So there’s this letter published in the Journal of Bioethical Inquiry that moots the idea that the top biomedical ethics journals might be institutionally racist.  In it, Subrata Chattopadhyay, Catherine Myser and Raymond De Vries point out that the editorial boards of a good number of journals are dominated by members who are located in the global North – countries officially listed as being high or very high on the development index, with only 1.3% drawn from countries classed as least developed.

Developing World Bioethics has the highest proportion of its editorial board located in the least-developed nations; but even there, the figure is only just over 11%.  On the face of it, this doesn’t look too good, especially given the proportion of the world’s population in general that lives in the poorest countries.  The JME, by comparison, draws 100% of its editorial board members from people located in highly and very-highly developed nations.

Still: this isn’t likely to be the whole story.  Udo Schucklenk – a founding editor of DWB, of course – takes issue with the letter on a number of grounds.  For one thing, he he suggests that Chattopadhyay et al might be performing a sleight of hand with their metrics; by lumping together countries ranked as high and very high on the development index, they’re lumping together the UK, Germany, and the US with Iran, Malaysia, and Jamaica.  Neither Iran nor Jamaica is a classic basket-case economy; but, still, “high” and “very high” development covers a vast range of income levels.  Treating all these countries in the same way obscures that there’s a huge range of locations from which editorial staff may be drawn.

I’ll come back to this in a moment. more…

I thought our readers might be interested in this story which is happening in New Zealand as it has echoes of the Post-Birth abortion “debate” that occurred on this blog last year.

Then as now academics have argued in an academic journal (in this case the New Zealand Medical Journal) for a position that some find controversial – although the position seems considerably more innocuous than post-birth abortion since they are arguing that the introduction of earlier less invasive diagnosis of genetic disorders such as downs syndrome is morally acceptable and indeed preferable. You can see the paper here since it is open access at the moment.

In reaction to this disability activists have claimed that the authors are promoting discrimination against those with Downs syndrome and are calling for the resignation of the Head of the Otago Bioethics Centre.

Now there are several problems here. Firstly and most obviously the authors of the piece and in particular Gareth Jones who they have focused on is not in fact the Head of the Otago Bioethics Centre (that would be John McMillan) so it is hard for Gareth Jones to resign that position. Worse still as Udo Schuklenk points out in this thoughtful piece – Gareth Jones is in fact an emeritus professor – it is slightly difficult to resign from being retired… It’s also argued that some of the statements they are attributing to Gareth Jones (not that they seem that controversial) were actually made by a different Gareth Jones.

Still factual issues aside what seems illegitimate here is the personal attack involved. I must admit this looks to me like activists shamelessly latching on to an opportunity to kick up a fuss about an issue which they care deeply about, without any consideration of the potential impact on the individuals involved. While discussions like this one must be written with consideration and due care as John McMillan points out the paper is both careful and considerate, so why attack the authors?

While they of course have a right to their opinion and to express them vocally – given that what they are arguing against is the status quo there doesn’t seem to be any reason to demonise academics, why not engage with the arguments – play the ball not the player. After all if their position is strong then the truth should out right? Resorting to smear tactics like this makes the position they are defending seem weaker than it actually is, I share the concern that selective abortion of the disabled may constitute discrimination – although like abortion itself I’m inclined to view this as regrettable rather than morally objectionable.

Sadly, the list entitled “Great Moments in Italian Pop” is short; but the entry that must surely be at the top is probably very near the top of the list entitled “Great Moments in All Pop”.  It’s a 1972 song by Adriano Celentano.

Prisencolinensinainciusol.

It’s pure gibberish – a parody of what anglophone pop sounds like to people who don’t speak English.

I mention it here for a couple of reasons.  The first is that it’s great.  The second is that it’s a nice way of talking about people who appear to be going through the motions of thinking about ethical matters, but who just get it wrong, and are actually talking gibberish.

Via Dominic Wilkinson, this gem from BioEdge is a lovely example of bioethical prisencolinensinainciusol.  On the face of it, it’s a plea for consistency when it comes to policymaking.

[I]n the Australian state of Queensland [...], the police union has argued that pregnant women who abuse alcohol should be forced to live in safe houses. “Those [unborn] children also deserve a right to full life and health and should not be disadvantaged simply because of the actions or inaction of their birth mother,” said Union president Ian Leavers.

Obviously this is a controversial issue, but I can’t understand how one can both defend access to legal abortion and lock up women who might harm their children.

The link provided is to The Australian, which is behind a paywall, so not something I can access.  However, News.com.au carries the story, too, reporting Union president Levers to have said that the state should be able to intervene in cases where children are at risk of foetal alcohol syndrome and drug addictions.

“Those children also deserve the right to a full life and health and should not be disadvantaged simply because of the actions or inaction of their birth mother.  The state must have the ability to intervene and protect the unborn child when its mother refuses, or is incapable or unwilling to do so.”

Mr Leavers said tougher laws would complement the criminal code, which provides for a charge of killing an unborn child or grievous bodily harm for any person who violently kills or harms an unborn child.

This is a bit odd, all told.  I mean: it might be easy enough to agree that pregnant women probably ought to reduce, or even eliminate, certain behaviours.  But the idea that that might be a matter for the law is very strange indeed.  What would the sanction be?  Is the idea that it’d be better for pregnant women to be in prison?  Fined?  And what about the plausible claim that alcohol or drug abuse is itself a health problem?  Or the distinct possibility that women who do drink or use drugs are much less likely to seek any medical advice at all during their pregnancy if they think that the state might punish them for their behaviour, thereby making a suboptimal situation even worse?  Legal intervention of the sort indicated would be both cack-handed and unjust.

But what about BioEdge‘s plea for consistency?  From what I can see, there’s a fairly obvious set of rejoinders.  First, the police union can say what it likes about what the law should be, but the role of the police is to enforce the law as it stands.  So not interfering with a woman’s legal right to abortion is not the same as defending it.  Likewise, mooting the idea that women might be sanctioned for risking the health of the foetus is not the same as locking women up.  BioEdge seems to have got the difference between voicing an idea, and enforcing a policy, utterly the wrong way around.  BioEdge‘s writer makes it sound like a moral argument is being made; but, really, it isn’t.  Second, that it’s odd to defend abortion but advocate sanctions against risky behaviour in pregnant women may be true – I mean, it’s not a crazy suggestion – but it doesn’t follow from that that one ought to change one’s mind about abortion (which is, I think, given BioEdge‘s commitments generally, what the implication is): all else being equal, and given a whole truckload of secondary arguments about the moral status of the foetus and the moral status of the mother, it’s at least prima facie more likely that it’s the risky behaviour claim that’s off.  Third, that the representative of a policing union has made a statement about what the law should be is in no way an indication that that statement should be taken seriously.

Come on, BioEdge.  Fair play to you: you look like you’re doing the job… but… Prisencolinensinainciusol.

Maybe there’ll be richer pickings from the other story behind the link.  In Tasmania,

the premier and deputy premier have released a long report on legalised euthanasia. They insist that there is no “sound evidence” of potential elder abuse. However, rates of child abuse are nearly 60% higher there than in other Australian states. Isn’t that a bit inconsistent? The kind of people who abuse children probably won’t mind abusing grannies.

Ummm… wait a sec: What?

Spoiler alert: Almost certainly not.  But hear me out for a bit.

The Christian Medical Fellowship blog had an article posted yesterday about what it praised as a balanced documentary concerning “sexual orientation change efforts” – gay conversion therapy to you and me – on Radio 4 on Sunday.  Actually, it wasn’t a documentary – it was a short article on Sunday, the station’s religious-affairs-quota-filling hour (go to about 30:50 here), and it’s no more a documentary than is the sports bulletin - and the balance is “BBC balance”, which means giving equal airtime to the fireman and the fire.  But anyway, that’s not what struck me.

Neither am I particularly bothered for the sake of this post about whether or not psychotherapy can make any difference to sexual orientation.  I’ll simply allow, for the sake of the argument, that it can at the very least make a difference to sexual behaviour, and maybe to orientation tout court.

What struck me was a couple of things that Peter Saunders says on his CMF blog post about the use of such “therapies”.  One of the striking things was this: more…

A bit more on the cochlear implant thing that I’ve been mentioning off and on for the past couple of months.  William Mager posted a link to something a little while ago on why some members of the deaf community are against CIs.  This attitude had always puzzled me.  Anyway, this, by Christina Hartmann, is the thing to which he linked.

Not wanting one yourself, I can understand easily enough.  Not wanting one for your children based on uncertainty about their benefit, I can understand.  But being against them in principle?  Couldn’t get my head around that.  It always seemed a bit wilfully isolationist – a bit identity-politics.  Hartmann’s contribution, I think, makes things a bit clearer.

Without ASL, there is no Deaf community. We band together not because of our “hearing loss” but because of a common language.  Like English, Bengali, French, American Sign Language (ASL) informs the cultural underpinnings of the Deaf community. Deaf history shows the importance of ASL to Deaf people. It’s not something we’ll give up easily and gladly.

In the 1800s and early 1900s, many educators tried to eradicate ASL in favor of oralism. They wanted to assimilate deaf people into the “mainstream” community. Many deaf people suffered because of this. They received marginal education because they couldn’t understand the spoken language. One of the older deaf men that I knew in my childhood couldn’t get a job better than a janitor because he received no valuable education from his oral school.  They just tried to teach him how to talk, to no avail.

Amidst all of this, a vibrant community emerged. People would converge at Deaf schools and churches just for a chance to use their own language with someone else. A feeling of kinship grew in face of oppression. (Yes, trying to abolish a language and forcibly integrate people is oppression.)  Many Deaf people throughout history fought very hard for the right to sign and live on their own terms.  One example is the Gallaudet protests of the 1980s. The thought that this hard-earned culture will disappear because parents don’t want to learn ASL sparks abject fear and anger in many Deaf people.

And why not?  Wouldn’t you be angry if someone told you that your culture is outdated and irrelevant now?

This last sentence or two seems to me to be important.  CIs reduce the need for ASL (or BSL); SL sustains a culture; therefore CIs erode that culture. more…

A few weeks ago, I linked to a post on William Mager’s blog in which he said (a) that he was about to have a cochlear implant fitted, and (b) that he’d write about the experience as it progressed.

I don’t know how many readers of this blog followed the link or subscribed; for those who didn’t, I thought I’d just point you in the direction of the latest update.  In short: the implant was fitted; it was turned on; it was… unexpected.  Not completely pleasant from the word go, and a little odd.  But also… well:

I spent an hour yesterday walking round the house tapping different surfaces with a wooden drumstick. Before, with a hearing aid, I’d have heard these taps simply as a ‘tap’ sound. But I had a eureka moment when I realised that tapping a wooden stick on a wooden surface sounded different in pitch and tone to tapping on a glass surface, or a metal surface. Of course, I knew that was the case – but this was the first time ever, EVER… that I’d actually heard that and been able to distinguish so clearly between the different sounds.

That has to be a little bit magical, doesn’t it?

On the other hand, what he can hear is limited.  And so

[n]ow I’m sitting in a world of silence, punctuated by random, violent bursts of sounds that I’ve never heard or experienced quite in the same way before.

What I’m experiencing now isn’t hearing as I imagined it, or as I’ve known it for the last 30 years. It’s completely different, and it’s making me feel really tired and disconnected from everything. I’m finding it really hard to concentrate, to hold on to a specific thought for a long time. [...]

Most disconcerting of all is the dawning realisation that what I thought I was hearing for the last 30 years of my life wasn’t actually hearing. It was just compressed, distorted garbage noise through a hearing aid. What I’m feeling in my head now is much, much closer to actual sound, but it isn’t sound.

I’m fairly confident in my hunch that being able to hear is on the whole preferable to not being able to hear; though there might be times when not hearing is preferable, being able to do so at least gives you the choice – which raises the intriguing possibility that someone with a device that he could used to switch his own hearing on or off might be, in that sense at least, very well off indeed: better off than someone with no ability to hear and someone with no ability not to.  (In just the same way, having a car is good all else being equal, even if there’re times when walking is preferable, because you have the option of using it.)

But still: it’s worth keeping in mind that the process of restoring – or instilling – hearing isn’t a straightforward leap from position A to more desirable position B.  There’s an ambiguity about it.  Even granted confidence that B is more desirable, we can’t take it for granted.

There’s a couple of things that’ve been playing on my mind since the post about the Daily Mail‘s coverage of the Liverpool Care Pathway a couple of weeks ago.

One of them is the letter that Fiona Godlee, editor of the BMJ, sent to Paul Dacre, editor of the Mail.  It points out to him what I noted – that the LCP isn’t mentioned at all in the original piece – and adds something important that I had suspected but didn’t know: that it told us nothing about the NHS because the doctor writing wasn’t even UK-based.  (For those without institutional access, I’ll reproduce it in full below the fold.)

I’ve just done a search of the Mail‘s website, and it seems not to have been published, or even acknowledged, anywhere.  I’m not wholly surprised by this.  It might have appeared in the paper version - but that’s not enough.  After all,the attacks on the LPC certainly have appeared in the online version of the paper – and continue to do so – and so it makes sense that any attempt at rectification should appear in the same place.  Yet it would seem that the Mail is rather less keen to publish letters that contradict its editorial line than it is to print vexatious gibberish as a part of that line.

(As it happens, the fact that the BMJ article was used without permission isn’t necessarily all that big a problem.  I think that there probably could be a public interest defence – a sort of fair use system – in relation to publishing things without permission when it’s in the public interest.  But the quid pro quo here is that what’s published has to be an honest representation, rather than misleading crap.  On this front, the Mail has failed.)

Anyway: an important aspect of not having published Godlee’s letter online is that it’s links to the electronic version of the paper that people would have been passing around.  And that leads me to the other thing that’s been playing on my mind: the question of whether I should have provided links in my previous post.

We like to think that newspapers are primarily about news; but that’s not true. more…

via the Philosopher Shaming tumblr:

*narrows eyes*

In the wake of Savita Halappanavar’s death, a statement was issued by the Irish Catholic Bishops’ Conference.  The whole thing is available here.  However, I think that a couple of paragraphs is particularly worth picking out:

Where a seriously ill pregnant woman needs medical treatment which may put the life of her baby at risk, such treatments are ethically permissible provided every effort has been made to save the life of both the mother and her baby.

Whereas abortion is the direct and intentional destruction of an unborn baby and is gravely immoral in all circumstances, this is different from medical treatments which do not directly and intentionally seek to end the life of the unborn baby. Current law and medical guidelines in Ireland allow nurses and doctors in Irish hospitals to apply this vital distinction in practice while upholding the equal right to life of both a mother and her unborn baby.

I think that the first of these paragraphs is pretty unexceptionable, and describes something approaching the default setting for medical interventions anyway.  We might want to talk about “reasonable efforts” rather than “every effort”, since the latter does perhaps tend towards the onerous; but the general gist seems OK to me – almost trivially so.

Note, though, how a great deal rides on a distinction between different kinds of pregnancy-terminating procedure (PTP, from now on).  Notably, there’s a line drawn around abortion as a particular form of PTP.  The statement admits that certain PTPs may be permissible: what matters is that there should be no intention to kill.  Thus certain PTPs may be permissible notwithstanding foetal death if that death is not intended.  I take this to mean that, should the foetus survive, permissible PTPs would be those in which there is no sense that the procedure had gone wrong.  Abortion would be the kind of PTP that is impermissible, precisely because the intention is to kill.  (At the extreme, successful delivery is a kind of PTP, too, since it does end the pregnancy – it’s just that it’s the kind of PTP that we celebrate, rather than tolerate.)

Fairly clearly, the Bishops’ statement relies on some form of the Doctrine of Double Effect: the idea that there’s a moral difference to be had between intending some outcome, and foreseeing it.  If the Doctrine holds water, it would provide a way to say that acting in order to shorten a life may have one moral value or require one moral argument, but acting despite a foreseen shortening may have or require another.

Now: put that slightly to one side, but keep it simmering while we look at something else. more…

Kelly Hills has been data-mining – collecting and collating information about the frequency with which certain terms appear in paper titles in three journals: the JME, Bioethics, and the AJoB.

I was going to say that the charts are not much use, but that they are pretty and quite cool; and I was going to add that their lack of utility doesn’t matter at all because prettiness and coolness is sufficient to make them worth looking at.  Not everything worthwhile is worthwhile because it’s useful, after all.  Being a philosopher, I have to believe that.

But then it occurred to me that there probably is some utility to them.  Taken with some care, they help us to see what is held to be important by people publishing work – and, I suppose, they might also help decide which journals are more receptive to certain topics (or, conversely, which journals are saturated with them).

Here’s what the JME‘s chart looks like:

The image isn’t perfect, of course: because size is a mark of brute numbers and the algorithm that generates the image isn’t sensitive to context, “ethics”, and “ethical” get separated, when the reality might not indicate that they merit separate consideration.  “Euthanasia” gets only a small amount of attention – which tells us something about the heat-to-light ratios in debates on the topic.  It also gives some support to John Coggon’s idea that it’s getting hard to find anything new worth saying in that particular field – though I’d've thought the same, and more, would apply in respect of consent, and that seems to generate a heck of a lot of attention.