Teeny-tiny deities

 kw: book reviews, nonfiction, genetics, recombinant dna, gene editing, ethics, morality

When I saw the title of As Gods: A Moral History of the Genetic Age, by Matthew Cobb, I knew I was in for a bit of preachiness. I was right, but it was worth it. Dr. Cobb has been among those in the forefront of genetic research for several decades. His perspective is unique. His moral perspective is also nearly unique, as he reports. Few can keep their integrity: As is usual with us faulty humans, when something gets big, really big, you can ferret out nearly every motive by keeping in mind, "Follow the money." There's enough potential money involved that whole national political attitudes have been shifted, repeatedly. I am politically unwise, so I'll leave it to you to read the gory details; I'll look at the technologies he presents us.

The book traces the history of genetic modification, including the dreams of those who, before the ink was dry on Watson and Crick's publication of the structure of DNA, began to opine rapturously about "rewriting the code of life". The predictions of "what we can do with DNA" exceed even the rhapsodies of those promoting "artificial intelligence". I see these two realms of technology running in parallel, a neck-and-neck race for general godhood on both fronts.

Let's look at the current situation first. The present culmination of all the technologies called "genetic editing" is the precise removal and replacement of a single nucleotide, an advance called Base Editing. It's a step beyond the more familiar CRISPR (more below). Versions of this called Prime Editing and Double-Prime Editing are being worked out at present. These technologies still need to go through a number of medical and regulatory hoops before they can be used for therapies, but they are the most promising to date.

CRISPR, when it appeared a decade ago, and garnered a Nobel Prize for Drs Jennifer Doudna and Emmanuelle Charpentier in 2020, was called "DNA scissors". I describe it a little more here. Once the CRISPR agent latches onto DNA, a CAS protein (CAS9 is best known) cuts both strands, and related molecules add "new stuff" at the break and the knit it back together. In more recent years it has been found that the agent isn't as specific as was first thought, and that multiple trials are often needed to get the result you were after. That makes it too risky to use for editing the human germline (the sex cells that turn into babies). Base and Prime Editing methods need a great deal more research and testing to make sure they are as reliable as we need.

However, these targeted mechanisms are a great deal better than older methods, outlined in the book, including something called TALEN, which I liken to a moderately-well-aimed axe. A TALEN needs less accessory machinery than CRISPR and its descendants, because the aim is to remove the "bad half" of a DNA double strand, and let cellular machinery patch the break with a copy of the opposite, "good" side.

Let us consider, though, that methods such as TALEN and earlier tools are not totally obsolete. A proverb of mine (from the Computer Science arena) is, "Nothing is obsolete if it does something you want done." Nature typically takes the "If it isn't broke, don't fix it" approach; our bodies are full of remnants of older structures that work well enough that evolution hasn't removed or replaced them. Think of the appendix; its function has been largely superseded by the spleen, but is still does a couple of immunological functions well enough that we still have it. It is worthwhile keeping, even though we can live without it (mine is gone, 20 years past). Other animals with a less-developed spleen have a much larger appendix. Irony personified: "appendix" means "added on" or even "useless". It isn't.

"Recombinant DNA" is now considered old hat. The technology is more than forty years old. Millions of diabetics are alive because nearly all the insulin they need is produced by this technology. Before recombinant insulin was economical, an eye doctor prescribed insulin drops for my eye, to heal an injury. It was pork insulin, and I was allergic to it; I almost lost the eye. This is the real "Frankenstein" method, where DNA from one organism is spliced into DNA from another. 

Every time a new genetic technology was developed, it was both hyped and decried. Purple promises abounded in medical literature and the popular press, and accusations of "acting like God" abounded right alongside them. On four occasions, lovingly detailed by our author, the researchers have come together and slowed things down. Though they have never called for a moratorium (the "m" word, to many of the author's colleagues), perhaps at least temporary moratoria ought to have been urged. The researchers may not have gone far enough, but the fact that they went as far as they did, and four times, indicates the moral quandary in which they found themselves. 

One side aspect of CRISPR (I think  I have this right) is the Gene Drive, which produces a kind of non-Mendelian inheritance that can drive a species to extinction, either by eliminating all the males or making them all sterile. The mechanics of XY chromosome systems makes it easier to target males. The appearance of this technology led to the closest thing to a moratorium, but eventually, this did not come about. As it happens, a Gene Drive isn't the magic bullet. Limited tests had some early success followed by reduced effectiveness of the Drive. It isn't 100% effective (is anything?). Thus, there are a few survivors. They sire a population that isn't affected by the Gene Drive, and pretty soon the pest (such as a mosquito) you were trying to eradicate returns in a more resistant form. But suppose you did drive a malaria-bearing mosquito species to extinction, worldwide: How likely is it that another species will take its place? Will the replacement be better, or perhaps worse?

If a Gene Drive were developed that affected the human species, then what? There are some folks, often called "environmental wackos", who think the Earth is better off without humans. If a few of them get their hands on a few million dollars, what's to stop them from producing, and then releasing, such an agent? Could its progress be stopped? "Playing God" works both ways.

I find I haven't said much about AI, though I intended to. Similar noise abounds around AI as a doomsday technology. But I think I don't need to say more at this point. Mark Twain wrote, "The reports of my death are greatly exaggerated." So are the predictions of imminent human extinction by DNA or by AI, and also the utopian fantasies regarding both.

A quote near the end of the book sums up a lot of this very well, as told to the author by Sheila Jasanoff:

I think that the fears, the nightmares, serve their own purpose. They are prods to make people think harder about the things that can go wrong. If the 'hope people' are the warriors, then the 'fear people' are the worriers. I think we might need both of them in society, to keep the one calibrating the other, and in some kind of balance.

Although there are those who really wish to exercise godlike powers, it's ironic that the best anyone can so far do is make tiny changes—one base here, half a dozen there—to a DNA library with several billion. A real God, for those who believe in Him, made all of it, all at once.

__________________

A bit off a quibble as a postscript. A chapter titled "Weapons" describes several kinds of what are called "gain of function" research, and mentions several viruses, including a variant of Smallpox, that were made many times more virulent than the "natural" product. But the author goes out of his way to say that the SARS-Cov-2 virus that causes COVID-19 was not produced this way, stating "there is no evidence of this". He has believed a lie. I do not attribute falsehood to Dr. Cobb, but naivety and foolishness. A very few facts:

• Dr. Fauci is known to have responded to a Federal moratorium on gain-of-function research by going around the regulations to funnel several million dollars to the Wuhan Institute of Virology to carry out such research on coronaviruses. (This is usually called money laundering)
• He and others said for a long time that the virus came from a bat bought at a "wet market", and later that it came from a pangolin. The Wuhan wet market does not have either bats or pangolins for sale, not now, and not in 2019. (Yes, I have sources in China)
• He has more recently said that there may have been a "lab leak".
• One of the doctors at the Wuhan lab published several articles, including in Nature, about gain-of-function research on coronaviruses collected from bats a few years previously.
• Thousands of Wuhan residents took vacations in the US and other Western countries in mid-to-late 2019, before the Chinese government announced anything about a new respiratory disease erupting in the Wuhan area. This "pulse" of Wuhan-resident vacationers was unusual. It was followed by the first "pulse" of COVID-19 cases in the West.

I conclude that there was a lot more involved than a "leak" from the Wuhan lab. It is a near certainty that the first genetically-engineered bioweapon has already been used. In folklore, the "bad gods" such as Loki always seem to get their licks in first, and are just barely overcome. Human gods are no better, and typically far worse.

How do we restore appropriate doctoring?

kw: book reviews, nonfiction, medicine, ethics, doctors, memoirs

In all the various stories I have gathered of troubles I have had with or about medical doctors over the years, the problem has always been competence, not ethics. If the experiences Dr. Sandeep Jauhar has described are truly typical, it seems I've been quite lucky. His new book is Doctored: The Disillusionment of an American Physician. The main title is a reflexive jest, because he was the one "doctored", or taught, through his experiences. He got an attitude adjustment, and not one that I would applaud.

General Norman Schwarzkopf said (I paraphrase), "Hardly anyone goes to work daily expecting to do a bad job." In the same way, very few begin a medical career intending to do harm or to get rich off the poor. In his former book Intern Dr.Jauhar described his trials after completing medical school and entering residency. There, he was the abused one, and he harks back to those days a few times in Doctored, when he meets residents and interns who callously take advantage of new ways of doing things, going home at the end of a shift, regardless what is happening, seemingly without caring a whit for the patient being handed off to the next shift's physician. While he never saw one stand up in the midst of CPR because "it was time to go home", but it almost came to that.

To become a family doctor these days is the fastest way to get into practicing on one's own, but it still takes a good while: four years of medical school and at least two years of residency, and perhaps a year or two of fellowship. At the earliest, a newly minted family physician can begin practice, whether privately or with an organization, by age 28 or 29. Dr. Jauhar is a cardiologist. The residency was longer—I am not sure whether he did one or two—and he performed a few years of fellowships before being hired as the attending cardiologist at Long Island Jewish Medical Center at age 36. This accords with the experience of a family friend who also got free of his "education" at age 36 and is now in practice as an orthopedic surgeon.

When you are pushing 40 and have a quarter-million in education loans to pay off, it's hard to make ends meet, even if your pay is well above the national median of $52,000. The book covers a period of about eight years, just the right span of age for most of us to get around to having a midlife crisis. Dr. Jauhar didn't really have time for a midlife crisis. He had a career to jump-start, and soon found the jumper cables were badly frayed. We read a lot about his wife's increasing distress as their savings dwindle after one child is born, and then when another is on the way.

Urged, berated, and nearly bludgeoned by his wife and by circumstance, he began to work part time for another doctor who is in private practice. He soon learned that is it all about business. He didn't have the heart, or the right way of thinking, to do well in business. Ask a doctor why there are so many tests ordered these days, and why nearly everyone gets the same tests regardless how sick they are. The standard answer you'll get is likely to be something about "defensive medicine", the need to "cover all the bases" to avoid litigation. The answer you won't hear is that the insurance companies pay better for some tests than others, and it is the high-dollar ones that are the most overused. Dr. Jauhar found himself "doing scut work for peanuts", to use a phrase he doesn't use, but that I've heard from others. Though he could now make ends meet, he felt he was beginning to lose his soul, helping a doctor game the system and get rich at the expense of the American public.

Make no mistake about it, we all pay for unethical medicine. Most of Medicare is paid for by a payroll tax, and its losses are covered out of the general Federal budget, from taxes we all pay. Insurance companies are not in business to subsidize health care, and must indeed make a profit, so premiums increase and increase to cover the actual costs they incur. Don't pay any mind to a few blind guides who boast that American medicine is the best in the world. Yes, there are a few areas in which treatments in America are the most effective, but in general we pay more than twice as much per capita as in any other developed nation for the thirtieth or fortieth best medical system.

The book is in three parts, titled "Ambition", "Asperity", and "Adjustment". In the end, he adjusted. That, I find rather sad. He got doctored all right. I remember once remarking that a good subtitle to the musical Grease would be "The corrupting of Goody Two-Shoes." Here, I cannot say Dr. Jauhar has been corrupted, not quite, but he has to admit there is a stain on his soul. The incentives built into moderm American medicine, which will be only partly relieved and otherwise exacerbated by the Affordable Care Act (AKA "Obamacare"), practically force a doctor to defraud the system to make a living, and yield incredible riches to those most adept at doing so.

I recall the "traditional" insurance plans called "Major Medical." Patients were expected to pay out of pocket for all the ordinary stuff: doctor visits or office visits (in a day when the doctor visited you a third of the time), and most pills or shots. If you needed something less ordinary such as setting a bone, or sutures, or an operation, the Plan paid 80%, and rates were such that most middle-class Americans could afford their 20%, maybe with a little short-term loan. Now that insurance plans purport to "cover everything" (It's not true, but that's what they advertise), where is the incentive for anyone to economize? When everyone pays thousands and thousands yearly for their medical plan, they feel entitled to go to the doctor for every little thing, and they're OK with the doctor ordering dozens of tests of all sorts, because "the Plan will pay for it". The next year, premiums go up, and the few who are wise realize that once "the Plan" has paid, it has to get the money back, and premiums are its only source of income.

Our system isn't just broken, it is devastated. Dr. Jauhar doesn't have much in the way of solutions to offer. I do. Vote with your feet. Get your "ordinary doctoring" from a local physician. If you need something major, assuming you're capable of travel, go to India or England or somewhere else with one of those 30-40 medical systems that outperforms ours, where you'll pay less at full price, including your travel costs, than you would for the "Co-pay" demanded by the hospital here. Medical tourism is on the increase, for good reason. If enough of us do so, the American medical system will respond to the only force mighty enough to change it: Competition.

Declared dead, or made dead?

kw: book reviews, nonfiction, medicine, organ transplants, ethics

There were 28,114 organ transplant operations in the US in 2010. In that year, the gross income of the "organ transplant industry" was about $20 billion. That is more than $700,000 per transplant. In 2011, 6,669 people died who were waiting for a transplant. Had organs been available for every one of them, it would have generated an additional $4.7 billion in revenue. When that kind of change is on the line, many people's ethical compass can become quite skewed. For a bit more detail, see note 29 on page 328 of The Undead: Organ Harvesting, the Ice-Water Test, Beating-Heart Cadavers—How Medicine is Blurring the Line Between Life and Death by Dick Teresi.

This book is a splash of fresh-off-the-glacier ice water in the face of anyone considering being an organ donor. Did you ever watch the 1978 movie Coma, or read the book (1973)? At the time, it was fiction. Very little of it is fiction any more. Only one of the book's premises is still not fulfilled: there is no widespread practice of over-anesthetizing people into a coma to make their bodies available for "harvest". Note that I wrote "widespread"; there have been a few such cases, but they went nearly unreported. There is increasing sentiment among transplant proponents to make this also come true!

Actually, anesthesiologists are a major group that works for more restraint in organ harvesting practices. Author Teresi interviewed a number of them who told of being ordered not to apply anesthetic to "brain dead" patients, even though they were showing signs of agony as they were dissected and their organs removed. It is widely thought by transplant doctors that anesthetic will damage the organs in some way, making them less likely to "take" in their new hosts. This has not been shown to be true, but evidence is very scanty, precisely because so few transplant harvesting dissections have been done with anesthesia!

The book is very thorough, and thoroughly researched. It took over a decade. On a subject of this importance, you don't want to hurry. The author is reporting the facts as they have been presented to him. He is not anti-transplant, but some doctors evidently think he is. He has garnered rather furious reactions from a few. He has been accused of homicide by proxy, for any people he might discourage from being an organ donor. And it is a fact that when someone who could donate dies without having any organs "used", three or four people will probably die as a result. But they will die anyway, just perhaps a little later.

The opening section of the book covers this matter at length. The death rate hasn't changed in thousands of years: one per person. Medicine has two parts. One is improving wellness so that the years you have are better years. The other is attempts to delay death. A life "saved" is actually a death postponed. Death-postponing medicine is a Tetris game. You might zap block after block for a long time, but sooner or later one is going to make it to the bottom row, and "Bing!", the game is over.

A friend of mine had a kidney transplant about ten years ago. He was told that a kidney lasts ten to twenty years, but sooner or later the anti-rejection drugs can't keep up with the immune system and the kidney is rejected and dies. Then it is back on dialysis while awaiting another kidney that "matches". Actually, modern drugs can make just about any organ "match". You just go to the back of the line and wait until your name comes to the top. It takes 7-10 years, unless you are somebody important enough to get preferred treatment, but that's beyond our scope here.

Do you know what "brain dead" means? If you do, please let everybody know, because you are the only one! The laws that (very badly) regulate a doctor who will declare someone dead have been changed again and again, primarily to make it easier and quicker to change the legal status of a person from "living" to "dead" and get the body into the hands of the transplant team. The situation is so confusing that the studies which have been done to determine whether guidelines are being properly followed have found that the "compliance rate" is only 35%. Nearly two-thirds of death declarations are made prematurely or on the basis of insufficient testing. At one point the author wrote, "Whether you are judged to be living or dead depends on which doctor gets to you first." (p 45) He goes on, "I had hoped to write about the science of death determination. But the denial of death affects scientists, too…" There is no science of death determination!

The author relates visiting his father, who was in the ICU. He had a brief conversation with him. His father asked a question and responded clearly to the answer. A young doctor came in, interrupted, and took the author into the hall, to tell him not to be fooled by random noises, "Your father is in a coma and will not recover." As he stood, aghast, an older doctor came over and told him that is how young neurologists are trained. Guess which doctor I would have immediately ordered barred from further contact with the patient? The author doesn't say what he did about it.

The first big change came in 1968, when thirteen Harvard men gathered behind closed doors and hashed out a definition of "brain death" that has since superseded the old definition of death as "heart stopped, can't reliably restart it". Be it known that simpler (easier to apply) definitions have been implemented since then, step by step. Nowadays, the doctors want the heart to be in good working order, and they want it to keep the organs in good, transplantable condition. So when a patient has sufficient brain injury that they are unresponsive to the four or five typical tests (such as squirting ice water on your eardrum; if you have any awareness at all, you'll jerk and shout), your death is "pronounced" and the transplant team is notified. If the heart is having difficulty breathing, machinery is used to keep it going. Usually within minutes, unless your family very, very strenuously intervenes, your "operation" begins.

Do you think determining brain death ought to require some kind of objective test, such as monitoring blood flow to the cortex, or using an EEG? So does almost everybody except the transplant team. Where some wise person has forced an EEG to be used, about ten percent of the time the brain was active. There was just some problem with the brain stem. Past experience has shown that such persons can gradually recover, at least to some extent, and usually don't wish to die just yet.

Then there are NDEs, near-death experiences. There are thousands of such cases. In some, there was no EEG for many minutes, but after recovery the patient reported seeing or hearing things that happened during the "flat line" time. They were "brain dead", but clearly it was not a permanent condition, and they were somehow aware in spite of being legally dead. There are mysteries here that the doctors are very far from plumbing.

Laws are still being changed. In Washington, D.C. and a few other places, a declaration of "terminally ill" is enough to get you at least partially dissected, before your family is notified. And, more and more ICU's are effectively becoming places where early attempts at restoration are followed by "warehousing" until death can be pronounced. Frequently, most medical treatment is withheld at this stage, to quote: "In 1988, 51% of ICU patients died because medical treatment was withheld. By 1993, that number had shot up to 90%." (p242) If you take more than four or five days to recover in the ICU, you, too, could be the target of this kind of medical murder. Sure, some folks get "terminal enough" that it makes sense to pull the plug, but the difference between 51% and 90%, in just five years, is mostly related to a increasing pressure to find transplant donors.

A few bad apples spoil things for everyone. It seems the transplant industry has succeeded in attracting more than its share of bad apples. Doctors have angrily told the author that people are going to die because of his book. People may tell me the same thing over this review. I look at it this way, why should I support continued bad behavior? Put your house in order, and I'll support you. I am philosophically in favor of organ donation, but the current medical climate has turned the philosophy on its ear.

My driver's license indicates that I am a donor; I don't recall whether I actually said Yes or No or if I was even asked. I think the same applies to many of you. When you are getting a driver's license, if they ask about organ donation at all, it is done quickly, usually when you are distracted signing your name or filling in a form. Do you remember giving consent? Neither does my wife. She and I will probably get new licenses that say "No", very soon. Changes must be made in the organ transplant system before I will agree to be involved in any way.

Do you know which doctors get the highest pay? Transplant surgeons. $400,000 per year or more (that is their net, after they have paid their staff and so forth). Nurses, hospitals, and a host of others are paid large amounts for their participation. But it is illegal for the organ donor or the heirs to receive any money. They usually get stuck with large hospital bills for any unsuccessful attempts that were made to save the person's life! A week in the ICU can cost $100,000. I suggest the following:

• Mandate the use of both EEG and blood flow monitors to determine if the cortex is living or dead. Current tests only check certain brain stem functions, and poorly at that.
• Do not allow any member of the transplant team access to the patient until after the attending physician has pronounced death. That includes a "transplant team friendly" nurse, a frequent occurrence that ought to stop.
• Reduce the amount paid for transplant surgery to about 25% of current amounts.
• Require the donor's estate to be paid the same amount as the transplant surgeon(s), for the total of all operations involving this person's organs.
• Wipe off the books all medical costs accrued by the patient. Charge them to someone else if you must.

The monetary provisions above are controversial. While they may lead to conflict of interest within your family, they will greatly reduce conflict of interest among the doctors and hospitals. Who do you trust more, your kids or your doctor? If you don't trust your kids, you need help beyond the scope of this essay.

Meantime, what can we do?

• Make a living will, or advance directive, or whatever it is called where you live. Carefully think through every provision. This is not a one-hour job! Make sure all your relatives have a copy (even the faraway ones; you may get sick on a visit), and, of course, every doctor you are employing. Carry a copy when you travel.
• If you wish to be a donor, you would do well to get politically involved and work towards getting the five provisions above enacted into law. You don't want to be the one who isn't quite as dead as they thought you were, when the knife goes in. More importantly, get your spouse, parents, children and other relatives on the same page with you, so they will defend you adequately if needed, to prevent premature harvest.
• If you prefer not to donate, make sure there is no "red heart" or other indication on your driver's license that you are a donor. Have you ever looked? If it is there, get a new license, and state specifically that you DO NOT want to be a donor. It also might be a good idea to get a tattoo, preferably in the middle of the chest, in inch-high red letters, "NOT an Organ Donor!!". Show it to your relatives. Show it to your doctors. Make sure they all understand that your relatives will sue the butt off anyone who dissects you anyway.

I sure wish life were simpler.

The new voodoo

kw: musings, genetics, ethics

On the way to work, I was listening to a discussion of genetics and privacy. One of the participants was Art Kaplan, a bioethicist from U. Penn, who was warning just how hard it is to keep our DNA private. We shed skin cells at the rate of a couple of grams a day—that is billions of cells—and a small sample of our saliva, such as a lip mark on a drinking glass, contains a sample sufficient for sequencing. I recalled that we lose several dozen hairs from our head daily, and men with body hair lose another few dozen from arms, chest, whatever. Then there is shaving residue, both male and female.

Who might want our DNA? Plans are in the works, for example, to maintain a national DNA database for criminal investigations, similar in nature to the FBI's fingerprint database. So far, the FBI hasn't gained authority to have everyone fingerprinted, but you'd be surprised how many fingerprint sets are on file. All sorts of programs that take prints get into the files (For example, I've been fingerprinted for a criminal background check, needed to teach music. I am sure the FBI got a copy). So, the FBI and most other criminal investigative bodies are interested in our DNA, though they are likely to have political trouble getting authority for comprehensive DNA gathering.

Who else? My insurance company would love a DNA sample. They could find out if I'm prone to genetically-determined chronic diseases; they can't as yet exclude coverage, but they are sure to try to get such powers. Will the day come when I won't be able to get coverage without having a mouth swab taken?

Even if such measures never become legal, some entities may find it worthwhile to gather DNA on the sly. It is so darn easy! Legends of voodoo, not much based in reality so I'm told, imagine a kind of "espionage of body stuffs", where a practitioner gathers skin flakes from your mattress and pillow, shed hairs off the floor of your room, and even cells shed into your toilet. Such measures, found in fiction, but not much in real life, could become a new trade in "gray DNA harvesting".

But it doesn't need to be that intrusive. The waiters at a restaurant, or the busboys, can get DNA from drinking glasses. It can be gotten off doorknobs, and from sweat in garments and gloves. Imagine what a cloakroom attendant would be willing to do for a doubled or tripled salary. The mouse pad at my desk probably contains millions of cells shed from the skin of my hand over recent months. Who is able to enter my office after hours? Does anybody in my company care? Will they ever? (Therefrom cometh paranoia)

Your hair and fingernail shavings may not be much use in making a voodoo doll, but they could be gold to your insurance company. Perhaps the only defense is rampant vigilantism against such practitioners, to make it so NOT worth their while…

Legislation and Morality

kw: laws, ethics

I began to hear something new starting in the 1960s. People began do oppose or disparage laws proposed or laws existing, by saying, "You can't legislate morality." My response is always, "Oh, really. Can you tell me anything we legislate that is not morality?" Where there is no moral issue, there is no need of law.

Every system of law is based on a moral code. Like it or not, the legal system of all Western societies is rooted in the second five of the Ten Commandments. At times, groups or nations have experimented with adding "theocratic" laws, those based on the commandments related to worship, idolatry, blasphemy, sabbath-keeping, and filial piety. All such experiments have failed, though a few lasted a generation or two. But the strictures that prohibit murder, theft, adultery, perjury, and greed are all upheld at some level by legislated statutes.

By making such laws, we as a society declare our minimum standard of moral behavior. We state that we will sanction behavior that falls below that standard (whether or not such sanctions are enforced consistently). While we may expect most people to live by a standard higher than "what's legal," we refrain from legal action until the line is crossed.

Let's take commandments in order. While not all killing is murder, the state reserves for itself (that is, to its agents) the right to kill for judicial purposes, or for conducting war. A few narrow areas are exempted, primarily for self defense. Even then, someone who kills another while defending herself is likely to suffer legal consequences nearly as great as someone convicted of lesser degrees of manslaughter. Few deny the government the power to decide the boundary between justified and unjustified killing. What is subject to current legislation (and court action) is the rather mobile location of that boundary. For example, killing a fetus was once defined as unjustified murder. Now it is is not.

Recently, a man was allowed by the court to finally accomplish a killing that it seems he began to perpetrate about fifteen years ago. When that happened, I said to my son, "It may happen in your lifetime that you will be asked to determine if my life should be ended for the sake of convenience."

Theft, we all know what that is, don't we? We all agree it is wrong, but we do not all agree on where the boundary lies between legal taking and illegal taking of another's property. Taxes are considered a legal taking (by most, anyway). Recently the boundary moved, in two areas. An airline company was allowed to deny pensions to many employees, even removing funds that some employees had "earned" in the pension plan. One could say that is a theft, but the courts ruled otherwise. Of course, now we are talking judicial action, not legislation. Congress is presently struggling with new laws to reverse this. They are unlikely to succeed.

Another case that has so far been decided only judicially is the vast expansion of eminent domain powers, so that a city can raze a neighborhood for the sake of replacing it with something like a mall, that will of course bring in more taxes than the residential properties could. This effectively eliminates the value of holding property, and I predict there will be vigilante action before the matter is sorted out. Dear reader, please note that I do not state actions I might take, but predict the actions of others.

Third, there are quite a number of laws still on the books in various places that disallow various sexual actions. Once "no-fault" divorce became the norm, the police in most places stopped enforcing them. Gay rights activism led to "de-enforcement" of quite a number of others. So far, nobody has persuaded the government of any U.S. state or county to de-criminalize sex between an adult and a minor. It could happen...

This is a hot topic these days, particularly now that Canada has enacted statues that allow and support "marriage" between two people of the same sex. Many U.S. states have laws, recent or not, that disallow such unions. These are being attacked by likening them to old miscegenation laws that disallowed unions between black and non-black. The issue isn't the same, for it requires re-defining the word "marriage," in a way that it has not been used, in any society, since there was human language.

Some Native American societies had a system in which a woman could take another woman as a "wife," but the union was not called a marriage. They had other words, in every known case.

Perjury, and deception. We have lots of laws about this. Not enough to keep your nest egg safe from the next con artist who rings your phone, but enough to keep things to a dull roar. We came close to convicting two Presidents of perjury (Nixon and Clinton). But the sanctions for most kinds of lying are pretty minor. Particularly when we enter the realm of "white-collar crime," we find that paying fines for committing deception is considered a cost of doing business...if you're caught.

Just think. If you cut off a carpenter's arm, you could get 20 years for battery, and be paroled in nine. Kill the same carpenter, and with a plea-bargain you'll still get about twice that. But if you cause an Enron crash, removing the livelihood of thousands of people, leading to hundreds of untimely deaths on the side, you get five-to-eight, if you get any time at all, and you can be paroled in a year.

Oh, well. My point here is not whether the laws are equitable, but that they are all moral. One more. Greed. The former four Commandments are all results of greed of one kind or another. We have very few laws addressing greed itself, and for good reason. It is hard to measure. Covetousness may lead to all kinds of other misbehavior, but the legal system waits for the misbehavior before taking action.

I suppose that's as it should be. Attempts at thought control have a more dismal record than theocracies. But, I hope you find yourself with a more clear response when someone says, "You can't legislate morality." We can so. We do so. And we must, if we are to have society at all.