Speaker 1: A quick note before we start the show. This episode
Speaker 1: is about depression and treatment for depression. It contains references
Speaker 1: to suicide. If you or someone you know is struggling
Speaker 1: with thoughts of suicide, we have links to hotlines and
Speaker 1: resources in our show notes.
Speaker 2: I am completely dependent upon electricity as medicine and there
Speaker 2: will never be a point in my life where I
Speaker 2: can quote go off the grid because I can never
Speaker 2: be without electricity for my own survival.
Speaker 1: Brandy Ellis calls herself a cyborg. She has an electrical
Speaker 1: implant in her brain twelve years ago. Before she got
Speaker 1: the implant, she often struggled with depression. She says it
Speaker 1: has made her feel more like herself. Brandy was first
Speaker 1: diagnosed with depression when she was twenty. At that time,
Speaker 1: she slept twenty hours a day and she cried often
Speaker 1: when she was awake for no reason. So she saw
Speaker 1: a therapist and went on medication, and she felt better
Speaker 1: like herself again. She consulted with her doctor and decided
Speaker 1: to stop taking medication, but a few years later her
Speaker 1: symptoms came back. Starting back up with medication and therapy
Speaker 1: pulled her out of it. The depression lifted. This cycle
Speaker 1: went on for over a decade, but when she was
Speaker 1: thirty two, the depression came back, and this time it
Speaker 1: felt different.
Speaker 2: I wasn't sleepy, I was anxious, and I had insomnia,
Speaker 2: and I was less weepy and more cranky.
Speaker 1: She had assumed her depression would resolve like it had
Speaker 1: every other time, once she found the right combination of
Speaker 1: medication and therapy, but for four years nothing helped.
Speaker 2: I tried over two dozen different medications of every conceivable type,
Speaker 2: and that is not counting all the various dosages of
Speaker 2: those medications and all the various combinations of multiple medications.
Speaker 1: Meanwhile, she couldn't hold a job. She moved back home
Speaker 1: to Dowray Beach, Florida, where her parents supported her financially,
Speaker 1: but not everyone in her life was so supportive. Some
Speaker 1: relatives told her that her depression was her own fault,
Speaker 1: that she was just being lazy. For the first time
Speaker 1: in her life, Brandy had thoughts of suicide.
Speaker 2: He never understood what it meant to be suicidal in
Speaker 2: any of my previous depressive episodes, and I refer to
Speaker 2: it now as my brain tried to kill me and
Speaker 2: I was trying to survive.
Speaker 1: As a last result, Brandy's doctors suggested she tried something
Speaker 1: called electroconvulsive therapy. It's a procedure where small amounts of
Speaker 1: electricity are sent through the brain to relieve mental health symptoms.
Speaker 1: It helped, but the relief only lasted for a couple
Speaker 1: of weeks. Brandy's doctors said that in order to keep
Speaker 1: her symptoms at bay, she'd have to keep coming back
Speaker 1: in for treatment every month indefinitely.
Speaker 2: And that was just something that I could not do forever.
Speaker 2: So it did look like I was going to be
Speaker 2: suffering like this for the rest of my life, and
Speaker 2: I didn't know how long I could survive that kind
Speaker 2: of life.
Speaker 1: Brandy's doctors said there was nothing left to try, but
Speaker 1: she wasn't ready to give up. She scoured the internet
Speaker 1: for other treatment options and did an online mental health
Speaker 1: support group. She read about a clinical trial that seemed promising.
Speaker 1: Researchers at Emory University were studying a type of treatment
Speaker 1: called deep brain stimulation. She said she didn't have high
Speaker 1: hopes that it could help her, but she thought it
Speaker 1: might be worth doing anyway.
Speaker 2: I felt like I was going to do the brain
Speaker 2: surgery and then it would not work, and I would
Speaker 2: still have this terminal depression and I would eventually die
Speaker 2: rather than continue to suffer. But I thought that I
Speaker 2: could be a data point that helped people who came
Speaker 2: after me.
Speaker 1: I'm Lauren and Rora Hutchinson. I'm the director of the
Speaker 1: Ideas Lab at the Johns Hopkins Berman Institute of Bioethics.
Speaker 1: On today's show, we're talking about the revolutionary technology of
Speaker 1: deep brain stimulation or DBS. DBS is a highly effective
Speaker 1: treatment for neurological conditions in the rare instances that patients
Speaker 1: aren't responding to other types of treatment. But computer based
Speaker 1: implants can change more about the brain than the disease
Speaker 1: they're meant to treat, which raises all kinds of ethical dilemmas.
Speaker 1: So when it comes to the possib ability of altering
Speaker 1: our personalities by implanting electronics, where do we draw the line?
Speaker 1: Are we giving computers too much control over who we
Speaker 1: are when we allow them to alter fundamental human traits
Speaker 1: like our emotions? And if it's okay to change our moods,
Speaker 1: what about other things like our intelligence? From Pushkin Industries
Speaker 1: and the Johns Hopkins Berman Institute of Bioethics, this is
Speaker 1: playing god.
Speaker 3: This is a neurosurgical procedure that involves the implementation of
Speaker 3: thin electrodes that are, i say, like the thickness of spaghetti.
Speaker 1: This is Patricio Riva Porse. He was one of the
Speaker 1: researchers conducting the study that Brandy came across. These days,
Speaker 1: he's the director of the Treatment Resistant Depression Clinic at
Speaker 1: Emery's a lot of his time working on deep brain
Speaker 1: stimulation and explaining how it works.
Speaker 3: The electrodes is implanted with a canula that keeps it,
Speaker 3: you know, kind of rigid until the point where you
Speaker 3: hit the target.
Speaker 1: The electrodes, he says, empowered by a device that's similar
Speaker 1: to a pacemaker, which gets inserted under the patient's skin
Speaker 1: near the collar bone. Before researchers brought DBS to people
Speaker 1: with depression, they were already using it for conditions like
Speaker 1: Parkinson's disease.
Speaker 3: This idea came from that application into saying, well, what
Speaker 3: if you can deliver small amounts of electricity to specific
Speaker 3: areas of the brain to stimulate circuits that are related
Speaker 3: to mood and emotions towards the circus that control those
Speaker 3: behaviors and those thoughts. In Parkinson's disease. The usual targets
Speaker 3: that are chosen are the ones that are involved in
Speaker 3: treating the tremor or the rigidity, and in depression, the
Speaker 3: circuits are quite different. Different areas were chosen to stimulate,
Speaker 3: and it seems to be that patients with depression have
Speaker 3: an increase in the activity in that area. And the
Speaker 3: thought was, well, what if you implant an electro there
Speaker 3: and you deliver a lot of electricity there. What you
Speaker 3: do is you put that area in an inhibited mode.
Speaker 3: So he turned it down.
Speaker 1: Patricio says that by the time Brandy came across his
Speaker 1: clinical trial, there was already some published research showing that
Speaker 1: his theory helped promise A small study show that out
Speaker 1: of six initial patients, DBS helped four of them. After
Speaker 1: six months of treatment, they were no longer depressed.
Speaker 3: The satisfying aspect of deep brain stimulation and other implantable
Speaker 3: devices is that when patients get well, they stay well.
Speaker 3: Continuous delivery of small amounts of electricity, you know, as
Speaker 3: as simple as it may seem, it seems to be
Speaker 3: a treatment that is sustained over time. That's I think
Speaker 3: is what is so hopeful about these implantable neuromodulation techniques.
Speaker 1: He says, the procedure comes with risks too, like brain
Speaker 1: hemorrhage or infection. It is brain surgery after all.
Speaker 3: And then you have negative outcomes of what happens if
Speaker 3: treatment doesn't work right. These are patients that are very,
Speaker 3: very ill with depression for years. They have a much
Speaker 3: higher risk of suicide. And unfortunately, across the trials there
Speaker 3: have been patients who have died of suicide. I have
Speaker 3: not seen patients who because of the DVF they attempted suicide.
Speaker 3: I think that we attribute the suicide, of course as
Speaker 3: the ultimate negative outcome, but as the failure of the treatment,
Speaker 3: of treating the illness that we want to treat. Right
Speaker 3: as if you were having a clinical trial that treats
Speaker 3: advanced cancer, if patients die of that cancer, you don't
Speaker 3: say that it's because of the treatment.
Speaker 1: All these things were explained to Brandy when she first
Speaker 1: contacted Patricio and the other researchers back in twenty eleven,
Speaker 1: and none of it scared her off. In fact, almost
Speaker 1: the opposite.
Speaker 2: It sounds terrible, but I felt like the people who
Speaker 2: thought that I wasn't trying hard enough to get well
Speaker 2: would change their mind if they knew that I had
Speaker 2: had brain surgery trying to get well.
Speaker 1: Not everyone was convinced. To some of her family members,
Speaker 1: DBS didn't sound like medicine. It sounded like a shortcut,
Speaker 1: just turning her emotions over to the control of a computer.
Speaker 2: After a few.
Speaker 1: Appointments to determine whether she was a good candidate, Brandy
Speaker 1: was accepted to the clinical trial for DBS. She moved
Speaker 1: to Atlanta, where she'd need to live for at least
Speaker 1: a year.
Speaker 2: The surgery itself was exhausting. It was very long. So
Speaker 2: it starts way before dawn, and you go in and
Speaker 2: they give you a nice IV to keep you calm,
Speaker 2: and they start drilling a frame into your skull.
Speaker 1: The frame is temporary. It's just to stabilize the patient's
Speaker 1: head during the operation, because for the first part of
Speaker 1: the surgery Brandy would be wide awake.
Speaker 2: Then you go into the operating room and they bolt
Speaker 2: that frame to the operating table, and this way you
Speaker 2: absolutely cannot move your brain, your head, any part of
Speaker 2: your upper body.
Speaker 1: The operating room was crowded with neurosurgeons and the research team.
Speaker 1: Surgeons started stimulating different points in the target region of
Speaker 1: Brandy's brain, trying to pinpoint where to place her implant.
Speaker 1: Each time, they asked her if she felt anything, and
Speaker 1: at one point she did.
Speaker 2: It felt like gravity decreased a little bit, like I
Speaker 2: did not. My mass was less, you know it was.
Speaker 2: I felt lighter, like more air came into my body.
Speaker 1: The surgeons put Brandy under anesthesia, placed the implant in
Speaker 1: that spot, and sewed her back up. The surgeons gave
Speaker 1: Brandy's body a few weeks to heal before turning on
Speaker 1: her device. By chance, that date happened to be the
Speaker 1: eleventh of November twenty eleven.
Speaker 2: I thought eleven eleven eleven was an amazing day to
Speaker 2: become a cyborg.
Speaker 1: Cyborg, of course, is a science fiction term, not a
Speaker 1: medical one, but she likes the way it sounds. When
Speaker 1: the implant was initially turned on, Brandy didn't notice much
Speaker 1: of a change, but about two months later, she has
Speaker 1: what she calls her first good day.
Speaker 2: I was still very very sick, still very very depressed,
Speaker 2: but I could get out of bed and brush my
Speaker 2: teeth and maybe leave the house, and I didn't hate
Speaker 2: my existence.
Speaker 1: Slowly, Brandy started having more good days. Six months after
Speaker 1: her device was switched on, she felt significantly better. By
Speaker 1: the time she'd had it on for eleven months, she
Speaker 1: no longer met the diagnostic criteria for clinical depression.
Speaker 2: I did my best to be very mindful about adding
Speaker 2: one thing back at a time, you know, getting a relationship.
Speaker 2: I met my partner then, and I started to be
Speaker 2: able to support myself and go on trips with friends
Speaker 2: and build a life again.
Speaker 1: Brandy's surgery was twelve years ago now, and she's still thriving.
Speaker 2: In that time.
Speaker 1: She's only felt depressed once out of nowhere. About two
Speaker 1: years after the surgery, she'd started feeling weepy and exhausted,
Speaker 1: so she went to see her research team. They discovered
Speaker 1: that her device had had a minor electronic glitch and
Speaker 1: it had turned itself off.
Speaker 2: And then realizing that was why was when the light switched.
Speaker 2: You know, that was when I realized that this absolutely
Speaker 2: was what was responsible from my recovery. Was this implant,
Speaker 2: This entire bonus life that I have, this sort of
Speaker 2: extra life from a video game that I got from
Speaker 2: this device is the only reason that I am still
Speaker 2: alive today.
Speaker 1: After hearing Brandy's story, I wanted to know more about
Speaker 1: the ethical issues surrounding DBS, like how valid are the
Speaker 1: concerns that DBS outsources too much of a person's self
Speaker 1: to a computer. So I talked to someone who's thinking
Speaker 1: critically about the current and future applications of this technology
Speaker 1: and the thawny ethical questions that surround it. That's after
Speaker 1: the break. Karen Ramelfhanger is a neuroscientist and ethics scholar.
Speaker 1: She's the founding director of the Institute of Neuroethics. She
Speaker 1: explores the potential trajectories of new technologies like DBS and
Speaker 1: the various ethical, medical, and legal ramifications.
Speaker 4: On a day to day basis. I'm exploring the ethical, legal,
Speaker 4: and social pations of new neuroscience. So I am thinking
Speaker 4: about and trying to systematically address questions about how neuroscience
Speaker 4: might challenge our notions of identity, the kinds of world
Speaker 4: we want to live in our day to day life
Speaker 4: as we know it.
Speaker 1: Karen also happens to know Brandy Ellis, who we heard
Speaker 1: from earlier. They both get a lot of invites to
Speaker 1: speak to medical students and bioethicists about DBS and sometimes
Speaker 1: end up on the same panel. I call Karen to
Speaker 1: get a better understanding of where the technology is today,
Speaker 1: where it's going, and what the ethical concerns are.
Speaker 4: While there are remarkable clinical effects tied to deep brain stimulation,
Speaker 4: there were some puzzling ethical tensions that came up around
Speaker 4: deep brain stimulation, and that was for Parkinson's patients. There
Speaker 4: were a small number and still are a small number
Speaker 4: of patients who experienced really identity kind of changing or
Speaker 4: perceived changes in personality and behaviors that they tied to
Speaker 4: the technology. So there were questions about who was actually
Speaker 4: the narrator of the life at that point. Was it
Speaker 4: the technology or was it the person? Was it some
Speaker 4: kind of combination And the goal of the intervention at
Speaker 4: that time was to alleviate movement problems, and now we
Speaker 4: also are exploring brain technologies for intractable depression mood disorders
Speaker 4: that can't be treated by anything else. In this case,
Speaker 4: some of those fundamental features of one might argue those
Speaker 4: or personality features or ways that someone had learned to
Speaker 4: interact with the world for a long time with terrible
Speaker 4: suffering with depression, that maybe now we're actually using the
Speaker 4: deep brain stimulation to change those fundamental features of that
Speaker 4: person's life. So it's not a side effect, It's actually
Speaker 4: part of the treatment. So how do you manage some
Speaker 4: of the tensions in that space around ensuring that the
Speaker 4: person who is getting the treatment is in the t
Speaker 4: I ever see that they are aware of the types
Speaker 4: of experiences they might have in their relationship with that
Speaker 4: technology might change over time.
Speaker 1: So would you say that deep brain stimulation could change
Speaker 1: who we are?
Speaker 4: It's a question that I explore. So I believe that
Speaker 4: all technologies that we create are really a social mirror
Speaker 4: for our fears or aspirations for the kind of world
Speaker 4: we want to live in. So in that way, you
Speaker 4: might ask if these kinds of technologies are tools for
Speaker 4: us to better become ourselves, are they collaborators for becoming ourselves?
Speaker 4: Or in some cases, are some of these tools identities
Speaker 4: in their own right? So these are the types of
Speaker 4: questions I'm exploring.
Speaker 1: And you're involved in the essical and legal approaches to
Speaker 1: these technologies. So who gets to decide, like, even if
Speaker 1: it matters whether they change who we are, who gets
Speaker 1: to say in that?
Speaker 4: Thus far, the conversation hasn't really involved a lot of
Speaker 4: the lived experience the people who are actually using these technologies,
Speaker 4: or might use them in the future, and in a way,
Speaker 4: we are all patients in waiting who may one day
Speaker 4: need these technologies for a variety of reasons. So a
Speaker 4: lot of these ethics conversations, and rightly so, they might
Speaker 4: emerge from scholars in the university. They're people who have
Speaker 4: close interactions with the research and the evolutions of it,
Speaker 4: and we start to see clinical researchers in those conversations
Speaker 4: as well, and then you start to see them kind
Speaker 4: of enter into the policy maker space. But there hasn't
Speaker 4: been a lot of room for people like Brandy Ellis,
Speaker 4: and that's a problem, and we don't have a good
Speaker 4: systematic approach for that, and so I think it's important
Speaker 4: to have formal platforms to give patients and those who
Speaker 4: have lived experience with the devices a voice. But right
Speaker 4: now it's largely dictated by the people doing the research
Speaker 4: and the people who fund that research.
Speaker 1: Could you talk a bit about health equity and who
Speaker 1: so far gets access to these treatments.
Speaker 4: Deep brain stimulation requires a lot of expertise and specialized materials.
Speaker 4: You're not seeing this readily available and accessible most places,
Speaker 4: though in the US I wouldn't say it's easy to
Speaker 4: get it. I mean, I think you'd need to go
Speaker 4: to a specialty center to get it, for example, and
Speaker 4: then you might not have places like low and middle
Speaker 4: income countries who have access to expertise or materials.
Speaker 1: And so what does consent mean in this context with
Speaker 1: this kind of technology.
Speaker 4: That's a good question, and it's something that ethicists think
Speaker 4: a lot about, especially with brain disorders and where cognitive
Speaker 4: capacity might be different due to disease or ability. So
Speaker 4: it's important for us to note that consent is but
Speaker 4: one instrument of ensuring a patient's dignity, their agency in
Speaker 4: their care, and their right to health. So consent is
Speaker 4: not a perfect tool, and we should recognize that consent
Speaker 4: is also not a moment. It's an ongoing exercise where
Speaker 4: you don't just it shouldn't end when you sign a
Speaker 4: piece of paper. There should be an ongoing dialogue between
Speaker 4: the researcher and the participant in the study. I've actually
Speaker 4: listened to other patients talk about the way that they
Speaker 4: were evaluating the kind of risk was just, you know,
Speaker 4: I've already feel like I've got nothing left to live
Speaker 4: for and if this can actually help me want to
Speaker 4: live again, then maybe, but maybe I don't even care
Speaker 4: at that point. So the task is to not have
Speaker 4: the patient decide on their own. So they should also
Speaker 4: have a family member involved who can help them deliberate.
Speaker 4: So there should be someone else present to help. In
Speaker 4: the case of some of these studies, family member is
Speaker 4: required to also sign onto the study and be involved,
Speaker 4: because you need it's very involved for these participants. They
Speaker 4: have to come back from many visits, it's time consuming.
Speaker 4: They need another perspective to also track day to day
Speaker 4: how that patient is progressing.
Speaker 1: And I'm curious. So we're talking about consent of the procedure,
Speaker 1: but what about consent when it comes to turning an
Speaker 1: implant off.
Speaker 4: Yeah, there was a case where an individual had a
Speaker 4: deep brain stimulator put in for a Parkinson's disease, and
Speaker 4: they were one of the few cases that developed adverse
Speaker 4: effects of mania, and they ended up while the stimulator
Speaker 4: was on gambling, ruining their marriage. And the clinical team
Speaker 4: had to decide, you know, should this person The person
Speaker 4: has two choices, this patient, this patient can keep the
Speaker 4: stimulator on. Their motor symptoms are fairly resolved, but they're
Speaker 4: living in such a way that basically they should be
Speaker 4: institutionalized because of their reckless behavior and related to the mania.
Speaker 4: But if they had the device turned off, then the
Speaker 4: patient would be confined to a bed because they wouldn't
Speaker 4: be able to move around. So what should we do here?
Speaker 4: But the first step was the team needed to decide
Speaker 4: were they going to ask the patient if he wanted
Speaker 4: the stimulator on or off when he was on or
Speaker 4: when he was off. So it was a very tricky
Speaker 4: situation and they ended up asking the patient while he
Speaker 4: was off, thinking that this was his more authentic state
Speaker 4: of who he was. And when they asked the patient
Speaker 4: what he wanted to do with a stimulator off, he
Speaker 4: said he'd rather have it on, so he wanted it
Speaker 4: left on.
Speaker 1: And how common is it that deep brain stimulation has
Speaker 1: led to the negative consequences of people's behavior.
Speaker 4: It's actually not that common. So there are a handful
Speaker 4: of cases that have been documented that ethicis and scholars
Speaker 4: have really focused on and written tons of papers. In fact,
Speaker 4: new ethicists cut their teeth on this type of case study,
Speaker 4: but in reality, there's not that many cases. But still
Speaker 4: it's worth paying attention to because that's still one person's
Speaker 4: life who's dramatically changed in a way. They didn't want
Speaker 4: and you don't want that to happen again.
Speaker 1: Yeah, for sure. So I'm just curious with these devices,
Speaker 1: when would you say that they cross over from being
Speaker 1: therapeutic to actually providing some kind of enhancement.
Speaker 4: The therapy enhancement line has always been a blurry on.
Speaker 4: This really does tie to the kind of a knee
Speaker 4: jerk reaction of the notion of who has the right
Speaker 4: to change the human condition and society? Who is the
Speaker 4: right to play God? This is the name of the series.
Speaker 4: Sometimes it's not the playing god part that people are
Speaker 4: worried about, it's the playing part. So are you creating
Speaker 4: new circumstances that are irresponsible? Are you allowing humans to
Speaker 4: go beyond their swim lanes then they shouldn't. Are you
Speaker 4: overriding what is given? But we also know that many
Speaker 4: people are born with certain disabilities, and in those cases
Speaker 4: we don't say it's playing God, typically to try to
Speaker 4: cure them. So in that case, it's not just playing God,
Speaker 4: But how do we play God in the right way?
Speaker 1: Well, thank you so much, Karen. This has been really
Speaker 1: really fascinating to hear all about the important way that
Speaker 1: you're doing today. Brandy Ellis is grateful that she went
Speaker 1: through with the DBS implant. Now that she's back to
Speaker 1: feeling like herself, she seeks out opportunities to speak with
Speaker 1: physicians and researchers to help them understand what that dark
Speaker 1: period of depression and suicidal thinking was like for her.
Speaker 1: She feels that implant essentially saved her life and wants
Speaker 1: be able to know about how much it helped her.
Speaker 2: I want to make it clear that the DBS didn't
Speaker 2: change me. I am not a different person because of
Speaker 2: this implant. Depression changed me. Those years of suffering the
Speaker 2: depression altered my personality, every aspect of my life. The
Speaker 2: DBS did not change me. It restored me.
Speaker 1: Next time on playing God dging category of drugs can
Speaker 1: cure debilitating and even fatal diseases, diseases that were previously untreatable.
Speaker 1: But often these so called miracle drugs can cost a fortune,
Speaker 1: as one mother learned when her child was diagnosed with
Speaker 1: a fatal disease.
Speaker 2: We were talking about him living.
Speaker 4: I mean, you'll pay anything, Like I would say that quickly, like.
Speaker 2: Absolutely, I would pay anything.
Speaker 4: But then how can I pay anything? Like?
Speaker 1: How do I pay one hundred and twenty five thousand.
Speaker 2: Dollars a dose. Just get that out three times a year.
Speaker 2: That's impossible.
Speaker 1: Join us next week for more Playing God. Thank you
Speaker 1: to our guests Brandy Ellis, Karen Rommelfanger, and Patricio rev
Speaker 1: paulse Playing God is a co production of Pushkin Industries
Speaker 1: and the Johns Hopkins Berman Institute of Bioethics. Emily Bourne
Speaker 1: is our producer. This episode was also produced by Sophie
Speaker 1: Crane and Lucy Sullivan. Our editors are Karen Chakerjee and
Speaker 1: Kate Parkinson Morgan. Mixing by Samir Sengupta, Theme music by
Speaker 1: Echo Mountain, Engineering support from Sarah Bruguer and Amanda Kaiwang.
Speaker 1: Show art by Sean Krney, fact checking by David jar
Speaker 1: and Arthur Gompertz. Our executive producer is Justine Lang at
Speaker 1: the Johns Hopkins Berman Institute of Bioethics. Our executive producers
Speaker 1: are Jeffrey Kahan and Anna Mastriani, working with a Melia Hood.
Speaker 1: Funding provided by the Greenwall Foundation. I'm Laurena Rura Hutchinson.
Speaker 1: Come back next week for more Playing God. If you
Speaker 1: have enjoyed hearing about these stories and want to know
Speaker 1: more about the history of bioethics. We have been creating
Speaker 1: something very special for you. We have an oral history
Speaker 1: collection with the founding figures of modern bioethics in America.
Speaker 1: The collection is called Moral Histories, and in it you'll
Speaker 1: hear from people who are in the room as some
Speaker 1: of the most significant decisions were made about how to
Speaker 1: manage new technological developments in science and medicine. Go to
Speaker 1: Bioethics dot Jhu dot edu forward slash Moral Histories to
Speaker 1: learn more.