#bioethics

[floral-ashes]

“Bioethicists must sometimes speak up and sometimes shut up. The greatest professional virtue is knowing when each is needed.”

New commentary essay in the Canadian Journal of Bioethics on the power of silence.

[imperatorsapphiosa]

Hey, do people know where I can find good resources about disability rights and advocacy from the perspective of a medical provider, especially from in reference to mental illness (particularly stigmatized mental illnesses like psychotic disorders)

As I finish my EMT training there’s a lot of stuff about my obligations to treat patients who don’t want to be treated, or even my obligation to apply restraint, and I want to learn ways to handle those situations that don’t involve violating consent.

[lilacsupernova]

Acknowledging that there is a symbiotic relationship between a pregnant woman and her developing baby, no matter whether she is a 'surrogate' or a 'real' mother – goes counter to the origin story of IVF and surrogacy which depicts 'making a baby' as a technological feat by 'technodocs' in which bits and pieces are combined – eggs, sperm, wombs, and of course the almighty genes. This origin story is far removed from the reality of a live woman's body that can grow a three-kilo-baby from an egg and a sperm cell. For potential baby buyers, thinking of a 'surrogate' as a petri dish eliminates the need for uncomfortable questions.

– Renate Klein (2017) Surrogacy: A Human Rights Violation, pp. 60-1.

[gay-jewish-bucky]

there really do need to be far more pediatric bioethics training programs. there are so many nuances to pediatric care that are not covered by any general bioethics program. most notably, the lack of power when it comes to their own medical decision making, and the importance of having adults to advocate for them where parents and doctors fail.

i think the absence of these programs comes from wider society not valuing those under the age of 18 as whole people who deserve to have their needs understood and met.

there are conversations happening now over if these programs are needed, but i feel like the best way to discover this is to actually create these programs and observe their impact on patient care.

[doctorspork]

Unlike cases of becoming a vampire, dementia patients do not wake up a radically different kind of being.

a real sentence in a real bioethics paper

[troythecatfish]

[fzzr]

Go read the Vorkosigan Saga. Don't worry, I'll wait.

What if I told you there's a science fiction series of well over a megaword written by a woman with a mix of male and female viewpoint characters? What about how it uses just a single bit of technology to interrogate gender roles, reproductive politics, bioethics, and more? I give you the Vorkosigan Saga, and its number one trick: the uterine replicator. It's dead simple to explain - a fully functional exowomb. What Lois McMaster Bujold does with it is the real draw.

First you have the table stakes, the things you get for totally free:

Eliminating any chance of teratogenic damage during gestation

Perfect cloning

Making any prevention of "natural" conception irrelevant to one's future reproductive options

Then the ideas from the first few books:

Engineering a new kind of human for zero-G by giving them four hands

Creating a monastery planet with only men, but a reproducing population through replicators

Pre-natal hostage taking

Later we have:

Engineering a class of übermenschen to rule over a galactic empire

Allowing a couple to have their honeymoon while leaving their kids to gestate at home

Creating children with two genetic fathers

Another technology that asks some questions is cryorevival - as long as you get the brain on ice fast enough, you can bring back the otherwise biologically dead (think "chest turned into a crater") with few if any side effects. What if a society decided that everyone who dies should be put in cryo just in case technology advances in the future to the point where they can be revived effectively? If you're in cryo and thus "potentially alive", what is your position in the line of succession?

That's far from all the series has to offer. Beta Colony, inventors of the uterine replicator, also offers perfect sex transitions. How exactly does the law work when a new male heir pops up in the middle a line of succession? There's a weapon called the nerve disruptor, which does exactly what it sounds like. What do you do with someone lobotomized in combat, but otherwise perfectly healthy?

Also, this is a space opera. Most of the viewpoint characters are aligned to some degree with a patriarchal galactic empire. If you capture a planet mid-terraforming, do you keep working on the terraforming to increase the value of the planet to your empire, or stop it so the population remains trapped in their domes and unable to mount effective resistance? How do you balance a desire to push for modernization from within against the risk of civil war if you go too fast?

Before I set you on your way, a few content advisories: Some of these books deal intimately (but not grotesquely) with sexual assault, and the physical and psychological consequences thereof. Mental health more generally is also explored, up to discussions of suicide. Infanticide comes up at least once. Terrorism and mass civilian casualties are discussed mostly but not entirely in the past. From above you should also have gathered that while the series doesn't revel in gore, it does partake in it.

So, your potential starting points:

Falling Free - A distant prequel to the rest of the series, it deals with the creation of the four-handed people mentioned above. As such, it mostly stands alone. Themes: Bioethics, technological disruption of labor.

Ethan of Athos - The book about what happens when a gay man from the monastery planet meets galactic society, and women, for the first time. It takes place in the middle of the timeline, but it largely stands alone with only one shared character due to being one of the first books published. Picking this just means you're starting with a stronger emphasis on gender politics instead of bioethics, you have to pick one of the other options listed here after you read this one to actually get into the series. Themes: Gender politics (emphasis on sexuality), bioethics, intrigue.

Cordelia's Honor - A collection of the two early books. The protagonist of these books is the mother of Miles, who will be the protagonist of many of the books going forward. Themes: War (inter-state and civil), bioethics, gender politics (emphasis on gender roles), terrorism.

Young Miles - A collection of the two books which follow Cordelia's Honor, about the early life of principal protagonist Miles Vorkosigan. Themes: Physical disability, politics, irregular war, intrigue.

Personally I would recommend chronological order, starting with Falling Free. This is implicitly the order endorsed by the publishing history, as the collections are organized chronologically. For example, Cetaganda (1995) is in the same volume as Ethan of Athos (1986) because they take place at roughly the same time. The only exception is that Falling Free was stand-alone for a long time until it was republished in Miles, Mutants, and Microbes alongside Diplomatic Immunity, despite the long distance between them in the timeline. This is for good reason - Diplomatic Immunity is the book in the main part of the timeline that most directly interacts with Falling Free. If you choose to start with Cordelia's Honor, this is not a problem and you can read Falling Free when it comes up later.

Final notes: Lois McMaster Bujold is retired and has no current plans for more books in this series, but it's not impossible that could change. For now you can at least treat the series as provisionally complete. Remember to get your books from a library or buy from a local bookstore, used if possible. Don't buy from Amazon if you can at all avoid it. Audible is Amazon.

[ngaatee]

I'm very curious about the thesis! I've been trying to look into posthumanism/transhumanist ideas more, especially from multiple perspectives. There's stuff I see never talked about irt it, for example, you see a lot of people idealizing robot bodies or whatever, but this sometimes gets weaponized into negative views towards disabled bodies. Meanwhile, the idea in your thesis is a complete blind spot for me and I would LOVE to see what it's about.

Hi anon, thank you so so much for the question! I agree, there are so many areas in this topic that are underexplored and under researched, and I intend to change that. I will be posting more and more research alongside my artwork, but I will probably also make the entirety of my academic thesis available considering how little research there is in the area altogether.... Would that be something you'd like access to? Enough of that though lets get into what the thesis is about:

Broadly speaking before we even get into the posthumanism/transhumanism aspect of bioethics, we have to contend with the increased access in, and the proliferation of biotechnologies. Biotechnology has come to include a lot of medical interventions that could be viewed as falling in line with the positions, goals and aims espoused in posthumanism and transhumanism.

This increase in access has challenged the way that we think about existing within our physical bodies because it changes the limitations of our human bodies that we are bound to. In order to consider the potential impact of biotechnology, bioethics has grappled with issues of the correct ways of “being” or existing within our bodies including but not limited to the emergence of identity, performance of identity, body modification as escapism, and movements such as posthumanism and transhumanism.

However, like much of philosophy as a broader field, bioethics is plagued by the exclusion of ways of thought that are nonwhite, nonmale, non-Western and non-working class and that has been a glaring problem. The above issues that bioethics deals with are arguably all related to the right to bodily integrity which can be defined in this context as the right to protect one’s body from the interference of other people.

In the philosophical space, the right to bodily integrity typically involves but is not limited to reproductive rights and general autonomy. This has made bioethics a space that requires philosophical feminist thought to confront the uneven ideologies about identity formation and the correct ways of existing in one’s body.

Given that Black African women have been greatly impacted by the issue of the right to bodily integrity, it is especially important that there is an African feminist framework that deals with the power dynamics that determine how people are allowed to exist and identify with themselves. The absence of African feminist thought in Bioethics is an epistemic injustice, that has weakened the overall process of collective knowledge building in the field. As a result, the practical application of ethics and morals in biotechnology is skewed into a cisheteronormative and masculinised colonial gaze.

The cisheteronormative gaze or cisheteronormativity refers to the oppressive institutions of socialisation such as the media and structural systems in general that use cisgender and heterosexual behaviours or norms as the prevailing or dominant status quo. By doing this, the lived experiences of queer and transgender people are excluded. This is compounded by the ways that social institutions reinforce white supremacist and patriarchal ideas, creating communities whereby groups that do not belong to the dominant status quo perform their identities in a way that oppressive institutions deem acceptable, similar to the panopticon view presented by Foucault.

The cisheteronormative and masculinised colonial gaze is a socialised way of thinking that favours the assumed moral and ethical values of cisgender, straight and white men, who form the majority of both the biotechnological and the bioethical fields. This gaze imagines existing in one’s body as a stagnant and neutral form of identity whereby decisions that we make regarding our bodies exist in a vacuum away from the impact of colonisation, white supremacist thought, the patriarchy and classism amongst other issues of marginalisation such as homophobia.

The scholar Pumla Gqola refers to the overlap of white supremacy, classism and the patriarchy as the “triple threat of violence”. In this conceptual framework, she suggests that when we consider ways of being, we have an emergence of new identities based on the need to navigate this triple threat of violence. This triple threat of violence has, according to Gqola, led to the treatment of Black African women’s bodies as public property which must be wielded in ways that people who are not Black African women deem appropriate.

The issue of treating Black African women’s bodies as public property is echoed by Gabon Baderoon who uses the case of Sarah Baartman as a means of understanding private and public performances of identity. In doing so, Baderoon highlights the specific ways that Black African women have historically not been treated as having ownership over their own bodies and instead have been made into a spectacle for the consumption of other people who act as voyeurs when it comes to Black African women.

This creation of spectacle has turned Black African women into hypersexualised beings whose bodily integrity has been inherently compromised through colonial violence and violation. These issues are relevant to the philosophical conception of identity, as it highlights the relationship between certain identities and shame or humiliation. Over time, Black African women’s identities have transformed. In part this is because identity evolves with societal, cultural and philosophical developments that challenge our assumptions about correct ways of being. However, this is also in part due to an effort on the part of Black African women to escape the violence and violation of identity, and fantasise about existing anew, in a body that is not subject to public spectacle.

The notion of fantasy is central to biotechnology and by extension bioethics because it imagines the human body and identity beyond biological limitation. The human body and identity beyond biological limitation is a general way of understanding posthumanism and transhumanism as movements.

In my academic thesis, I argued that African feminisms in the space of bioethics would assess whether or not posthumanist and transhumanist technologies compromise their bodily integrity by looking at the extent to which it bodily integrity may push them to either violate their bodies or free them to reimagine their identities, and by extension their bodies anew. I also explained the notion of a “cisheteronormative and masculinised colonial gaze” using Foucault’s panopticon, explained what posthumanism and transhumanism is (and how we tend to differentiate the two), discussed how identities emerge, showing how violation and violence relate to decisions about our bodies, the fantasy about ways of being versus socialised identity and responding to potential objections.

The reason I included Foucault in this is because I wanted to convey the ways that in posthumanism and transhumanism there can be an element of performing specific ways of "being" that are akin to the idea of the panopticon. More specifically, posthumanism and transhumanism force us to contend with what we think "humanness" is, and to what extent it should be preserved, and what that preservation looks like. This has a domino effect of sorts, because when we concern ourselves with what humanness looks like in the posthumanist and transhumanist sense, we also then deal with the idea that our idealised bodies are a performance of some kind of standard.

Overall for the most part, I used the works of feminist scholars from Southern Africa to build up my thesis, most notably Pumla Gqola's notion of triple violence. This is because posthumanism and transhumanism in the philosophical space is also about the way that human bodies can encounter violence, or violation. When we speak of bodily integrity and bodily autonomy, in part we are talking about protecting people from violence, and from violation. What this then means, is that the philosophy and the ethical and moral conceptualisations need to explicitly contend with the history of the human body, and of violence and violation, this also extends into how posthumanism and transhumanism then engages with disabilities, dignity in the difference between bodies and so on and so forth.

I needed examples for this so I opted for the field of biogerontology, an area of biotechnology that can involve things like facial reconstruction which has a use outside of cosmetics, but is also an area with a lot of technology that is strictly cosmetic related to concerns around things like aging which comes up in a lot of posthumanist and transhumanist literature.

Interestingly, as I studied this, I was also tutoring the ethics of artificial intelligence to second year students at my university so I actually noted a lot of overlap in some of the concerns regarding posthumanism and transhumanism, and the way we discuss the positives and negatives of technology with regards to humans as a whole. This was not the focus of my paper, but if you would like to know more about that, I would be happy to explain farther.

I think one of the key elements of bioethics as it pertains to posthumanism and transhumanism is to ensure that the ideas are not treated as though they exist in a vacuum, separate from history, societies and so on and so forth. Rather, bioethics is at its most robust when we confront the relationship between the philosophies and their histories. It is that grey area, between imagination and history, where philosophers who concern themselves with bioethics must reside and it means seeking a balance between the more idealised and fantastical side of biotechnologies, and goes into the realities of what manifests in real life, and what that means for our ethical and moral standards.

That is the basic primer for the thesis that I wrote. Let me know if you have any questions! I really loved answering this, my thesis really truly is my baby you know haha, and I am proud of my firstborn.

[prose-mortem]

Baby X Book Review

Rating: 5/5 Stars

Wow, what a fun ride!! Baby X is a unique and fast-paced science-fiction/medical/bioethics thriller about the dangers (and rewards) of engineering children. Baby X takes place on a future earth where, instead of having sex to create children, parents provide DNA samples to a lab. The lab then creates pluripotent stem cells from the sample, creates eggs and sperm, and engineers several embryos for the parents to choose from. The parents then choose (based on the stats and risk assessments) which embryo will be implanted for pregnancy.

This book contains everything we want in a sci-fi thriller: Morally grey heroines, total psychopaths, engineered babies, stolen DNA, kidnappings, celebrity stalking, family secrets, and a good dose of bioethical moral dilemmas. I was on the edge of my seat the entire time! Baby X is described as Black Mirror meets Gattaca, and this was so true. I am always looking for sci-fi books that parallel the existential themes in Black Mirror, but it is so hard to find good ones that are grounded and focused. Kira Peikoff nailed it!

Kira Peikoff was compared to Blake Crouch and John Marrs in the book's description, and I could not agree more. Since science-fiction can be extremely intimidating to newcomers, especially if it is "hard" sci-fi, the niche sci-fi/thriller genre is an incredibly attractive entry point for people who want to dive in for the first time. As a science-fiction veteran reader, I can honestly say that some sci-fis are just flat out dry. I am so grateful to authors like Kira Peikoff for demonstrating that science-fiction can be speculative in a grounded way, while meeting the needs of readers who want more than jargon and engineering blueprints from their reading experience. Science-fiction does not always have to occur in the "out there" regions of space. Sometimes the most poignant stories are the ones that feel much closer to home… This is one of the ways Baby X sources its power.

Baby X made me feel hopeful, even though it also caters to that delicious "angst" we love from Black Mirror. Perhaps we are not so very far away from a similar earth experience where we can bring children into the world with the confidence that they will have the best chances of succeeding in life without dealing with horrific diseases or unnecessary suffering. Baby X is a symbol of how we are asking the big questions and preparing ourselves for such a time in the near future!

Thank you so much to Crooked Lane Books and NetGalley for providing me with an e-ARC, so I could read this early. I feel incredibly lucky, and cannot wait to buy the hard copy version! Can someone please convince the author to write more Black Mirror-esque books? I am obsessed!

[spaceintruderdetector]

https://archive.org/details/35194e59-fa50-4192-86d2-b7a99c680312

Examining genetic research, biomedical ethics, autism research and the concept of risk, Hens illustrates that there is no ‘universal’ or ‘neutral’ state of scientific and clinical knowledge, and that attending to the situatedness of individual experience is essential to understand the world around us, to know its (and our) limitations, and to forge an ethical future.

[principleofplenitude]

In the philosophical literature on dementia, scholars speak of a contest between the “then-self” before the disease and the “now-self” after it: between how a person with dementia seems to want to live and how she previously said she would have wanted to live. Many academic papers on the question begin in the same way: by telling the story of a woman named Margo, who was the subject of a 1991 article in The Journal of the American Medical Association (JAMA), by a physician named Andrew Firlik. Margo, according to the article, was 55 and had early-onset Alzheimer’s disease and couldn’t recognize anyone around her, but she was very happy. She spent her days painting and listening to music. She read mystery novels too: often the same book day after day, the mystery remaining mysterious because she would forget it. “Despite her illness, or maybe somehow because of it,” Firlik wrote, “Margo is undeniably one of the happiest people I have known.” A couple of years after the JAMA article was published, the philosopher and constitutional jurist Ronald Dworkin revisited the happy Margo in his 1993 book, “Life’s Dominion.” Imagine, he asked readers, that years ago, when she was fully competent, Margo had written a formal document explaining that if she ever developed Alzheimer’s disease, she should not be given lifesaving medical treatment. “Or even that in that event she should be killed as soon and as painlessly as possible?” What was an ethical doctor to do? Should he kill now-Margo, even though she was happy, because then-Margo would have wanted to be dead? In Dworkin’s view, it was then-Margo whose wishes deserved moral weight. In his book, he made a distinction between two kinds of interests: “experiential” and “critical.” An experiential interest was reactive and bodily: the pleasure of eating ice cream, say. A critical interest was much more cerebral; it reflected the character of a person and how she wanted her life to be lived. In the case of advanced Alzheimer’s disease, Dworkin argued, there is a danger that critical interests will be usurped by experiential ones. Still, it was the critical interests, previously stated, that deserved to be satisfied, because it was those interests that gave human life its meaning and its dignity — and even made it sacred, in a kind of secular way. A person was respected if she was helped to live out her chosen course, not if her life trajectory was allowed to be derailed by the amnesiac whims of her diseased self. Some philosophers have devoted themselves to reconsidering Margo. They accuse Dworkin of holding too limited a view of meaning. Couldn’t a life of tiny pleasures be meaningful, even if it wasn’t the product of some sophisticated life plan? Critics have asked why we should privilege the decisions of a person who effectively no longer exists over the expressed choices of the person who is sitting before us, here and now. On a practical level, what authority could the then-self possibly exert over the now-self? And while Dworkin’s theory might apply to those in the advanced stages of the disease, it speaks less to a majority of patients in the mild and moderate phases. The in-between Margos. Dworkin’s theory also distinguishes between selves in a way that strikes some critics as misguided. A person is not like Plutarch’s Ship of Theseus: replaced, plank by plank, over the course of her voyages, leaving those aboard to wonder if she is still the old ship or instead a new one — and, if she is a new one, when exactly she ceased to be the other. A person always is and is not who she used to be. Still, many adult children cling to an image of a parent’s then-self and work relentlessly to protect it. Adult children “tend to be confident leaning on the side of a Dworkin-type view,” says Matilda Carter, a postdoctoral fellow in philosophy at the University of Glasgow and a former dementia caregiver. They don’t want a parent’s confused, 11th-hour choices to “tarnish the legacy of her life beforehand.”

“A Story of Dementia” from New York Times

[daemonicdasein]

[oodlenoodleroodle]

The use of racial categories in biomedical research often misattributes the cause of health inequities to genetic and inherent biological differences rather than to racism. Improving research practices around race and ethnicity is an urgent priority. Toward that end, the Emory University institutional review board recently instituted an antiracist intervention, described in an article in the latest issue of Ethics & Human Research.

The intervention is a change to the research protocol submission process that requires researchers to do three things: 1) describe the definition they are using for “race” and/or “ethnicity, 2) state whether they are using racial and ethnic classifications to describe or explain differences between groups, and 3) justify any use of race and/or ethnicity as a variable to explain differences between research participants. (In other words, what is race being used as a proxy for?)

“Our intervention was a simple evidence-based change . . . that we believe could have a significant impact on the production of high-quality research that makes meaningful strides toward eliminating racial health inequities,” write Francois Rollin, an assistant professor at Emory School of Medicine, and colleagues at Emory. “We recognize that this antiracist intervention at the Emory University IRB is nascent and will require further refinement over time. We encourage other institutions to pursue similar interventions at their institutions.”

[lilacsupernova]

And the 'other woman,' the female partner of the heterosexual commissioning couple is now in charge of a tiny newborn that, as is well know, posits many challenges for any new mother looking after her baby/ies. Indeed s/he may bring her to the brink of a nervous breakdown as she is trying to be the perfect mother to this foreign being that suffers from colic, doesn't stop crying, and won't let her sleep for months. But the the outside world she has to be radiant with happiness: after all, she and her partner finally have 'their' much longed-for child. Question: since the 'surrogate' was told again and again that her birth child is not her baby, as it does not have 'her genes,' is the 'social mother' told the same lie? I assume not. This is just one example of the many contradictory fibs in tales from the surrogacy world.

– Renate Klein (2017) Surrogacy: A Human Rights Violation, pp. 30-1.

[whilewewereyetsinners]

Colossal says it hopes to use advanced genetic sequencing to resurrect two extinct mammals — not just the giant, ice age mammoth, but also a mid-sized marsupial known as the thylacine, or Tasmanian tiger, that died out less than a century ago. On its website, the company vows: “Combining the science of genetics with the business of discovery, we endeavor to jumpstart nature’s ancestral heartbeat.”

In-Q-Tel, its new investor, is registered as a nonprofit venture capital firm funded by the CIA. On its surface, the group funds technology startups with the potential to safeguard national security. In addition to its long-standing pursuit of intelligence and weapons technologies, the CIA outfit has lately displayed an increased interest in biotechnology and particularly DNA sequencing.

“Why the interest in a company like Colossal, which was founded with a mission to “de-extinct” the wooly mammoth and other species?” reads an In-Q-Tel blog post published on September 22. “Strategically, it’s less about the mammoths and more about the capability.”

“Biotechnology and the broader bioeconomy are critical for humanity to further develop. It is important for all facets of our government to develop them and have an understanding of what is possible,” Colossal co-founder Ben Lamm wrote in an email to The Intercept. (A spokesperson for Lamm stressed that while Thiel provided Church with $100,000 in funding to launch the woolly mammoth project that became Colossal, he is not a stakeholder like Robbins, Hilton, Winklevoss Capital, and In-Q-Tel.)

Colossal uses CRISPR gene editing, a method of genetic engineering based on a naturally occurring type of DNA sequence. […] The eponymous gene editing technique was developed to function the same way, allowing users to snip unwanted genes and program a more ideal version of the genetic code.

The embrace of this technology, according to In-Q-Tel’s blog post, will help allow U.S. government agencies to read, write, and edit genetic material, and, importantly, to steer global biological phenomena that impact “nation-to-nation competition” while enabling the United States “to help set the ethical, as well as the technological, standards” for its use.

Okay, am I the only one that finds the idea of US government agencies having the authority to use this technology completely terrifying?

I remember when CRISPR technology was first developed bioethicists were like yeah, you shouldn’t do that, and everyone else was like shut up and think of the children! We can eradicate birth defects with this!! And have they eradicated birth defects with this? Don’t be silly, of course not! No, we’re going to build supersoldiers or morally-vacant human robots or something, that’s way more important!

[gear-project]

Could it be said that Asuka has “redeemed” himself at the end?

That's a tough one... and actually there's some aspects of the story that haven't been fully revealed.

Given how many "hidden" War Relics still exist that Asuka is trying to eliminate, his task is far from complete.

And the whole Asuka #R project of his, I'm not entirely sure is ethical from a Scientific point of view, even if he only used himself in the experiment.

Furthermore there's the idea that he fused the Tome of Origin to his body... I do not think other nations in the world will necessarily respond with approval of this.

Then of course there's what to do about Happy Chaos and former Scientists behind the P.W.A.B... a lot of what they did was completely unethical, and in most cases either killed people or ruined their lives completely.

And we STILL do not know the ultimate fate of the Flame of Corruption that Asuka extracted from Frederick. Even if what he did was for Frederick's well-being, the Divine Seed isn't something he can just simply take control of and call it a day.

And we also don't know what happened to Chronus, the last surviving member of the former Conclave Senato... he has much to answer for as well. Even if Asuka takes over Chronus' responsibilities, it's not exactly like the world will simply accept that and move on.

America had a hard time cleaning up the mess that Asuka started, and even dealing with Sol Badguy was a hassle they couldn't handle... even suggesting he be executed for war crimes of his own, simply for existing as a bioweapon of potential mass destruction. (Though technically America was partly to blame for the Gear War-machine buildup that occurred...)

Even if Asuka atones, many people (especially the Japanese people) may never accept him for the rest of his life, no matter what he does.

Even some Gears will never forgive Asuka for putting them in the situation of being the world's enemy.

Regardless, Asuka swore to HIMSELF that he would do his best to make things right... and that responsibility is his and his alone to take action for (whether Humans, Demihumans, and Gears accept him or not).

Even if the world does not entirely accept him... they will still have to cope with his decisions on his own terms, given how powerful he is.

But, that was true of the Gears themselves, Mankind just simply has to find a way to coexist with the "beasts" of this world that exceed their comprehension and understanding.