Should school start times be changed to accommodate the change in circadian rhythm which occurs during adolescence?

Okay, I know it’s a longer-than-normal title but that’s because it was also the title to the EPQ I carried out last year. For those of you that are unfamiliar with the EPQ, it stands for ‘Extended Qualification Project’ and is essentially a research project about anything you choose. At the end, you either make a product or write an essay; guess which I did? I wrote an essay debating whether or not high school start times should be changed or not, and found the topic so interesting that I thought I’d share a condensed version with you readers!

First things first: are teenagers actually sleep deprived? Constant tiredness is a stereotypical feature attributed to teenagers but are they really losing out on sleep or is it just every day complaining? The recommended amount of sleep for a teenager is about 9.25 hours, but the average that teenagers actually get is around 7 hours per night. This means that they are indeed sleep deprived, so much so that British children are rated to be the 6th most sleep deprived worldwide!

Sleep deprivation is very much a public health issue in my eyes, as the effects of it are detrimental to both physical and mental health. Coordination and endurance are hindered by tiredness, as well as skin problems and even metabolic deficits like obesity being linked to it. Mood can be poorly affected too, with higher occurrences of feeling unhappy or depressed. Outward behaviour can also change from being sleep deprived, with aggressiveness and irritability being seen in subjects lacking in sleep. This can harm relationships between teens and their friends and family. This, coupled with the increased feelings of sadness can lead to incidences of depression. Inordinate sleepiness also makes it difficult to concentrate and stay alert, as I’m sure any teenager you asked could testify to, making it hard to maximise learning at school.

But why are young people so tired? Well, some of this sleepiness could be explained by the teenage circadian rhythm. The circadian rhythm regulates when you fall asleep and wake up, but this sleep timing is all pushed back by 1-3 hours during puberty. More specifically the secretion of the ‘sleepy’ hormone, melatonin, happens and stops happening later into the night and morning. This means that teenagers naturally fall asleep later at night and wake up later in the day than an adult would.

As a result, waking up early enough to get to school by 8:30am clashes with the natural teenage sleep cycle. This impacts not only sleep length, but also quality. Clearly, if an adolescent struggles to fall asleep before 11pm but must wake at 6:30am then they’re not going to get the recommended 9+ hours of sleep needed. But the social jet lag effect created by ignoring your natural body clock results in poorer quality of sleep. Not to mention, the famed weekend lie-in is actually caused by a build-up of ‘sleep debt’ over the week. The body makes an effort to catch up on missed sleep after a week of deficit, but this later waking time on weekends leads to irregular sleep patterns. As I mentioned in my previous post about sleep, lack of routine damages sleep quality so lie-ins aren’t actually good for you.

So… could changing school start times help? Well, researchers at Oxford University predict that by changing high school start times from 8:30am to 10am, GCSE attainment could improve by 10%! This is because of the improved cognitive ability, concentration and attitude that would be seen as teenagers got more, better quality sleep. Thus by starting later, schools would be helping themselves and their students to maximise the time spent at school. Not only that, but the time spent out of school would also be put to better use as increased productivity would mean homework would be completed faster leaving more time for extra-curricular activities.

As I said before, sleep deprivation has very poor effects on young people. Naturally, by allowing teens to get the sleep they need many of these effects would be reversed leading to happier and healthier young people. The actual scale of these improvements can’t be predicted, but given the huge issues that the NHS currently faces with obesity and depression in youths, any improvements would be worth it- or would it?

Changing school start times, as simple as it sounds, would actually be a massive change. Transportation would need to be reorganised, new contracts for teachers would need drawing up, parents would need to change shifts or hire childcare and there would be less time available at the end of the school day. As well as school buses being used, many high school students and staff also use public transport. The shift in timings could affect costs to schools hiring buses and increase congestion, as the later finish would add to rush hour traffic and therefore travel times. This argument is full of faults though. I struggle to understand how the exact same route and the exact same number of buses and drivers would somehow result in higher costings just because it happens 2 hours later in the day. Also, whilst I can see how congestion could be made worse, at least less congestion would be found in the mornings as the rush to school and work would occur in staggered waves.

The later finish time is a common concern amongst young people, as it would leave less time after school for extra-curricular activities, homework and free time. For sports teams relying on outdoor practice, the loss of daylight hours could lead to less practice time and more competition between clubs for use of facilities. Similar competition over facilities could be found in other extra-curricular clubs, as well as less time being available for use of public services like the library. Less time to do homework after school is also a worry, though I have already mentioned the increased productivity that has been found in well-rested subjects meaning less time would actually be required to carry out the same amount of work.

Opposition from teachers would inevitably arise if school start times changed, for one thing because the later finish time added to the work many teachers do after school would result in very late finishes and isolation from their families as schedules clash. However, because adults do not need to wake up as late as adolescents do, teachers could easily adapt to the new school timings by moving all their extra work to the morning hours before school began and would still have the evenings to enjoy with their families.

Additionally, with high schools no longer starting and finishing around the same time as primary schools, childcare issues could cause a lot of stress for families. With older siblings no longer available to supervise younger siblings, parents would either need to change their shifts to make sure they’re home or pay for childcare. This would hit lower-income families the hardest, as lower-paid jobs often correspond with a lack of flexible working hours and to pay for childcare would leave behind less disposable income.

Finally, the sleep deprivation found in teenagers cannot be linked solely to their circadian rhythm. As with most things, a multitude of factors can be blamed either partially or wholly for the trend found and in this case the other considerations to think about are behaviour and the homeostatic system. The homeostatic system is yet another biological process that affects our sleep, but this time it affects sleep/wake length. Regardless of the time of day, the homeostatic system causes ‘sleep pressure’ to build up which can only be relieved by sleep. Now in teenagers, this sleep pressure takes longer to build up over the course of the day than it does in younger children which means that the desire to go to sleep kicks in later in teenagers which could explain the late bedtimes.

Another bit of biology for you: the circadian rhythm is controlled by the hypothalamus which detects light and dark signals in the environment and responds by releasing hormones, adjusting body temperature, etcetera to make you fall asleep. The key role that light plays in controlling our sleep timing and our ever-increasing use of technology may be a big contributor to why teenagers struggle to fall asleep at night. The blue-wavelength light emitted by electronic devices mimics daylight, tricking and stimulating the brain into staying awake and not triggering all of those bodily functions which make us feel tired. No doubt if you asked any young person, they could confirm to you that they routinely utilise some kind of electronic device in the 30 minutes before going to bed. And it is this behaviour which could be making it difficult for teenagers to fall asleep at night thus adding to sleep deprivation.

So you see, there is no simple answer to the seemingly simple question. There may be some biological component which fights against adolescents waking up early, but would fixing that fix the whole problem? And is it worth the effort it would require to implement such a huge change? In my opinion, even the smallest improvements are worth it. I know from experience what a huge difference just one extra hour of sleep makes to my mood and to how I receive the rest of my day. Imagine millions of people just that little bit happier, and what might’ve seemed like a small difference at first becomes something a lot bigger and better. As for the other question, realistically I don’t think that to only change school start times would completely fix the issue of sleep deprivation, but it is a start. For the best results, I would say that education on the importance of sleep and good sleep hygiene should be taught in schools alongside the start time changes.

 

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Genetically Engineering the Human Embryo- is it ethical?

Genetically engineered crops have been in use since the late 90s, and even that has flared up opposition based on possible risk to human health, the environment and other unforeseen repercussions. So mention genetic modification of humans, and the immediately conjured image is that of a perfect, superior and absolutely terrifying race of people that seem far less human than us. Whilst the technology for such things aren’t quite in our grasp yet, I think it is worth keeping tabs on just how advanced genetic engineering is becoming and start considering the consequences… before it’s too late (dun dun duuuuuun!).

So where are we at right now? Well, in 2015 this debate was reignited by a group of Chinese researchers who attempted to remove a mutated gene causing a deadly blood disorder from non-viable embryos. They did this using the game-changing gene-editing CRISPR-Cas9 tool which came about in 2013. CRISPR is part of a natural defence mechanism within bacteria against viruses, and cas9 is an associated enzyme to CRISPR. When it comes to genetic modification CRISPR-Cas9 can be manipulated to cut out any section of DNA, and if a new piece of DNA is placed near the cut site it is accepted by the body as a replacement. This means that ‘bad’ genes can be removed and replaced by the healthy version, but it’s not as straightforward as it seems. The research in China had to be abandoned partway through, because unintended mutations were found in the genome which could cause cell death and transformation. Clearly, not a great outcome but it did, as I said, grab the public’s attention and get people talking about it which in itself is a much needed effect.

Since then, research on human embryos has been carried out in various places but never with the intent to implant them into a woman. Recently, details of the first successful genetic modification of a human embryo in the US were released. The scientists also used CRISPR, this time to remove the mutation causing a heritable heart condition which can cause sudden cardiac death. This was an exciting discovery but again would not result in implantation. So why not? Implantation of genetically modified embryos is illegal everywhere, with any research at all in the UK being very limited. But should it be?

Let’s first consider how genetic engineering of embryos could be an asset to the medical world. The most obvious use for genetic modification is to use it to eradicate genetic diseases. Countless diseases, many of which are very dangerous, are caused not by viruses or bacteria but due to mutations in our DNA. Whilst genetic engineering cannot help those already living with such a disease, it can prevent those diseases from being passed on to offspring and future generations. Long term, this could lead to targeted diseases eventually dying out. Clearly, that would be a desirable outcome which could save many lives. But as well as how dangerous a disease may be, it is important to also consider how living with that disease affects quality of life.  Many genetic diseases, like cystic fibrosis, can only be managed rather than cured. That management can sometimes require a lot of care to be provided by medical staff and/or family members and can limit the freedom and capability of sufferers. By correcting the mutation in an embryo which screens positive for a certain disease, the resultant baby when born would be void of the disease as opposed to having to manage the condition for the rest of their lives.

Some have suggested that the need to eradicate genetic diseases is unnecessary, given that embryo screening means parents who are concerned about passing on a disease to their offspring can screen embryos and select to use those which are healthy. However, this method still results in diseased embryos being destroyed which in itself is considered unethical dependant on at what point you believe life begins. Furthermore, some parents can go through countless expensive IVF treatments, screening each time, and still be unable to produce an embryo which doesn’t have the disease. In this case, the only other way to ensure a child can be born from those parents is from the use of genetic engineering.

One fear voiced by some is that any change to our DNA could create a butterfly effect, with unpredictable consequences affecting future generations with altered genes. Indeed any change would always carry a risk of unexpected and unwanted repercussions and so any and all genetic modifications would need to be considered carefully to try to minimise the occurrence of such ramifications. Some say that better yet, no changes should be made full stop to the human genome as the risk isn’t worth the benefit. This argument could be coupled with the above one, ensuing that genetic engineering is not necessary as alternative options are available so why take the risk for something that isn’t an absolute must?

A similar issue surrounding genetic modification is the idea that by selecting or ‘deselecting’ certain genes and versions of genes, we make the gene pool smaller and reduce genetic diversity. In the future, this could cause problems should the deselected genes became useful, desired or even necessary. For example, if a disease was deadly to everyone except those with a certain mutation but that mutation was no longer around due to genetic engineers targeting the removal of it, then the human race could be seriously under threat. Of course, this is a worst-case-scenario example but one which still needs to be considered, not to mention that lower scale versions of this could happen also. There is a flaw with this argument though, in that I struggle to see how the mutation for, say, Down’s syndrome could benefit future generations. Whilst I understand that we should preserve as much genetic variety as possible, I do not think that retaining genes which are not just ‘undesirable’ but are actually harmful and causes suffering is necessary for the sake of genetic diversity.

Finally, and most importantly to most people, there’s the matter of designer babies. Even with the emergence of genetically modified crops, worries about the applications in humans to create designer babies were loudly voiced. The selection of certain characteristics which are considered more desirable, such as intelligence, would clearly be wrong… wouldn’t it? Of course, one could say that a great many characteristics, physical or otherwise, do have some sort of health benefit so it is ethical to seek them. After all, medicine looks not just to cure illness but prevent it and improve quality of life. So it stands to reason that if freckles are associated with a higher risk of developing skin cancer, then genetic modification to remove freckles makes sense, no? And if self-esteem issues could be prevented by genetically engineering babies to make attractive adults, would that not improve the mental health of the general population?

I’m hoping at this point that you can see the point I am leading into, and not just cheering me on. Almost all genetic modifications can be argued to be of value medically, with some arguments being admittedly less believable than others, and so we reach the heart of the problem with genetic engineering; at what point is the modification acceptable, and when have we gone too far? And so the solution for many is to just proclaim all modifications are unacceptable, and the result is that no progress can be made because everyone is too busy worrying about the worst case scenario.

But how likely is this scenario, really? Already, research happening now must have ethics approval. The currently proposed use of genetic engineering would be carefully monitored and controlled. Any governments that endorsed it would no doubt be setting guidelines and restrictions to make sure it didn’t get out of control, wasn’t misused and was safe and ethical. If these rules set out were even in the least bit breached, the watchful eye of the authorities would be alerted and the scientists could be stopped long before they got anywhere close to the production of ‘designer babies’.

What’s more, many characteristics are not solely controlled by genes, but by environmental influences. And even though genes do play a part in it, often more than one gene affects a feature that a person may have. So qualities like intelligence or sportiness can’t just be ‘manufactured’ into a person, and the emergence of designer babies isn’t quite as realistic as people fear it could become.

Whether you agree with genetic engineering embryos or not, the most important thing right now is that the matter is brought to the public eye in a big way. We need people talking and thinking about where they stand on the matter, so we can begin to put regulations like the ones mentioned above into place. Perhaps society will continue to ban genetic engineering altogether, as it generally has in the past. Or maybe, common sense and a little faith in the human race not to take it too far will push us into the future, one with fewer genetic diseases and less suffering.

 

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Euthanasia- Should it be legalised in the UK?

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There is no doubt that euthanasia is a difficult debate, with passionate views  both for and against it. Assisted suicide has been legal in Oregon since 1997, and assisted suicide and euthanasia have been legal in the Netherlands since 2002- so why, in 2017, is no form of assisted suicide or euthanasia legal in the UK?

 

First, what is euthanasia? Euthanasia is the act of deliberately ending a person’s life to relieve suffering. Meanwhile, assisted suicide is the act of deliberately assisting or encouraging another person to kill themselves.

Euthanasia can be defined as active or passive and voluntary, non-voluntary or involuntary. Active euthanasia is when a person directly ends someone’s life, for example giving a person a lethal injection. Passive euthanasia is when a person causes death by withholding or withdrawing treatment which is necessary to maintain life, for example taking a person off a life-support machine.

Voluntary euthanasia is when a person wants to die and involuntary euthanasia is when a person is killed against their express wishes. Non-voluntary euthanasia is when a person is unable to give consent so another person makes the decision on their behalf, for example if a person is in a coma.

 

Under English law, euthanasia is regarded as either manslaughter or murder and is punishable with a maximum penalty of life imprisonment. Assisted suicide is also illegal and punishable with up to 14 years imprisonment.

Active euthanasia is legal in Belgium, the Netherlands, Luxembourg and Colombia. Assisted suicide is legal in the Netherlands, Oregon, Washington, Vermont, Montana and Switzerland.

One of the few doctors in Britain charged with attempted murder was Dr Nigel Cox in 1992. He injected his patient of 13 years, Lillian Boyes (70 years old) who had rheumatoid arthritis, with potassium chloride in order to stop her heart. She was said to have pleaded with him to end her life and during the court case, Ms Boyes’ family never wavered in their support of the doctor’s actions. Dr Cox was charged with attempted murder because it couldn’t be proved that the injection itself killed her and he was given a 12-month suspended sentence.

 

The principle of autonomy can be used to argue for the legalisation of euthanasia. In medicine, autonomy is the right of competent adults to make informed decisions about their own medical care. This means that patients have the right to refuse medical treatments and to decide what happens to their body after they die (for example, donating organs). It could then be argued that patients should also have the right to die, and that making euthanasia illegal does not allow for complete patient autonomy.

This must be weighed against beneficence. Doctors are meant to ‘do no harm’ and do what’s in the best interest of the patient. Therefore, it is questionable whether or not ending a patient’s life is breaking a doctor’s code of conduct. However, one could argue that as long as the patient understands every facet of the decision at hand and would still like to end their life, then it is a doctor’s duty to help them do so. As well as beneficence, there is fear that the legalisation of euthanasia could damage the doctor-patient relationship. Patients could begin to lose trust in their doctors, and believe that the doctor does not have the patient’s best interest at heart but instead just want to ‘get rid of them’.

 

The law against euthanasia can be unfair, as it does not allow those wanting to end their lives to do so in a safe and peaceful manner. Without an assisted dying or euthanasia law people try to commit suicide in private, ending their lives at home and alone as they cannot talk to their family or doctor about the decision. People should not be forced into such circumstances, and should be able to say a proper goodbye and be with loved ones if they still make the decision to die.

Also, people may instead decide to travel abroad to die (e.g: Dignitas in Switzerland) because they cannot die how they want to in the UK. A trip like this can cost up to £10, 000 and people are often in pain, so travelling may put them in distress. Furthermore, a person wanting to die may journey abroad sooner than is necessary as they fear that if they stay in the UK, they will miss their chance to leave by becoming too ill to travel.

 

Many people believe that the government should not be able to intervene in personal matters like death. In the past and even currently, should the government introduce a policy for vaccination it is met with a flood of opposition and yet the government can make assisted dying illegal? It is a fair argument to say that the state should not create laws that prevent people from being able to choose when or how they die, as that is not the purpose of the government.

Despite that, the government do have a duty to protect those who are vulnerable such as the ill, elderly and disabled from feeling pressured into ending their lives and being exploited. In 2015, MPs rejected the legalisation of assisted dying in England and Wales with 330 votes against and 118 in favour- this shows that clearly the government is nowhere near legalising assisted suicide or euthanasia with such an overwhelming majority voting against it.

 

A sizeable proportion of those opposing euthanasia argue on religious grounds; human life is sacred and only God has the right to take life away. Some go as far as to say that the pain terminally ill people may experience in death is just another test set by God, similar to some of the reasoning behind refusal of chloroform use during childbirth when it was first discovered in Victorian times.

However, not all religious people do oppose euthanasia. In the above mentioned rejected bill a Rabbi said, “We are saddened that it failed to progress, as it dashes the hopes of those who wish to avoid ending their days in pain or incapacity”. Like with many other things in religion, opinions of euthanasia is dependent on personal understanding and observance of religious teachings thus can vary from person to person.

 

Religious and atheist people alike argue that euthanasia devalues life in society’s eyes, making it easier to end lives and accepting that some lives are worth less than others. This is one of the more potent arguments against euthanasia, as it links to the ever prevalent ‘slippery slope’ issue. The concern that legalising voluntary euthanasia might lead to allowing non-voluntary and involuntary euthanasia is at the forefront of most people’s mind when discussing euthanasia, and with good reason.

Nevertheless, the very fact that people are so apprehensive of the ‘slippery slope’ means that if euthanasia or assisted suicide was legalised, people would be vigilant and safeguarding would be put into effect to ensure no one was pressured into ending their lives and that any euthanasia carried out was definitely voluntary. What’s more, Oregon is a working model and proof that the slippery slope is not inevitable. Assisted suicide for the terminally ill has been legal for almost 20 years in Oregon and there have been absolutely no cases of abuse reported. The UK would not be the first to legalise euthanasia and we could use the methods in places like Oregon and the Netherlands as a template for our own laws.

Likewise, another case made against euthanasia is that it could lead to a lack of compassion in doctors as they become used to ending lives although I think this is unlikely as such fears are voiced about abortion yet it has not happened in the 50 years that abortion has been legalised.

 

The final and perhaps simplest argument against legalising euthanasia: with modern medical care and pain relief, there is no reason that in the right environment a person can’t have a dignified and painless death. So is legalisation of euthanasia or assisted suicide really necessary?

Sadly, not all people would agree. Quality of life is very subjective and impossible to truly measure, so we cannot decide for other people whether they’re life is worth living or not. Despite the alternatives to ending one’s life, such as palliative care, if a person believes their pain is too great for them to  bear then no matter how great the alternatives are, euthanasia should be available to them should they request it as it is almost cruel to force people to live and adds to their pain.

 

In conclusion, euthanasia is possibly one of the toughest and most serious medical ethics debate but it is important to think and form opinions about it. The 2015 vote was the first ever serious attempt to change Britain’s assisted suicide laws in the House of Commons in at least 20 years, but that was only the beginning. Currently, a man with Motor Neuron Disease (Noel Conway) is seeking a judicial review of the Suicide Act of 1961 and other countries have increasingly been changing their laws to support assisted suicide and even euthanasia in the last 10 years.

I think, on balance, that I would support a change to the law regarding assisted suicide and euthanasia. Whether or not I agree with euthanasia is besides the point because for me, I see this as a choice issue and I believe people should be given that choice as it is not fair that the law forces the opinions of those opposed to euthanasia on those in need. That said, if it ever is legalised in the UK, the law must support and protect both those who wish to end their lives and those who do not to ensure that there is no abuse at the same time as providing mercy to those who ask.

 

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