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Archive for February, 2012

John Harris Clarifies his Position on Infanticide

29 Feb, 12 | by Iain Brassington

John Harris writes in response to Julian’s post:

I wish to clarify my position on infanticide to correct the impression that infanticide is something I defend or advocate.  There is a big difference between an analysis of the moral symmetry of some abortions and some cases of infanticide on the one hand,  and the defence of infanticide or indeed the advocacy of infanticide on the other.  I have always drawn a clear line between what I call “Green Papers” and “White Papers” in ethics.  Green papers are intellectual discussions of the issues, white papers are policy proposals.  I have never advocated or defended infanticide as a policy proposal.

I would not and do not advocate the legalization of infanticide on the basis of any alleged  ethical parity of infanticide with abortion.

After-Birth Abortion: Editorial Comment

28 Feb, 12 | by BMJ

Rev Prof Ken Boyd, Associate Editor, Journal of Medical Ethics, writes:

Coming up to me at a meeting the other day, an ethics colleague waved a paper at me. “Have you seen this ?”she asked,  “It’s unbelievable!” The paper was ‘After-birth abortion: why should the baby live?” by two philosophers writing from Australia, Alberto Giubilini and Francesca Minerva. Well yes, I agreed, I had seen it: in fact I had been the editor responsible for deciding that it should be published in the Journal of Medical Ethics; and no, I didn’t think it was unbelievable, since I know that arguing strongly for a position with which many people will disagree and some even find offensive, is something that philosophers are often willing, and may even feel they have a duty, to do, in order that their arguments may be tested in the crucible of debate with other philosophers who are equally willing to argue strongly against them. Of course for that debate to take place in the Journal of Medical Ethics, many of whose readers, doctors and health care workers as well as philosophers, may well disagree, perhaps strongly, with the paper’s  arguments,  we needed first to make sure that the paper, like any other submitted to the Journal, was of sufficient academic quality for us to publish; and the normal way in which we determine this is to invite academics in relevant disciplines to review the paper critically for us, so that we can eventually make an informed decision about whether or not to publish it, either in its original or (as in this case) a form revised in the light of the reviewers’ reports. Satisfied by the reviewers’ reports and my further editorial review that the paper was of sufficient academic quality to be published in the Journal of Medical Ethics, and being charged with making the decision as an Editor with no conflict of interest in the matter, since unlike my fellow-editors in the relatively small world of international academic medical ethics I have never met the authors, and indeed personally do not agree with the conclusions of their paper, I decided that it was appropriate to publish it in the interest of academic freedom of debate.  It has subsequently been suggested to me that people whose lives might have been ended by ‘after-birth abortion’ were this legal, might be deeply offended by this paper. If that is the case I am sorry, but I am also confident that many of these people are equally capable of mounting a robust academic reply to the paper which, again subject to peer-review, the Journal of Medical Ethics will be very willing to consider for publication.

(IB adds: the paper in question is here; Julian Savulescu defends publication in the next post down.  I’ll add relevant links, both pro and contra, as I find them.)

“Liberals Are Disgusting”: In Defence of the Publication of “After-Birth Abortion”

28 Feb, 12 | by BMJ

The Journal of Medical Ethics prepublished electronically an article by Alberto Giubilini and Francesca Minerva entitled “After-birth abortion: why should the baby live?

This article has elicited personally abusive correspondence to the authors, threatening their lives and personal safety. The Journal has received a string abusive emails for its decision to publish this article. This abuse is typically anonymous.

I am not sure about the legality of publishing abusive threatening anonymous correspondence, so I won’t repeat it here. But fortunately there is plenty on the web to choose from. Here are some responses:

“These people are evil. Pure evil. That they feel safe in putting their twisted thoughts into words reveals how far we have fallen as a society.”

“Right now I think these two devils in human skin need to be delivered for immediate execution under their code of ‘after birth abortions’ they want to commit murder – that is all it is! MURDER!!!”

“I don‘t believe I’ve ever heard anything as vile as what these “people” are advocating. Truly, truly scary.”

“The fact that the Journal of Medical Ethics published this outrageous and immoral piece of work is even scarier”

(Comments from http://www.theblaze.com/stories/ethicists-argue-in-favor-of-after-birth-abortions-as-newborns-are-not-persons/#comments)

As Editor of the Journal, I would like to defend its publication. The arguments presented, in fact, are largely not new and have been presented repeatedly in the academic literature and public fora by the most eminent philosophers and bioethicists in the world, including Peter Singer, Michael Tooley and John Harris in defence of infanticide, which the authors call after-birth abortion.

The novel contribution of this paper is not an argument in favour of infanticide – the paper repeats the arguments made famous by Tooley and Singer – but rather their application in consideration of maternal and family interests. The paper also draws attention to the fact that infanticide is practised in the Netherlands.

Many people will and have disagreed with these arguments. However, the goal of the Journal of Medical Ethics is not to present the Truth or promote some one moral view. It is to present well reasoned argument based on widely accepted premises. The authors provocatively argue that there is no moral difference between a fetus and a newborn. Their capacities are relevantly similar. If abortion is permissible, infanticide should be permissible. The authors proceed logically from premises which many people accept to a conclusion that many of those people would reject.

Of course, many people will argue that on this basis abortion should be recriminalised. Those arguments can be well made and the Journal would publish a paper than made such a case coherently, originally and with application to issues of public or medical concern. The Journal does not specifically support substantive moral views, ideologies, theories, dogmas or moral outlooks, over others. It supports sound rational argument. Moreover, it supports freedom of ethical expression. The Journal welcomes reasoned coherent responses to After-Birth Abortion. Or indeed on any topic relevant to medical ethics.

What is disturbing is not the arguments in this paper nor its publication in an ethics journal. It is the hostile, abusive, threatening responses that it has elicited. More than ever, proper academic discussion and freedom are under threat from fanatics opposed to the very values of a liberal society.

On the Blaze which reported it (http://www.theblaze.com/stories/ethicists-argue-in-favor-of-after-birth-abortions-as-newborns-are-not-persons/#comments):

“Liberals are disgusting. They have criminal minds. To think that a person must be considered “worthy” to live is criminal.”

“It seems to me if good people are not going to stand up to do away with people who believe in doing away with live babies, then it means no one is good, and it’s just easier for God to drop a couple asteroids on earth.”

“i can’t even comment on this atrocity. I know these people are murderers in their hearts. And God will treat them as such. They are completely spiritually dead.”

“I have to say that I would personally kill anyone doing a after-birth abortion if I had the chance. Is that clear enough?”

The comments include openly racist remarks:

“Alberto Giubilini looks like a muslim so I have to agree with him that all muslims should have been aborted. If abortion fails, no life at birth – just like he wants.

“Journal of Medical Ethics” — hahaha! You libs and your quack science. Ya think that’s impressive, Albutt & Franpoop? No ****! I can beat you in my sleep. Here goes:

I take a ‘subject of a moral right to life’ to mean an individual who is capable of attributing to my own existence some (at least) basic value such that being deprived of this existence represents a loss to me.

Here’s the “projected moral status” you comunisti italiani pigs would get: Bang, bang. Drop in toxic waste dump reserved for left-wing contaminants.”

What the response to this article reveals, through the microscope of the web, is the deep disorder of the modern world. Not that people would give arguments in favour of infanticide, but the deep opposition that exists now to liberal values and fanatical opposition to any kind of reasoned engagement.

Julian Savulescu, Editor, Journal of Medical Ethics

Conference: “Other Voices, Other Rooms: Bioethics, Then and Now”

28 Feb, 12 | by Iain Brassington

Richard Huxtable has asked me to publicise this:

The EACME (European Association of Centres of Medical Ethics) annual conference will be hosted by the Centre for Ethics in Medicine at the University of Bristol, between 20 and 22 September 2012:
http://www.eacme2012.org/welcome/

This conference will mark the 25th anniversary of the Association, which provides an ideal opportunity to reflect on the many contributions made in and to European bioethics to date.  The conference theme, “Other voices, other rooms: Bioethics, then and now” is borrowed from Truman Capote’s novel, which deals with issues of coming of age, including embracing one’s identity, understanding others, caring and being cared for, as well as searching for oneself and for those to whom one is relationally bound.

In keeping with these themes and the aims of the Association, we therefore invite speakers to reflect on the identity of European medical ethics, and the many places and people with whom it is intimately bound.  As such, we’re keen to hear from across the different disciplines which encounter bioethical issues, including (but not limited to) medical sciences, nursing, allied health, law, social sciences, philosophy, classics and drama. The deadline for abstracts is 1 March 2012.a

It’s a very tight turnaround to submit an abstract – but the conference as a whole could be very interesting, and touches on some of the worries I’ve articulated over the years here concerning what bioethics is.

The Status of Bioethics

24 Feb, 12 | by Iain Brassington

There’s been a couple of things that’ve appeared on the net over the last few days that have revivified something that’s been niggling away at the back of my mind for quite a long time now: the status of bioethics as an academic discipline.

First there was Brian Leiter’s blog post.  Commenting on the oddness that has been overtaking the American Journal of Bioethics for the last couple of weeks (Not been keeping up?  Christian Munthe and Carl’s posts on the Fear and Loathing in Bioethics give a pretty good account), he points out that “[b]ioethics already has a fairly dim reputation in academic philosophy” – and he’s right: it does, even without the alleged strangeness at the AJoB.

And then there’s this interview with Hilde Lindemann in 3:AM Magazine, with this eye-catching passage:

A few years ago I was at a metaethics workshop, and over breakfast a male colleague and I made a game of ranking the different specialties in philosophy according to how prestigious they were – a ranking with a precise inverse correlation to gender. Here’s the list we came up with:

Philosophy of Mind, Philosophy of Language, and Metaphysics: The alpha-dominant philosophy, done by Real Men

Epistemology and Philosophy of Science: Done by manly enough men

Metaethics: Done by men who aren’t entirely secure in their masculinity

Ethics, Social and Political Philosophy: Done by girls

Bioethics: Done by stupid girls

Feminist philosophy, of course, is not philosophy at all.

The status of bioethics isn’t the primary concern of the interview, but it’s what jumped out at me; and – speaking as someone whose PhD was in metaethics in a very mind-and-language department, and who subsequently got work in bioethics – the ranking seems to be about right.  (I was warned at the start of my career that setting out down a bioethics path would make it hard to get a job in a “proper” philosophy department in future – a prediction that I think has something to it.  David Hunter’s recent move to a proper philosophy department is the exception that proves the rule, notwithstanding that his previous job was with a very good bioethics place.)

Bioethics employs philosophers, and makes use of philosophy; but it’s not enormously highly regarded as a discipline by philosophers.  Why should that be?  Does it matter?

more…

Obligatory Ventilation: Why “Elective Ventilation” should not be Elective

16 Feb, 12 | by BMJ

Guest post by Dominic Wilkinson

(Cross-posted from Practical Ethics)

On the BBC’s Moral Maze this evening, the question of elective ventilation was discussed at some length. (For those who missed it, the programme is still available here). There were several striking features of that discussion, but one argument that stood out was the argument against elective ventilation based on the importance of respecting the autonomy of patients, and the absence of consent, This has been the basis of previous ethical concerns about Elective Ventilation.

But actually, it seems to me that the consent/autonomy argument is completely upside down.* Patient autonomy provides one of the strongest arguments in favour of elective ventilation. So strong, in fact, that the proposed form of Elective Ventilation should arguably not be ‘elective’. It is morally obligatory that we embrace Elective Ventilation.

Why should this be the case? It is based on a simple, and intuitively plausible idea: more…

Back from the Grave: Should we Allow Elective Ventilation?

15 Feb, 12 | by BMJ

Guest post by Dominic Wilkinson

(Cross-posted from Practical Ethics)

Mary is 62 years old. She is brought to hospital after she collapsed suddenly at home. Her neighbour found her unconscious, and called the ambulance. When they arrived she was deeply unconscious and at risk of choking on her own secretions. They put a breathing tube in her airway, and transported her urgently to hospital.

When Mary arrives she is found to have suffered a massive stroke. A brain scan shows very severe bleeding inside her brain. In fact the picture on the scan and her clinical state is described by the x-ray specialist as ‘devastating’. She is not clinically brain dead, but there is no hope. The emergency department doctors have contacted the neurosurgical team, but they have decided not to proceed with surgery as her chance of recovery is so poor.

In Mary’s situation, the usual course of events is to contact family members urgently, to explain to them that there is nothing more that can be done, and to remove her breathing tube in the emergency department. She would be likely to die within minutes or hours. She would not be admitted to the intensive care unit – if called, the ICU team would be likely to say that she is not a “candidate” for intensive care. However, new guidance from the National Institute of Clinical Effectiveness, released late last year, and endorsed in a new British Medical Association working paper, has proposed a radical change to this usual course of events. more…

Building for the Past

14 Feb, 12 | by Iain Brassington

David Edmonds poses a question:

Imagine three cities.

1. A medieval city (something like Oxford).

2. A city heavily bombed in World War II and completely rebuilt, with original materials etc. (e.g. the centre of Warsaw).

3. A city constructed in 2012 to look just like the medieval city (e.g. Poundbury the ‘traditional’ village Prince Charles has created in Dorset).

Now imagine that these three cities look identical.  And let’s stipulate that the experience of living in them is pretty much the same (the houses are no more likely to suffer from dry rot in the first than the third).   Here’s the question: where would you rather live?

He reckons that most would prefer Oxford over Warsaw, and both – comfortably – over Poundbury.  I suspect that he’s right.  Why is this, and why does it matter for bioethics?

Edmonds’ hypothesis is that it’s because we care about origins and back-story.  We like to have some sense of where things came from – it’s a part of how we assess their worth.  The problem with a place like Poundbury is that its backstory is completely ersatz. (Whether an ersatz history is better than none at all is a further question, and we could extend the thought-experiment by adding a fourth option: what about living in an unashamedly modern town?  What if an architect was allowed to start from scratch, and didn’t look to the past at all?  Depressingly, my hunch is that many people would prefer to live in Poundbury than in Neopolis.  Without genuine history, they’d prefer fake history.  Prince Charles obviously would.  Mind you, if it wasn’t for a history, fake or imagined, he’d have nothing at all.  Except Cornwall.  And about a billion pounds.  But I digress…)

As for bricks and mortar, so for genetic origins. more…

Henrietta Lacks and “Enchanting Rhetoric”

7 Feb, 12 | by Iain Brassington

Note: There’s a couple of errors of interpretation in this post.  I’m not going to re-write it, because I wrote what I wrote, and it’s in the public domain, and I don’t think it’s all that dignified to pretend that one never makes blunders; it’s better to acknowledge them, take the hit, and move on.  But please do have a look at Rebecca Skloot’s response in the comments, and at my answer to her. – IB, 8.ii.12

*     *     *     *     *

Since I read it in the autumn, there’s been a few things nagging at the back of my mind about Rebecca Skloot’s The Immortal Life of Henrietta Lacks.  A few things that don’t seem quite right somehow; and prompted by Pär Segerdahl’s post on The Ethics Blog, I’m tempted to see if I can put them into words.

For those who haven’t read the book, it deals with the story of how it was that an apparently immortal cell culture line, HeLa, was obtained.  The cells were taken from a cervical tumour that went on to kill one Henrietta Lacks, a poor black woman who lived near Baltimore.  During the course of her treatment, a sample of cancerous cells was taken for testing, as was a sample of healthy cells.  (“HeLa” gets its name from the convention of naming culture lines by contracting the name of the person from whom they’re derived.)  These biopsies were apparently unconsented.  But what’s important about them is that, whereas most cell lines at the time died fairly quickly, the cancer sample kept on dividing and dividing.  The HeLa strain proved to be important in all kinds of areas of research.  Doubtless, some of this research has made some people very wealthy.  Yet Henrietta’s descendents have seen none of this profit.  Indeed, many of them are not much more enfranchised today than a black woman would have been 60 years ago; they weren’t even aware that there was such a thing as HeLa.

So what’s the problem?

One of them is definitely stylistic.  I have problems with something that Skloot thinks is a virtue, which is that “dialogue appears in native dialects” (xi).  I don’t share the notion that it’s in any way dishonest to polish out people’s linguistic infelicities, just as one would polish out all the ums and ahs and placeholders in everyday speech.  And I can’t shake the feeling that the professionals who get speaking parts in the book have had their speech tidied; though it’s probably true that the higher your social status, the less susceptible you are to malapropisms, I don’t believe that the educated people directly quoted in the book were always grammatically perfect and never used colloquialisms.  But this is a minor quibble.

What’s more nagging – and potentially more interesting from an ethicist’s point of view – is a question about why any of this is particularly important. more…

CfP: Criminalizing Contagion: Ethical, legal and clinical challenges of prosecuting the spread of disease and sexually transmitted infections

3 Feb, 12 | by Iain Brassington

The BMJ Group journals Sexually Transmitted Infections and Journal of Medical Ethics, in conjunction with academics at the Centre for Social Ethics and Policy (University of Manchester) and the Health Ethics and Law Network (University of Southampton), would like to publish a collection of articles on the criminalization of disease and sexually transmitted infections. We invite article contributions to be published as part of this themed collection.

Funding has also been sought from the ESRC for a seminar series on the same theme and, if successful, authors contributing to this collection may also be invited to present their papers at one of the seminars (which will take place in winter 2012/13 and summer 2013 in Southampton, and winter 2013/14 and summer 2014 in Manchester).

Themes

The use of criminal law to respond to infectious disease transmission has far-reaching implications for law, policy and practice. It presupposes co-operation between clinicians and criminal justice professionals, and that people who infect others can be effectively and fairly identified and brought to justice. There is a potentially difficult relationship between criminal justice and public health bodies, whose priorities do not necessarily coincide. We are interested in receiving papers of broad interest to an international readership of medical ethics scholars and practicing clinicians on any of the following topics:

·      Legislative and policy reform on disease and sexually transmitted infections

·      Health services and the police: privacy, state interference and human rights

·      Evidence and ethics: prosecuting ‘infectious’ personal behaviours

·      Clinicians and the courts: the role of health professionals and criminal justice

·      The aims of criminalization and public health: a compatibility problem?

·      International comparative studies on disease and criminalization: policy, practice and legal issues

More details below the fold. more…

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