The Conundrum of Informed Consent

I read The Immortal Life of Henrietta Lacks recently, a masterful book about the real-life story of a woman named Henrietta Lacks who died of cervical cancer in the 1950s. Before her death, Henrietta’s cancer cells were collected by doctors at the Johns Hopkins Hospital and it was found that they had a remarkable capacity to grow and proliferate. The sheer scale of the scientific achievements that followed and which owed a measure of credit to HeLa, as the cells came to be known, is immense. The crux of the book, however, is that Henrietta Lacks never gave informed consent to the harvesting of cells from her body.

Towards the end of the book, the author juxtaposes Henrietta’s case with that of other individuals, like Ted Slavin, who recognise the potential that parts of their bodies have for research and medical advancement, and ensure that they have control over who uses the tissue in question and under what circumstances.

The following text from the book, centred around these examples, is one of the best enunciations of the dilemma of informed consent that I have read:

“This is a capitalist society,” says Wayne Grody. “People like Ted Slavin took advantage of that. You know, the way I see it is, if you think of doing that on the front end, more power to you.”

The thing is, people can’t “think of doing that on the front end” unless they know their tissues might be valuable to researchers in the first place. The difference between Ted Slavin, John Moore, and Henrietta Lacks was that someone told Slavin his tissues were special and that scientists would want to use them in research, so he was able to control his tissues by establishing his terms before anything left his body. In other words, he was informed, and he gave consent. In the end, the question is how much science should be obligated (ethically and legally) to put people in the position to do the same as Slavin. Which brings us back to the complicated issue of consent. [emphasis from the text]

Ambedkar on Equality

These lines from BR Ambedkar from Annihilation of Caste on the concept of Equality, are an absolute must-read.

First, he classifies equality along three dimensions:

Equality may be a fiction but nonetheless one must accept it as the governing principle. A man’s power is dependent upon (1) physical heredity, (2) social inheritance or endowment in the form of parental care, education, accumulation of scientific knowledge, everything which enables him to be more efficient than the savage, and finally, (3) on his own efforts. In all these three respects men are undoubtedly unequal. But the question is, shall we treat them as unequal because they are unequal ? This is a question which the opponents of equality must answer. From the standpoint of the individualist it may be just to treat men unequally so far as their efforts are unequal. It may be desirable to give as much incentive as possible to the full development of every one’s powers. But what would happen if men were treated unequally as they are, in the first two respects ? It is obvious that those individuals also in whose favour there is birth, education, family name, business connections and inherited wealth would be selected in the race. But selection under such circumstances would not be a selection of the able. It would be the selection of the privileged. The reason therefore, which forces that in the third respect we should treat men unequally demands that in the first two respects we should treat men as equally as possible.

Assuming this three-fold classification of (in)equality, one can deduce what Ambedkar would have said about the contemporary demands for reservation. He would have opposed them as the groups seeking affirmative action are not disadvantaged in the first two respects. If anything, some of these groups have been the most dominant political communities in the states.

Ambedkar then gives a utilitarian reason for why we need to uphold the principle of equality.

On the other hand it can be urged that if it is good for the social body to get the most out of its members, it can get most out of them only by making them equal as far as possible at the very start of the race. That is one reason why we cannot escape equality. But there is another reason why we must accept equality. A Statesman is concerned with vast numbers of people. He has neither the time nor the knowledge to draw fine distinctions and to treat each equitably i.e. according to need or according to capacity. However desirable or reasonable an equitable treatment of men may be, humanity is not capable of assortment and classification. The statesman, therefore, must follow some rough and ready rule and that rough and ready rule is to treat all men alike not because they are alike but because classification and assortment is impossible. The doctrine of equality is glaringly fallacious but taking all in all it is the only way a statesman can proceed in politics which is a severely practical affair and which demands a severely practical test.

Politics as Persuasive Performance

In this post, I juxtapose two notions about politics that I came across in the past couple of weeks.

One, in Slate’s Lend Me Your Ears podcast on Julius Caesar (which I referenced in my two earlier posts, available here and here), Mark Antony’s famous speech is seen as an appeal to emotion and is in stark contrast with Brutus’ appeal to reason. It is a performance, a façade that Antony puts up to get what he desires.

Two, in an episode of the Waking Up Podcast on the current fate of liberalism in the USA, Mark Lilla argues against the pull of identity politics. He says that politics should not succumb to self-expression. Instead, it should be a tool for persuasion.

So, there you have the reason for the annoying alliteration in this post’s title. Politics as a combination of performance and persuasion. A persuasive performance, if you will. Of course, this begs the larger question: would it be good politics, and I use good in a value-neutral sense here, if one of these features is absent? This is something to mull over in the future.

A Case for Unpredictability

Researchers in Germany have created a machine learning tool that has predicted the winner of the ongoing FIFA World Cup. This tool says that Spain has a higher chance at the outset but if the Germans make it to the quarter-finals, the odds tilt in their favour.

The creation of this tool does not come as a surprise. Machine learning tools thrive at making predictions and this is just another example of a technology that has become adept at doing a task far better than humans.

However, impressive as a technology might be, there is always room to ask if it should be applied in a particular field. These were my thoughts as I read the article. It goes without saying that better predictions would be beneficial in a lot of fields, including ones like medicine and weather. But would they add value to a sport like football?

I must admit I pose this question from a philosophical bent of mind. Isn’t part of the thrill of a sport its inherent unpredictability, of the unexpected happening? Bookmakers and gamblers might beg to disagree but there is a reason why seeing an unfancied team win against all odds is deeply satisfying. Is it possible then that the invention of a machine learning tool that accurately predicts the result of every match might lessen the enjoyment of the game itself? Worse, can it contribute to a self-fulfilling prophecy where players contrive to fit the results of the prediction (of course, this means having a particularly low opinion of the free will of the human beings involved)? I do not have any concrete answers at present but this is a line of questioning worth pursuing, both for this particular application and for machine learning in general.

Chanakya is not a synonym for amoral politics

The name “Chanakya” is a favourite with political enthusiasts, who appropriate it as a nickname for themselves, and with political commentators who anoint the latest big fish in the political arena as “Chanakya”. The modern history of the use of the term perhaps dates back to Jawaharlal Nehru who adopted the pseudonym in a 1937 essay criticising himself. Today it is being used to describe the current BJP president, Amit Shah, for his leave-no-prisoners style of politics.

It is wrong to confuse Chanakya with amoral domestic politics. Not because ancient Indian political philosophy is irrelevant to contemporary politics — it is not — but because there is a difference between international and domestic politics. To read Chanakya out of context would be to arrive at erroneous conclusions. All politics may be about power but there are important moral differences between its use in international relations and domestic politics.

Chanakya’s proposals for amoral politics properly applies to international relations: to relations among sovereigns in his time, and among sovereign states today. Because there is no overarching world government, it is consistent with raja dharma to take the amoral route to power. Maximising one’s own power with respect to other (sovereigns) is the ultimate goal, because that is the surest way to protect one’s own independence, values and way of life. This is similar to what modern-day realists believe and practice.

However, when it comes to politics within a country, use of power is circumscribed by morality. Even in Chanakya’s days, a king could not violate raja dharma, nor could his subjects violate their common and specific dharmas. The Shanti Parva of the Mahabharata — where Bhishma does an AMA with the Pandavas while lying on his deathbed of arrows— goes into great detail on raja dharma, and how a king must rule. There was no written constitution then, but constitutional morality existed and bound the king (and his government) in the form of raja dharma and the dharma shastras.

We should not expect twenty-first century moral values in ancient moral codes, but the point is that moral codes existed and placed normative bounds on the actions of the king and government. In other words, in the domestic context, Chanakya’s prescriptions were and must be read within the constraints of a constitutional morality. Furthermore, to apply Chanakya’s strategies in business management and interpersonal relations would be wrong except where the law of the jungle prevails.

Raja dharma today is to be found in the written Constitution of India and the legal framework it has created.

People who breach this dharma cannot be called Chanakya. To do so would be to profoundly misunderstand a very sophisticated political philosophy.

Aftertaste. Both Voldemort and Vijay Dinanath Chauhan make the same mistake, as I wrote in my Pax Indica column some years ago. My Reading the Arthashastra archive has a few posts on how to relate Chanakya’s philosophy to modern times.

Did You Eat The Pig?

Here’s a thought experiment: scientists find a way to map all the information embedded in your brain, including all neuronal connections and so on. You have a fatal disease. You die. You are cremated along with your brain. But the digital replica of it exists on a hard drive, and is one day, in whatever form, brought back to life. Is that You?

In fact, if that is done to a parent of yours, and you are told they are now on your laptop and can interact with you, will you still respect them?

If that’s a deceased loved one, will you still love her? Is she a person to you? How can you tell?

Our sense of self, quite clearly, is a product of the brain. But if a brain is intact and the body is not, does the self still exist?

This is a stray thought brought about by this news about scientists having found a way to reanimate a dead pig’s brain. Suppose you ate the pig. Did you really eat it?