even of government helping to control health cost (statistically speaking, many of these people likely already purchase health insurance).  It is the very idea of government telling them that they must do something that seems to be the problem.

And so it may be with vaccines.  Simply put, it shows that Americans tend to reject what they see as an excessive reach of government which would repress autonomy, especially in issues of healthcare.  Thus we can begin to see that if vaccination is considered, at least by some, to be an overreach of government, the result can be distrust against it.

The Paradox

It should be noted that the intent is not to convince people at the far ends of the vaccine debate -- such a goal would be impossible anyway --  but rather to try to understand how one side, in this case the anti-vaccine groups, captures the minds of those in the middle.  Having said that, we can now see how the mandates might actually be counterproductive to encouraging widespread vaccination.

All conversations about the merits of vaccination must now take place against the backdrop of government mandates and power.  This allows members of the anti-vaccine movement to place these mandates in contrast with the American liberty narrative during any discussion, fostering distrust in government and convincing people of their cause.  Considered alone, the mandates might not cause much of a problem.  After all, they have existed for some time before vaccine rates started to decline, but we must also consider that we’ve developed what might be called “societal amnesia” with regards to many of these diseases. For my grandparents, concerns about polio saturated their lives, and yet many people from my generation have never even seen a polio victim beyond clips of Franklin Roosevelt.  This leads people to erroneously conclude the vaccines have no actual benefit, further reinforcing the idea of an overbearing government.  However, if the vaccine mandates were dropped, this would take away one of the key pillars of their argument. The movement would no longer be able to frame the debate in terms of a battle between personal autonomy and an overzealous government.

Of course the obvious potential fallout from such a maneuver would be that vaccines now have to stand (or fail) on their own merits.  However, not all hope is lost.  In eliminating the vaccine mandates, we will also have severed the connection between doctors and the state, at least to some extent. As such, the trust between the patient and physician, as well as the trust between medical science and society, can be allowed to grow without being poisoned by an overarching political discourse.

There is still a potential danger in rolling back vaccine mandates.  We risk a short term drop in vaccination.  But it’s not clear that this would be any worse than where we are now, with significant numbers of people opting out for dubious reasons, and old diseases (whooping cough, measles, etc.) making their rounds once again, even with mandates in place.

Tim Rubbelke is a PhD Candidate at the Saint Louis University Albert Gnaegi Center for Health Care Ethics. This essay was chosen as a finalist for the 2014-2015 Daniel Callahan Young Writer’s Prize. 

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[1] Goldberg, R. (2010). Tabloid medicine : how the Internet is being used to hijack medical science for fear and profit. New York: Kaplan Publishing.

[2] Interestingly, this is not the actual conclusions of the paper, but it is how Wakefield portrayed them in his numerous interviews following the publishing the study.

[3] Expression of concern: measles-mumps-rubella vaccination timing and autism among young African American boys: a reanalysis of CDC data. (2014). Translational Neurodegeneration, 3(1), 18. doi: 10.1186/2047-9158-3-18

[4] (Goldberg, 2010)

[5] (Goldberg, 2010)

[6] California makes for an interesting case study because it is one of the few states in which the PBE’s allow for “philosophical” objections as well as the commonly held religion based objections.  The interpretation of PBE’s is broad allowing almost anyone to get a waiver.

[7]  Ohio Votes to Nullify Insurance Mandates. (2011, November 8).   Retrieved November 13, 2011, from http://www.tenthamendmentcenter.com/2011/11/08/ohio-votes-to-nullify-insurance-mandates/

[8] Cannon, M. F. (2011, November 9). Ohio’s 2-1 vote against the individual mandate is a wholesale rejection of ObamaCare.   Retrieved November 13, 2011, from http://www.cato-at-liberty.org/ohios-2-1-vote-against-the-individual-mandate-is-a-wholesale-rejection-of-obamacare/

[9] GfK Roper Public Affairs & Corporate Communications. (2011, August). The AP-National Constitution Center Poll. from http://surveys.ap.org/data/GfK/AP-GfK%20Poll%20Aug%202011%20FINAL%20Topline_NCC_1st%20story.pdf

Daniel Callahan Young Writer's Prize Winner

Congratulations to Michelle Bayefsky on winning the first Daniel Callahan Young Writer's Prize! Michelle will be receiving the prize award of $500 and a copy of Daniel Callahan's autobiography, In Search of the Good: A Life in Bioethics. Thank you to the finalist judges, Daniel Callahan, Michael Gusmano, and Laura Haupt (their bios can be found here). 

Uterine Transplant: Where, If Anywhere, Should We Draw the Line?
By Michelle Bayefsky

In October 2014, researchers from the University of Gothenburg in Sweden reported the first case of a live birth following a uterine transplant. The uterus was transplanted from a postmenopausal woman into a 36 year-old woman born without a uterus. At nearly 32 weeks of pregnancy, she gave birth to a male child with normal birth weight for gestational age and excellent APGAR scores.[1]

The birth of this child represents a tremendous breakthrough in the treatment of infertility. There are many causes of female infertility, including damaged fallopian tubes, premature menopause and endometrial (uterine tissue) abnormalities. Corresponding treatments include in vitro fertilization, use of donor eggs, and use of a gestational surrogate. Uterine transplantation could obviate the need for gestational surrogates for patients with uterine infertility, allowing these mothers-to-be to carry their own pregnancies and potentially precipitating a decline of the controversial practice of surrogacy.

But why stop there? If uterine transplantation is a treatment for absolute uterine infertility, trans-women also have this condition, and so do all men. In this essay, I will explore whether and where to draw the line for those who should be eligible for a uterine transplant.

It is not yet possible for individuals with XY sex chromosomes to gestate a child. However, the desire for transgender women to carry a pregnancy is present,[2] and at least one bioethicist, Timothy Murphy, has begun to think about the prospect of uterine transplants into trans-women.[3] Murphy correctly focuses on state funding, since the hands-off regulatory attitude towards reproductive medicine in the United States[4] makes it unlikely that transgender uterine transplants would be banned outright. The debate about the appropriateness of transgender uterine transplants will therefore center on the need to prioritize limited healthcare resources.[5]

There are two central questions at stake. First, is there such a thing as a right to a uterine transplant? Second, is there a reason to distinguish between cis-women, trans-women, and men with regards to their claims to a uterine transplant, whether or not rights are at stake? If so, the state could be justified in prioritizing the needs of cis-women over trans-women over men who desire to gestate a child.

Uteruses are a scarce resource, and the state cannot ensure uteruses to all those who might lack and strongly desire them. It is therefore difficult to claim that people have a right to a uterine transplant, though they may have a right to fair access to an established supply of uteruses, should one come to exist. The scarcity issue is compounded by the fact that uteruses, like other organs, exist within other people’s bodies. Unless a sufficient number of uteruses are supplied via donation, claiming a right to a uterine transplant would be claiming a right to someone else’s body part. One could conceive of body parts as public goods, but such a view would violate our closely held beliefs about bodily autonomy. Since the state cannot forcibly redistribute organs, the right to a uterus can only be a right in an abstract sense. Nevertheless, the relative strength of claims to this abstract right can be used to determine what constitutes fair access to the limited supply of uteruses. Who, if anyone, should be prioritized?

Answering this question requires that we carefully examine our notions of infertility and instincts about childbearing. Intuitively, we might think there are reasons to differentiate among cis-women, trans-women, and men based on physical features and what it means to be “infertile.” For instance, it may be tempting to argue that cis-women without uteruses are infertile because they lack the typical reproductive organs of an XX-woman, while trans-women and men are fertile because they can still use sperm to ‘father’ children in the classic XY manner. However, all three categories are fertile in terms of their gametic capacity to reproduce but infertile with regards to the capacity to gestate.

One might also attempt to argue that women, whether cis or trans, have a stronger claim to the experience of carrying a child because it is typically a woman’s experience and part of being female. However, many women choose not to have children and are not lesser women because of it. Furthermore, arguments about childbearing based on assumptions about what it means to be a woman risk unjustly imposing societal norms and expectations on women, both cis and trans.

It may seem that distinctions among the three groups most plausibly rely on assertions relating to the prospective happiness of the transplant recipient. It is possible that cis-women have greater childbearing expectations, and would be most anguished by the inability to carry a pregnancy and should thus be given highest priority. Similarly, trans-women, who identify as the sex that typically bears children, may be more anguished than a self-identifying man. It is easy to imagine, though, a trans-woman who has always longed to gestate a child, or even a man with a very strong desire to carry a child, who would suffer deeply if they could not obtain a uterine transplant – even more than some cis-women without functional uteruses. Thus psychological impact could not reliably be used to distinguish among the three groups.

Ultimately, a priori distinctions could most reasonably be made on the basis of differential resource expenditure. If uterine transplantation is significantly easier, more successful or less expensive in a cis-woman, or a trans-woman who has undergone hormone therapy, this justifies prioritizing these groups the same way recipients are prioritized in the donation of other organs.[6]

Realistically, given the general lack of coverage for fertility services in the United States,[7] it is unlikely that either cis or trans-gender uterine transplants will be funded in the near future.

However, if uterine transplants do receive public funding and transplants into XY women and men are equally successful and no more economically burdensome than transplants into XX women, trans-women, as well as men with a profound desire to gestate, should be equally eligible to receive a uterine transplant.

Michelle Bayefsky is a first-year pre-doctoral fellow in the Department of Bioethics for the National Institutes of Health. She graduated from Yale University in 2014 with a B.A. in Ethics, Politics and Economics. She worked as a research assistant for two consecutive directors of the Yale Interdisciplinary Center for Bioethics. She also founded and served as Editor-in-Chief of the Yale Bioethics Journal. Michelle currently investigates ethical challenges posed by innovations in genetic technology, issues related to the regulation of genetic testing, and questions that arise at the intersection of genetics and reproductive medicine.
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[1] Brännström, M., L. Johannesson, et al. (2014). "Livebirth after uterus transplantation." The Lancet.

[2] Mott, Stephanie. "Trans-Uterus." The Huffington Post. TheHuffingtonPost.com, 21 Jan. 2014. Web. 14 Nov. 2014.

[3] Murphy, Timothy. "The Ethics of Helping Transgender Men and Women Have Children." Perspectives in Biology and Medicine 53.1 (2010): 46-60.

[4] Leigh, Suzanne. "Reproductive 'tourism'" USA Today - Health and Behavior. USATODAY.com, 02 May 2005. Web. 19 Sept. 2014; Williams, Benjamin. "Screening for Children: Choice and Chance in the “Wild West” of Reproductive Medicine." George Washington Law Review 79.4 (2011): 1305-342.

[5] Murphy, Timothy. "Uterus Transplants for Transgender Women?" Weblog post. Ethics and Choices about Children. Timothyfmurphy.blogspot.com, 27 Apr. 2014. Web. 14 Nov. 2014.

[6] The use of cost-effectiveness arguments in prioritizing organ transplantation is itself controversial (see, for example, Dan Brock, “Ethical Issues in the Use of Cost Effectiveness Analysis for the Prioritisation of Health Care Resources”), but I cannot explore this issue here.

[7] "State Laws Related To Insurance Coverage for Infertility Treatment." Insurance Coverage for Infertility Laws. National Conference of State Legislatures, Jun. 2014. Web. 12 Nov. 2014.

Congratulations Finalists

Thank you to every person who submitted to the Daniel Callahan Young Writers Prize! There were nearly thirty excellent submissions and the five finalists have been chosen. 

Their essays will be read by the following panel of judges:

Daniel Callahan, PhD-- As President Emeritus and co-founder of The Hastings Center, Callahan helped shape the bioethics field. He has written over 47 books and has had hundreds of peer-reviewed publications and op-eds. 

Michael K. Gusmano, PhD-- Gusmano is a a political scientist who holds adjunct appointments at Columbia University and Yale University and is a Research Scholar at The Hastings Center. He has published widely in the areas of health policy, aging, and comparative welfare state analysis.

Laura Haupt, M.A.-- Haupt is the Managing Editor for two peer-reviewed bioethics journals, the Hastings Center Report and IRB: Ethics and Human Research. Her background is in English literature and she has helped edit a number of special reports for the Hastings Center Report, including LGBT Bioethic: Visibility, Disparities, and Dialogue. 

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Daniel Callahan Young Writer's Prize Finalists

Avigile Baehr, MD/MBE Candidate, University of Pennsylvania

"DNR Ebola: Is There a Professional Obligation to Provide Treatment?"

Michelle Bayefsky, Pre-Doctoral Fellow, NIH Department of Bioethics

"Uterine Transplant: Where, If Anywhere, Should We Draw the Line?"

Rachel Conrad, MD Candidate, Baylor College of Medicine

"The Ethical Crisis in Medical Training"

Michael DiStefano, Research Assistant, University of Pennsylvania

"Religious Values and Refusal of Highly Effective Life-Saving Treatment by Minors"

Tim Rubbelke, PhD Candidate, St. Louis University Center for Healthcare Ethics

"The Paradox of Government Vaccine Mandates" 

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We anticipate an announcement of the winner in mid-January. Thank you again to all the participants, we look forward to posting some of the other compelling submissions to this blog in the coming months. There were far more fantastic entries than could be chosen.