This is the first installment of Matazone’s “Floppity MD” series - and it’s well worth spending a couple of minutes looking at more recent installments, too: they provide an all-too-easily forgotten warning about purple, scalpel-carrying, semi-psychopathic cuddly toys.

I believe there may be a Hugh Laurie reference or two in there as well.

Dan Sulmasy has a piece on Bioethics Forum at the moment in which he considers the next 40 years of bioethics.  It’s a curious piece, making six main claims or predictions about the future, to which I’ll return in a minute: but before that, I think it’s worth looking at his scene-setting:

I suggest that bioethics has evolved through three phases: a religious phase in the 1950s and ’60s, a philosophical phase in the ’70s and ’80s, and a political-empirical phase from the ’90s to the present. Much as been written and said about the first two phases, but little about more recent history.

By the late 1980s, just as I was starting serious study in the field, philosophical bioethics had created a standard canon and had begun to rest on its achievements. Physicians, who found the language of philosophers alien but had been taking courses in bioethics, began re-engaging the field (or, in some cases, reclaiming it as their own). 

The general public, policymakers, and many of the new young students entering the field of bioethics by this time also began to complain that philosophy did not supply enough concrete answers to their pressing questions. They wanted solutions to social policy problems such as the distribution of health care resources, cost-containment, and physician-assisted suicide.

I’m interested to know whether this natural history of bioethics is accurate.  On the face of it, I’m not sure.  It - perhaps - describes the genesis of bioethics in the US, but I’m not sure that the subject has followed the same route in Europe, where there simply has not been a religious or political phase.  Bioethics has grown out of a renewed interest in applied ethics, which has grown out of good, old-fashioned, seminar-room ethics.  To the extent that claims are made about what should be done, and what the law should say, bioethics is “political” - but it isn’t political in the strong sense that I think Sulmasy uses the term; it isn’t about activism on behalf of this or that group (and it shouldn’t be, either).  And I’ve already articulated my suspicions of the supposed “empirical turn” in the subject; empirical studies may feed ethical debate, but they oughtn’t to be treated as a substitute.

But back to the six points, which I’ve edited down here.

more…

For quite a while now, I’ve had the idea that I’d like to write something about the purpose of medicine - it’s something I’ve been adding on job applications for about 5 years, but I’ve not got around to doing all that much about it yet.  The question as I saw it was whether medicine is properly concerned with making us well, or with assisting us in our projects.  The latter may be a condition of the former - indeed, it may be a criterion of the former - but it’s not the same, because we could have all kinds of odd projects that’re only tenuously health-related.  For example, cosmetic surgery - and here I mean potentially quite extreme body modification - might potentially belong to medicine if we go for the latter option.  It might not be the sort of thing that medics should prioritise, but it could still be on their list of concerns.

Where’s this preamble leading?  Well, Alice Dreger has been considering a similar sort of question over on the Hastings Center’s blog.  It’s cosmetic surgery that worries her:

I’m not naïve; as an historian of medicine, I know that medicine has always advanced itself by offering improvements of patients’ social status, primarily by making patients healthier, but also by legitimizing their complaints.

But the noble profession has historically been primarily about something nobler than boob jobs and Botoxing wrinkles. The medical profession’s primary goal, historically speaking, has been prevention and relief of real suffering.

I can’t believe I even have to assert that. If the great men and women of medicine could come back from the dead and watch television today, what would they make of the fact that a large percentage of the medicine that is represented is cosmetic?

They might conclude, reasonably, that this reveals medicine’s success. Only in a world of astonishingly good anesthetics, infection management, and surgical technique would patients dare seek these procedures. But they might also reasonably conclude that something very strange has happened.

There’re some interesting considerations raised in the piece - I do recommend it.  However, there’s also a couple of things with which I’d pick a dispute.  The conclusion doesn’t strike me as powerful, for example.

Let’s just call these practices what they are: barber surgery. That way, when one of my idealistic, smart, principled students hears that the student next to her is going into “cosmetics,” she can just answer, “Really? And here I thought we were in medical school.”

Dreger is fairly clear that she goes along with the first of my options above - that medicine is about wellness - but I’m not sure that that’s right: I don’t think I see wellness as an end in itself.  Rather, I see it as something that’s valuable (and comprehensible) only within the context of a certain set of projects.  So it’s those projects that do the work - in which case, cosmetic medicine (or barber surgery - call it what you will) is, if not exactly back on the menu, at least chalked up on the “Specials of the Day” board.  The “and I thought we were in medical school” retort wouldn’t stick.

And I think that the tone of the article more generally suggests something important and interesting about the cultural background of bioethics as pursued on the other side of the Atlantic. more…

Wouldn’t you know it, my favourite religious commentator (and I favour one religious commentator over another in the sense that I favour a hangover over a migraine or burst aneurysm) George Pitcher has weighed into the prayer on the wards coverage.

Guess what?  His opinions aren’t impressive. more…

A little while ago, I mentioned Jamie Ross’ admirable Cancerous Capers blog.  Well - for all the best reasons - there won’t be any more updates.  His reason?  Having cancer was tedious enough; but with radiotherapy over, banging on about not having it would be even more tedious.  Assuming he gets the all-clear in a couple of months, there’ll be nothing more to add.

Good.  I wish him well.

I can stop, you know.  Any time.  Honest.

Perhaps as something of a counterbalance to the generally pro-decriminalisation stuff I’ve been posting for the past couple of months, it’s worth pointing to Alexandre Erler’s piece on the issue on the Practical Ethics blog.  The tone of the post is thoughtful and more sympathetic to the current state of affairs than the kind of thing I’ve been citing so far, admitting that

there might be something to the idea that decriminalizing the use of cannabis (and other drugs) would send the wrong message: presumably, we wouldn’t want a substance to be made freely available if its only possible use was to allow those who purchased it to kill themselves. And there is some scientific evidence that cannabis is actually more harmful than tobacco. Suppose this evidence were conclusive: it might then be argued that a state’s commitment to liberal principles cannot justify its endorsing the use of just any substance by its citizens, no matter how harmful it might be. A limit must be placed somewhere, and one might argue that cannabis (and “tougher” drugs), but not tobacco, goes beyond that limit. This line of argument might be the best way of developing idea that decriminalizing cannabis “would send the wrong message”. But even if it is, its proponents need to clearly present it in an open debate, and they might also need further scientific evidence to back up their claims about the harmfulness of cannabis use. The term “drug” is not a magic word that can justify prohibiting the use of any substance it is properly applied to.

There’s a lot that’s right about this - especially about the (mis)use of the word “drugs” and the way it gets used in a morally (and moralistically) loaded manner.  Just as there is no such thing as a bad food, there is no such thing as a bad drug - it’s what you do with it that makes the difference.  (The Greeks knew that: their word “pharmakon” was wonderfully equivocal.  A poison is just a drug you can’t handle.)

I’m not so sure about the safety restriction, though.  I can think of plenty of people who’d insist that there is no limit to the idiocy that people should be allowed to commit, as long as it’s an “authentic” action on their part, and noone else - or, at least, noone who hasn’t consented - is hurt.  Often, these people cite R v Brown as a paradigm example of the law getting things wrong (or protesting a wee bit too much): it should, they say, have been much more permissive.  Though I’m not much of a fan of Mill, I have to admit that something like the Harm Principle is, at least pragmatically, attractive: the Brown ruling does seem to me to hit the wrong note.  This being the case, it’d be harder to accept the assumption about the free availability of deadly substances; and, mutatis mutandis, the same would apply to drug policy.

The real question concerns the unconsented harm to others that may be caused, and how to balance that with the demands of liberty.  On this, it would seem that there is an argument of at least some sort against cannabis use: but even there, it’s only limited.  We’d have to say, I think, that public cannabis use ought to be restricted for just the same reason that public smoking or drink-driving ought to be - but that’s really no big deal, and concerns the circumstances of cannabis use more than cannabis use in itself (or harder drug use, for that matter), which would remain something of which we might disapprove, but not something that we’d be entitled to ban outright.

So the end point would seem to be that we ought to be careful about these things.  It’s remarkably trivial.

It’s another one of those posts about drug policy, I’m aftaid: this week’s All in the Mind covered the Portuguese experiment with decriminalisation (about which I posted recently), and is available to listen for the next few days.  Depressingly, one of the contributors dropped a fairly broad hint - accurately, I think - that the UK would not be willing to make any comparable experiment, not because of any evidence against its advisability, but because of the cowardice of MPs and the bone-headedness of the commentariat (and electorate) to whom they’re in thrall - this is about 13 minutes in.  (On which notion, remember this?)  The same contributor also pointed out that the three main political parties have been forced by this reality to admit tacitly that criminalisation probably isn’t the best move, but cannot actually say that this is what they think clearly and publicly - hence they’re not only pushing a policy that plainly doesn’t work, but also one in which they really don’t believe.

By spooky synchronicity, over at Practical Ethics, Roger Crisp considers the recent pulling of Release’s “Nice People Take Drugs” adverts, and suggests that

[m]odern attitudes to drugs mirror those of advocates of temperance in the nineteenth century, who were moved by the terrible harms done to individuals, families, and communities by the abuse of alcohol. Few these days campaign for the prohibition of alcohol, and it is widely thought that a licensing system can mitigate a good deal of the harm of alcohol without unduly restricting the liberty of individuals to consume alcohol should they wish

- which seems to be on the money.  Noone who argues for a reform of the drug laws is saying that there should be a free-for-all: it’s just a matter of pointing out that humans like getting off their chops (as do other animals, apparently), and that we aren’t going to let small considerations like legality and wisdom get in the way, so we might as well grow up about it and come up with a policy that reflects this.

Meanwhile, Ben Goldacre’s latest Bad Science column addresses similar concerns through the lens of the US’ reaction to the WHO’s report on cocaine in the 1990s.  I don’t want to give away the plot, but it’s fair to say that the word “petulant” could be used with justice.

A short time ago, I mentioned George Pitcher’s extraordinarily lame showing on the Today programme, when he was invited to talk about assisted suicide.  I included a link to his blog - and, I admit it, this was partly intended so that he’d get an “incoming link” notification and either make a comment here, or refer to my post there.

As far as I can tell, he’s done neither.  However, he has excelled himself when it comes to euthanasia paranoia.  He posted on the subject on the day of the Radio 4 interview, and you can read the full thing here if you really want.  I’m going to pick on a short extract:

And another thing: We have a growing elderly population, living longer, and palliative care is very expensive. It couldn’t be that the Government sees the ballooning NHS budget and realises that one way to save a bit would be for our senior citizens to be encouraged to top themselves?

Nothing would surprise me anymore.

Ahhh… wild speculation and scaremongering dressed as argument.  Rewarding stuff.

Of course, I’d like to think that things couldn’t get stupider… but, it seems, they can.  One should never underoverestimate the contributors to Telegraph blogs.  “BritishPatriot” has to have his poorly-spelled say on the subject:

In 1970 when Aborion was legalised they said it would only be used in extreme circumstances, we now have abortion clinics, err, sorry pregnancy advice centres in every town where potential mothers are lulled into aborting what they are told are ‘just cells’
7.2 Million British Babies later, we face a Demographics Timebomb.
Now they want to sterilise our Schoolgirls.
This Euthenasia drive they are trying ti get us to agree to is so they can asset strip the British Elderly then do away with them in their Privatised ‘clinic’
The EU doesn’t want you, they know you will not vote for the EU so they are getting rid of you every way they can.
WAKE UP !!!!

If I don’t contribute to this blog for a while, it’ll be for one of two reasons.  Either Gordon Brown and the entire staff of the European Commission will personally have come round to my house to euthanise me (coldly ignoring my cries of “No!  Really!  I’m all in favour of the EU and would sign up to Schengen and the Euro lickety-split!”), or I’ll have bought shares in Bacofoil and have moved to a private island in the Carribean.

Because there seems to be a growing market in tinfoil hats that needs to be exploited.