Population ethics in a fungal apocalypse

A bioethics professor weighs in on the Last of Us finale.

Hey readers,   Happy St. Patrick's Day! Springtime is almost here, and with that, several exciting stories that the Future Perfect team has been working on. You'll have to wait and see — keep an eye on your inbox!   In the meantime, I hope you read Rachel Cohen's exclusive on how the sole US supplier of a major abortion pill said it would not distribute the drug in 31 states.   As always, we love to know what you're thinking. Feel free to shoot us an email at futureperfect@vox.com to tell us what you've been enjoying and what you'd like to see more of.   —Kelsey Piper, senior writer The trolley has a fungus problem HBO The season finale of HBO's The Last of Us — based on the video game of the same name — thrust a longstanding philosophical question into the cultural spotlight: Is it ever ethical to kill one person for the well-being of many others?   If you haven't seen the show or played the game, a real species of fungus called cordyceps has evolved the ability to inhabit humans, turning them into mushroom-zombies that bite. Twenty years of apocalyptic chaos ensues.   The series follows a gruff man named Joel (Pedro Pascal) and a young girl named Ellie (Bella Ramsey), the only person to have displayed an immunity to the fungus. The duo travel to find a division of the renegade group known as the Fireflies, who are planning to engineer a vaccine using Ellie. What the two don't know is that the surgery to engineer the vaccine will kill her.    Ellie is given no opportunity to provide consent, and the surgery had questionable-at-best odds of success for delivering a vaccine. Upon finding out, Joel saves Ellie from the surgery, killing plenty of Fireflies in the process, while also putting an end to the best — perhaps only — shot at saving humanity through a vaccine.    The finale presents a bioethics question: When the entire species is at stake, should our decision-making logic change? So I spoke with Arthur Caplan, head of the division of medical ethics at the NYU Grossman School of Medicine and a professor of bioethics.   Conspicuously absent from The Last of Us was an Institutional Review Board (IRB), the group charged with reviewing and monitoring biomedical research involving human subjects in line with FDA regulations. We discussed whether IRBs today are flexible enough to handle decision-making in an apocalypse, what the relevant considerations would be, and if higher scales and stakes ever justify otherwise non-permissible actions. —Oshan Jarow      This interview has been edited for length and clarity.   Let's say there was a fungal apocalypse, and an IRB had to decide whether to allow an experimental surgery that would kill the subject, but offer a chance to save millions. How would they approach that question?   So there are two ways to approach that question. One is to reason from what the IRB looks like today. If somebody comes to you and says there's a terrible disease, we want to do an experiment. We think we could get something that could save many, but we have to kill you. And the answer to that is that would be the end of the discussion. Fatal experiments would not clear the standard IRB research ethics committee in the world today, even with the promise of big returns.    But in an apocalyptic scenario like in the show, where people have been dying for 20 years and someone proposes the experiment, I think you might get further. We almost got to this with Covid when the idea came up of doing challenge studies, deliberately infecting people with Covid [to help speed up vaccine research], not having any way to save them if they got very sick. And I defended the experiment.    Some said that you cannot do that, it's unethical. Others said, well, look, if you are truly volunteering, like imagine the girl in the show [Ellie] says she wants to help save the world and be an altruist, then as long as you choose knowingly and understand the risk — that's crucial — and as long as you're pretty certain of the science, because the odds of the experiment's success will drive some of the answer, but my own view is yes, in an apocalypse with the possibility of a real breakthrough, if the person volunteered and truly said, "I want to help, I'm going to be an altruist," I think I could approve that. "The IRB's job is to ensure that consent is there, but also to make sure that the science is sound."  In the show, Ellie wasn't given the option to provide consent, but let's say she did, and she was an adult. There's still a lot of uncertainty around whether the surgery will work, whether it will actually produce a vaccine, or whether there might be other options. So even when someone gives consent, can the presence of uncertainties still make the experiment unethical? Yes, the IRB's job is to interpret the chances of the science working; consent is not sufficient. Some of the early pioneers of artificial hearts did consent and said, "I'll take my chances, I'm gonna die anyway," but the IRB had to step in and challenge whether the scientific protocol was sound, whether the background information they had pointed in the direction that they were likely to get an answer. The IRB's job is to ensure that consent is there, but also to make sure that the science is sound.    Say we find ourselves somewhere in between the Covid pandemic and Last of Us on the apocalypse scale. Do you imagine current IRB processes are flexible enough to adapt to those sorts of situations? Is the IRB apocalypse ready? IRBs can be flexible; let me shift to something analogous. Sometimes people are out hiking and they eat a poisonous mushroom. They show up at the ER, unconscious. There's no antidote and no one knows what to do, and no time to bring in the IRB. Well, we have carved out a space where you could try an experimental antidote without the consent of the person. We have an emergency research waiver idea that says, facing certain death from this poisoning, most people would reasonably consent to the experimental agent. You're supposed to get consent after the fact, if they survive. You're supposed to do what you can to warn people in advance, but the flexibility is there for research under emergency circumstances, so it's not hypothetical. So yes, I think an IRB faced with a 20-year plague that was killing everybody, if you truly had an altruistic and consenting volunteer, I think they could go along with it. Pescetarians are responsible for many more animal deaths than regular meat eaters Andrew Skowron/We Animals Media Eschewing red meat and poultry but still eating seafood is often recommended to people who want to make better food choices but don't want to go vegan or vegetarian. Fishing typically has a smaller carbon footprint than factory farming, fish are often seen as less worthy of compassion than land animals, and, while wild-caught fish lives are cut short, at least they don't spend their entire existence in cages so small they can't turn around. In this reported personal essay, Garrison Lovely breaks down his pescetarian year and why he believes he did more harm than good.  More on this topic from Vox: The biggest animal welfare crisis you've never heard of Eggs are expensive for all the wrong reasons The bitter civil war dividing American veterinarians What is life? Scientists still can't agree. Mark Ralston/AFP via Getty Images "No one has been able to define life, and some people will tell you it's not possible to," says New York Times columnist and science reporter Carl Zimmer on Unexplainable — Vox's podcast that explores big mysteries, unanswered questions, and all the things we learn by diving into the unknown. You can read a transcript of Zimmer's interview with editor Brian Resnick here. More on this topic from Vox: 3 unexplainable mysteries of life on Earth How scientists discovered the universe is really freaking huge What science still doesn't know about the five senses WHAT WE'RE THINKING ABOUT Mark Felix/AFP via Getty Images For too long, the US space program has been stuck in Tomorrowland — a faded reminder of a dated future. Changing that will require astronauts boldly going … somewhere, at least. But in the meantime, at least they can start to look like the future. On Wednesday, NASA unveiled the spiffy new Artemis III lunar spacesuit. As New York Times fashion critic Vanessa Friedman put it, the "black, with orange and blue trimming" suits, made with the private company Axiom Space, are "Hulk-meets-anthropomorphic-anteater-meets-'Star Trek.'" I'm going to say that's good. —Bryan Walsh, editor    I've been gathering some string for a feature on Social Security reform here in the US, and hit on a paper that addresses one of my big dumb questions about the program: Why, if we have this massive pension program for seniors, were 10.7 percent of seniors in poverty in 2021? We even have a supplemental program for low-income seniors and people with disabilities, but it's not enough. Gene Steuerle and Karen Smith lay out a plan that would be enough, and pay poverty-level benefits to everyone getting old-age or disability benefits. —Dylan Matthews, senior correspondent    Electric vehicles, like the Tesla Model 3 and the Nissan Leaf, are clear environmental winners over gas-powered vehicles. But they still have a high "vehicle demand energy" — the energy required to get a hulking, two-ton car in motion — and a lot of that energy is wasted on quick trips to the grocery store or a friend's house. So why not have something in between, that's faster than a bicycle but not quite a full-on car? Enter the ChangLi, the world's cheapest (electric) car that's essentially a glorified golf cart. Read all about the tiny, charming vehicle in Heatmap, a new climate and energy journalism outfit, and why we could use more options to get around.  —Kenny Torrella, staff writer   Check out this collection of short essays by philosophers thinking about large language models like ChatGPT. There are some gems in there, like Atoosa Kasirzadeh's piece noting that "the promise that AI technologies will benefit all of humanity is empty so long as we lack a nuanced understanding of what humanity is supposed to be." One thing I'm thinking about is how these models might constrain or reshape human originality, potentially homogenizing our ways of writing, thinking, and being. How much do we care about that? Depends what you think humanity is supposed to be! —Sigal Samuel, senior reporter  Questions? Comments? Tell us what you think! We recently changed the format of this newsletter and would love to know your thoughts. Email us at futureperfect@vox.com.    And if you want to recommend this newsletter to your friends or colleagues, tell them to sign up at vox.com/future-perfect-newsletter. Access the web version of this newsletter here.   This email was sent to aymentanaze.news@blogger.com. Manage your email preferences or unsubscribe. If you value Vox's unique explanatory journalism, support our work with a one-time or recurring contribution.   View our Privacy Notice and our Terms of Service.   Vox Media, 1201 Connecticut Ave. NW, Floor 12, Washington, DC 20036. Copyright © 2023. 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