The 10th Oxbridge varsity medical ethics debate-should we fear the rise of direct-to-consumer genetic testing?

In an increasingly data-driven age of medicine, do companies that offer genetic testing directly to patients represent an important part of personalising care, or a dangerous threat to privacy? Should we celebrate this new mechanism of patient involvement, or fear its implications?The Universities of Oxford and Cambridge addressed these issues in the 10th annual Medical Ethics Varsity Debate, through the motion: “This House Regrets the Rise of Direct-to-Consumer Genetic Testing”. This article summarises and extends key arguments made in the debate, exploring the impacts of such genetic testing on both the individual patient and broader society, with special consideration as to whether companies can ever truly guarantee anonymity of genetic data.     

Hierarchies and levels of reality

We examine some assumptions about the nature of ‘levels of reality’ in the light of examples drawn from physics. Three central assumptions of the standard view of such levels (for instance, Oppenheim and Putnam 1958) are (i) that levels are populated by entities of varying complexity, (ii) that there is a unique hierarchy of levels, ranging from the very small to the very large, and (iii) that the inhabitants of adjacent levels are related by the parthood relation. Using examples from physics, we argue that it is more natural to view the inhabitants of levels as the behaviors of entities, rather than entities themselves. This suggests an account of reduction between levels, according to which one behavior reduces to another if the two are related by an appropriate limit relation. By considering cases where such inter-level reduction fails, we show that the hierarchy of behaviors differs in several respects from the standard hierarchy of entities. In particular, while on the standard view, lower-level entities are ‘micro’ parts of higher-level entities, on our view, a system’s macro-level behavior can be seen as a (‘non-spatial’) part of its micro-level behavior. We argue that this second hierarchy is not really in conflict with the standard view and that it better suits examples of explanation in science.     

Varsity medical ethics debate 2018: constant health monitoring - the advance of technology into healthcare

The 2018 Varsity Medical Ethics debate convened upon the motion: “This house believes that the constant monitoring of our health does more harm than good”. This annual debate between students from the Universities of Oxford and Cambridge is now in its tenth year. This year’s debate was hosted at the Oxford Union on 8th of February 2018, with Oxford winning for the Opposition, and was the catalyst for the collation and expansion of ideas in this paper.New technological devices have the potential to enhance patient autonomy, improve patient safety, simplify the management of chronic diseases, increase connectivity between patients and healthcare professionals and assist individuals to make lifestyle changes to improve their health. However, these are pitted against an encroachment of technology medicalising the individual and home, an exacerbation of health inequalities, a risk to the security of patient data, an alteration of the doctor-patient relationship dynamic and an infringement on individual self-identity. This paper will draw upon and develop these concepts, while contending arguments for and against constant health monitoring. This is not a review of medical devices and health monitoring, but a reflective development and more detailed elaboration of the main points highlighted in the 2018 Varsity Medical Ethics debate.     

Sex Differences in Visual Recognition Memory: Support for a Sex-Related Difference in Attention in Adults and Children

The selectivity hypothesis of Meyers-Levy (1989) proposes that cognitive sex differences reflect underlying differences in information processing between males and females. Males are considered to be more likely to organize information in a self-related manner, whereas females are more likely to adopt a comprehensive approach to information processing. We tested this hypothesis in children (10–15 years) and adults using recognition memory tasks. Tests were devised which employed male-oriented objects, female oriented objects, or random objects. In both the child and adult samples, females performed significantly better than males on tests using random and female-oriented objects. Males performed at the level of females only when tested for recognition of male-oriented objects. These results demonstrate that this sex difference is present prior to puberty and support the concept of sex differences in information processing.     

Reductive levels and multi-scale structure

I discuss arguments about the relationship between different “levels” of explanation in the light of examples involving multi-scale analysis. I focus on arguments about causal competition between properties at different levels, such as Jaegwon Kim’s “supervenience argument.” A central feature of Kim’s argument is that higher-level properties can in general be identified with “micro-based” properties. I argue that explanations from multi-scale analysis give examples of explanations that are problematic for accounts such as Kim’s. I argue that these difficulties suggest that some standard assumptions about causal competition need to be revised.     

Cognitive efficiency on a match to sample task decreases at the onset of puberty in children

Electrocortical evidence indicates that a wave of synaptic proliferation occurs in the frontal lobes around the age of puberty onset. To study its potential influence on cognition, we examined 246 children (10-17 years) and 49 young adults (18-22 years) using a match-to-sample type of task to measure reaction times to assess emotionally related information. Based upon the instruction set, subjects made a yes/no decision about the emotion expressed in a face, a word, or a face/word combination presented tachistoscopically for 100 ms. The faces were images of a single individual with a happy, angry, sad or neutral expression. The words were 'happy,' 'angry,' 'sad,' or 'neutral,' In the combined stimulus condition, subjects were asked to decide if the face and word matched for the same emotion. Results showed that compared to the previous year, reaction times were significantly slower for making a correct decision at 11 and 12 years of age in girls and boys, the approximate ages of puberty onset. The peripubertal rise in reaction time declined slowly over the following 2-3 years and stabilized by 15 years of age. Analyses of the performance of 15-17 year olds revealed significantly longer reaction times in females to process both faces and words compared to males. However, this sex difference in late puberty appeared to be transient since it was not present in 18-22 year olds. Given the match-to-sample nature of the task employed, the puberty related increases in reaction time may reflect a relative inefficiency in frontal circuitry prior to the pruning of excess synaptic contacts.     

Can I Reach That Sticker? Preschoolers' Practical Judgments About Their Own and Others’ Body Size

Research to date has focused mostly on children's representation of their physical self as a prelude to the development of a theory of mind (ToM) and on their understanding of the self as distinct from others over time. Whether children approaching the well-known age of ToM mastery are also accurately appraising their own body's functional relationship to the everyday environment remains largely an unanswered question. Little work has investigated typical preschool-age children's explicit accuracy when making judgments about their own body's proportions. In the current study, 98 preschoolers made 16 practical judgments about whether their own body or an experimenter's body could fit through an apparatus (half of the apparatuses were 30% smaller than the body in question, and half were 30% larger). Overall, accuracy increased with age but was unrelated to body size. Children in all age groups performed above chance, and accuracy did not differ depending on target (e.g., self or other). Children in a comparison condition judging fit of inanimate objects (n = 23) performed similarly, though showed less evidence of “yes” bias, and there were no age-based differences in accuracy. Results are discussed with regard to preschoolers’ developing body awareness, as are implications for research protocols in which children are asked to accurately identify their own body size and shape from an array.