This is an edition of Up for Debate, a newsletter by Conor Friedersdorf. On Wednesdays, he rounds up timely conversations and solicits reader responses to one thought-provoking question. Later, he publishes some thoughtful replies. Sign up for the newsletter here.

Question of the Week

Last week, Spiegel International reported on a country where carnivores can already legally dine on meat that is produced from the stem cells of animals. As the article put it:

Just imagine for a moment that you could save the world with chicken nuggets. All you would have to do is just eat them. Your teeth would sink into real meat, yet no animal would have lost its life for your meal. It will have been grown in the laboratory from a single chicken cell. Imagine that there would suddenly be enough meat from the laboratory to feed everybody in the world. Hunger would be a thing of the past. The land now used to grow corn for animal feed could be repurposed, perhaps even for a forest that could draw CO2 out of our atmosphere. Industrial livestock farming would no longer be needed.

To be sure, solutions that sound so simple should be approached with caution. But there is a place where the utopia described above isn’t as far away as it might sound. Where such laboratory chicken can be tasted and where the nuggets are being served up on real plates.

That place is Singapore.

There’s lots more at the link, including a review of lab-grown “chicken.” And still more fodder on synthetic meat from Virginia Postrel. What do you think about meat grown in a lab? Would you eat it? Will your grandchildren? Will we ever stop eating non-laboratory-grown animals?

Send your responses to conor@theatlantic.com or simply reply to this email.

Conversations of NoteDenying Treatment to the Imprisoned

Convicted criminals are among the most hated figures in most societies––and uncoincidentally, they suffer some of the most egregious injustices perpetrated by the state in America. Solitary confinement is often inhumane. Prisoners are sexually assaulted at inexcusable rates. And a Stat News investigation documents another practice that I find indefensible: the systematic withholding of lifesaving medical care from prisoners with hepatitis C.

Nicholas Florko’s report begins with John Ritchie, who was serving a 20-year sentence for armed robbery in Missouri when he sought a 12-week course of treatment that would cure his condition:

Ritchie begged repeatedly for the medicine ... The prison system knew he was getting sicker and sicker—it documented his deteriorating condition in his health records. The prison’s doctors wrote frequently he would benefit from hepatitis C treatment. But officials still denied him, in the same way a STAT investigation documented prisons around the country are still denying thousands of others the cure. So the virus infecting Ritchie’s blood continued to replicate, scarring his liver until it was so damaged that it could hardly function. Eventually he was diagnosed with liver cancer, a common complication of untreated hepatitis C. Now, the prison argued, he was too sick for the drugs to work. They refused him again. He died in June 2021 at the age of 64, nearly five years after his first request for medication.

STAT’s investigation found that 1,013 people died of hepatitis C-related complications in states’ custody in the six years after the first cure, a Gilead antiviral drug called Sovaldi, hit the market in late 2013. This tally, based on an analysis of 27,674 highly restricted death records, has never before been reported. Many of those 1,013 people were not serving life sentences; they would likely have had the chance to return home, reapply for jobs, and reconnect with parents, spouses, and children—or, in Ritchie’s case, his one grandchild, Gabe. Many should not have died. In fact, the treatment for hepatitis C is a modern medical marvel. The scientists who paved the way for its discovery won a Nobel Prize. Public health experts say it’s possible to cut hepatitis C deaths to virtually zero, and effectively eliminate the virus as we’ve done with smallpox or polio.

This article reminds me of a proposal I’ve been meaning to air despite the fact that it is almost certain to anger many and seems unlikely to be politically viable: much as Washington, D.C., and various territories have nonvoting members in the House, I think there should be a nonvoting House member who represents the interests of incarcerated people in the United States.  

When Educators and Parents Disagree

This week I published an Atlantic article about what ought to happen when parents and educators disagree about how to handle the gender identity or expression of very young children. It begins with a case study taken from the premier journal of early-childhood educators:

Meet Michael, a 4-year-old who “usually comes to school in jeans and a T-shirt but always goes to the dress-up area as soon as he arrives and puts on a dress or skirt.” The preschooler is the subject of a 2019 case study in the education journal Young Children’s “Focus on Ethics” column, a recurring feature about how educators ought to respond in fraught situations––in this real case, a parent objecting to their child’s gender expression.

Take off that skirt, Michael’s mother tells her child one day while volunteering in the classroom. She orders him instead to put on firefighter gear, a cowboy hat, or “something that boys do,” the authors Stephanie Feeney, Nancy K. Freeman, and Katie Schaffer recount. Later, the parent tells the teacher, Ana, that Michael “plays female roles at home and shows little interest in toys and activities typically associated with boys.” She asks Ana to prohibit Michael from playing with “girl stuff” at school. “Ana also has observed that Michael strongly prefers playing with girls,” the authors add, “and chooses activities that are stereotypically feminine, like having tea parties and wearing dress-up clothes that have lots of ribbons and sequins. He also frequently tells the other children that he is really a girl and that he wants to be called ‘Michelle.’”

What should Ana do?

The National Association for the Education of Young Children, which publishes Young Children, has a Code of Ethical Conduct that directs teachers to “recognize and respect the unique qualities, abilities, and potential of each child”; to “develop relationships of mutual trust and create partnerships with the families we serve”; and to “acknowledge families’ childrearing values and their right to make decisions for their children.” In essence, this case study explores what ought to happen when those obligations are in conflict.

In the case study’s telling, Ana has an ethical obligation to side with the child. For my own viewpoint, click through and read the rest, because I want to focus here on some reader responses.

D.M. writes, “I just wanted to echo my agreement with what I’d call your position of ‘principled ethical humility.’ We *know* what our principles are in general, and we should stick to them, but we shouldn’t pretend to have all the answers. This is a brand-new area of ethics, it’s really fraught among *all* cultures, and it’s OK to pause and appreciate that instead of making absolutist pronouncements.”

An anonymous reader who teaches high school in New England reports struggling with the issue of kids wanting to keep their gender identity from their parents.

He emailed:

There are wonderful things about the school: the kids are very intelligent, they explore their passion and care about their classes, and the community is accepting of everyone. However, there is a strange paradox where students are simultaneously seen as helpless children who deserve month-long extensions on assignments, a minimum grade of 50% on missing work, and hours and hours of social/emotional learning while also given radical self-determinism in how they present themselves, which teachers must hide from their families. There have been a number of policy decisions related to gender identity that have made me uncomfortable.

I want to provide a window into my school's policy:

1. I’d estimate 25% of all students identify as trans or gender non-conforming. Perhaps the number is higher, but it is certainly not lower. Many of these kids have never gotten a medical diagnosis; some even make no effort to present as the opposite gender yet insist on using different names and pronouns. The majority of these students are white females.

2. I have students who have changed their name/gender identity multiple times throughout a semester. It became pretty exhausting to keep up with.

3. Many students insist on being called a different gender than they present as with the plea “do not tell my parents.” School policy is to use their legal first name and assigned gender at birth in conversations with their parents while simultaneously using the student’s preferred pronouns in all internal school communication.

This seems to be a ticking time bomb.

There are absolutely students who suffer from gender dysphoria and have made the appropriate medical/social arrangements with their families. However, these students are few and far between, and the vast majority of students that identify as gender non-confirming have done so with no medical/psychological intervention.

Without medical or psychological intervention, students live one way at school and another way at home. I cannot imagine how traumatizing and confusing that must be. There is little dialogue or communication about how to handle these situations. Instead, we accept a radical tolerance, often at the expense of struggling teenagers’ mental health. To me, hiding such important and consequential decisions from parents seems entirely unethical. But there has been virtually zero pushback from staff, most of whom I think agree with these policies.

The gender identity issue is a sensitive topic. Treating it as something as inconsequential as a nickname will lead to disastrous results for a generation already struggling with mental health to the degree that is crippling. As you said, this rigidness is not the way forward, especially if medical professionals are not involved. I am uncomfortable and worried about the liability of working in this environment. Unfortunately, I will leave this school—and possibly education—after this school year.

Michael articulates one view of the relationship between educators and parents:

Is defying the parents ever an ethical choice? It could be, in rare cases when a judge decides to remove the children from their parents’ custody. This course is reserved for extreme cases of abusive parenting. Otherwise the only ethical choice is to cooperate with the parents. Remember that the educators are not co-parents, they are essentially agents hired by parents (directly or through taxation) to attend to their children while the parents focus on the day job. If an educator notices some problem with the child, it is their duty to inform the parents, and—optionally—to offer their professional opinion on how to fix it.

Now if the parents insist on the educator doing something that the teacher finds unacceptable, e.g. forcing the child to drink milk or calling the child by a name that causes a distress to the child or disruption to the others, the educator should have an option of denying the family access to child care. That way the parents could seek to fix the problem themselves, find a therapy or specialized care facility or do homeschooling. Using your words, usurping parental rights is not an ethical choice, nor is it legal due to fiduciary duty of the educator.

I suspect some readers agree and others would describe the relationship very differently.

Jaleelah would defer less to parents as a general matter:

I can’t tell what your actual stance on parental rights is, but I strongly disagree with the premise that parents morally have any kind of final say (apart from input about severe health conditions) over what goes on in their children’s public classrooms. Consider the following “ethical dilemma.” A 4-year-old girl comes to school wearing a religious veil and takes it off upon entering the classroom. Her mother notices one day and instructs the teacher to make her put it back on. When the teacher approaches the girl, she starts crying about how she doesn’t believe in God.

What should the teacher do?

What is the difference between this situation and the trans one? In both cases, a child has understandable preferences about their identity and their preferred clothing. In both cases, a parent wants a teacher to overrule these preferences on the basis of religious belief. Much of the language you use in your article to describe the potential outcomes of the trans kid applies to the atheist kid too. “A teacher has no way to know for sure whether any preschooler or kindergartener will grow up to be atheist or otherwise non-religious.” How does this uncertainty justify forcing the kid–—or at least humouring the request to force the kid—to try out the parent’s preferred religion?

Personally, I think children deserve the same rights to belief and expression as adults. This view is shared (at least in theory) by nearly every country in the world: the US was one of the only UN members to refuse to ratify the Convention on the Rights of the Child. Children who grow up in an environment that teaches them their parents’ and communities’ political and religious beliefs have authority over their own grow up to be adults who believe it is justified to pass laws restricting expression in schools and universities.

I confess that I don’t have fully formed views about the rights of children at various ages, but I don’t think it is tenable to proceed as if American or Canadian children “deserve the same rights to belief and expression as adults.” An adult can decide, say, that all doctors are quacks, that eating vegetables is for suckers, and that they’re going to stand on a street corner and denounce women to all passersby. A parent would be derelict in their duty if they didn’t compel their 6-year-old to visit the pediatrician, eat all the required nutrients, and cut out the name-calling. I do believe that children possess some rights, including some expressive rights, but deciding exactly when kids are owed deference strikes me as complicated.

Great Expectations

A longtime teacher of teenagers joins the conversation about sports by lamenting the unrealistic fantasies they can stoke:

I lost count of the number of kids who had the attitude, “why do I need an education? I’m going to be the next Kobe Bryant/Derek Jeeter/Patrick Mahomes/Lionel Messi!” A majority of male students labored under the idea that their future was as a famous, rich, pro athlete. When you tried to point out the statistical improbability of this happening, they always assumed they were the exception that proved the rule.

Then there were the parents. I had one student, a really great kid, friendly, helpful, eager, who struggled academically. When teachers or counselors would try to address his struggles with his parents, his father would deflect with, “he’s going to QB for UCLA, who cares about his grades!” Never mind that his grades would be a problem for any college, much less UCLA––this kid was 5’5”, was not in the running to QB the high-school team, and would get killed by the guys on a college team. He loved welding. He’d come to class with art pieces he’d created. I hope he got to pursue that passion.

One more kid: actual star of the high school team. In 11th grade, he was in line to be the lead QB. Instead, he spent most of that season on crutches after a twisted knee in practice required multiple surgeries. This kid had lots of options, given his relative strength academically, but so much of his focus that year was on trying to get healthy again. We as a society need to get better at managing kids’ expectations about their purpose.

A Low Point for the Catholic Church

In The Atlantic, Elizabeth Bruenig writes on Pope Benedict XVI and the Catholic Church’s child-molestation scandal:

This was and is the sort of darkness not seen for centuries, a historic catastrophe. It affected its direct victims, their families and loved ones, the parishes and dioceses that became responsible for settling with them, the parishioners who now had to salvage their faith. The world—and the Church—post-crisis can feel like a place too violent, too exploitative for the vulnerability of enchantment. Perhaps the pope emeritus saw the magnitude of the damage himself, and perhaps his retreat came nearest to acknowledging it.

How heavy the toll is—how it colors the Church’s recent history with a streak of predatory menace, how it demands an accounting for itself even in moments of celebration and loss for the Church, how it irrevocably complicates simple lay faith. The summary Catholic novel of the post-crisis era may well be Mary Doria Russell’s prescient The Sparrow, whose protagonist cries out before a council of his brother priests: “I had nothing between me and what happened but the love of God. And I was raped.” To speak of the Church now is always to speak after the crisis; to write about the faith now is always to grapple with this ghastly inheritance. But where there remains something whatsoever to be said, there remains some hope, and some capacity for redemption. That belief may at last be the very one upon which the entire faith survives.

Provocation of the Week

In Nature, Emily Sohn defends the colonoscopy against a recent study that questioned its effectiveness at preventing deaths:

Colonoscopy is much less common in Europe, in part owing to questions about whether the test is too invasive and expensive to be worth recommending, says Michael Bretthauer, a gastroenterologist at the University of Oslo. To address these questions, he and his colleagues planned a randomized trial of colonoscopies. Starting in 2009, they recruited more than 84,000 people aged 55 to 64 from Norway, Poland and Sweden. Some were invited to get screened. Others received their usual health care but no such invitation. With about ten years of follow-up data, Bretthauer and colleagues released their attention-grabbing results in October 2022, seemingly suggesting that colonoscopies had a smaller benefit than expected.

There was just an 18% reduction in the risk of developing cancer among those who had been invited to get colonoscopies, and no significant reduction in the risk of death. But the study itself offered layers of interpretation that cast colonoscopies in a more favourable light. Overall, only 42% of people in the group that had been invited to get colonoscopies actually got one. If the compliance rate had been 100%, the researchers’ analysis showed, the test would have reduced cancer risk by 31%—from 1.22% to 0.84%—and it would have reduced the risk of death from colorectal cancer by 50%—from 0.3% to 0.15%.

Those benefits are significant, says Chyke Doubeni, a family doctor and colonoscopy researcher at the Ohio State University in Columbus, and there are reasons to think that they could be larger in other circumstances, especially in populations that experience disproportionately high rates of the disease. And despite the huge scale of the European study, ten years of follow-up is a relatively short period of time for colorectal-cancer development, says Amy Knudsen, who studies disease simulation models to inform cancer-care policy at Massachusetts General Hospital and Harvard Medical School, both in Boston. “I think we’re only going to see the impact of colonoscopy increase the longer we follow up,” she says. The European study is continuing to track participants.

That’s all for this week––see you on Monday.