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Child Euthanasia: Should We Just not Talk about It?

12 May, 15 | by Iain Brassington

Guest Post by Luc Bovens

In 2014 Belgium passed a law that extends its euthanasia legislation to minors.  There were strong parliamentary majorities in favour of this law but nonetheless a scream of “Murderers!” was heard in the public galleries of the Chamber of Representatives.  What is the opposition like in Belgium?

Euthanasia for adults has been legal in Belgium since 2002.  Many opponents of this legislation, including the Catholic Church, abhor the decision to further extend this legislation to minors.  I do not engage with the legalisation of euthanasia in general.  What I am asking is whether, considering that euthanasia is legal, it is or is not reasonable to limit the legislation to adults only.  This is a separate moral question.  One may be an opponent of a particular practice, yet at the same time believe that, if the practice is legalised, then it would be wrong to restrict the legalisation to a particular subgroup.   (Likewise, one may be an opponent of, say, legislation permitting abortion, and yet, if abortion is legalised, oppose a restriction that would make it accessible to only certain sectors of society.)  I distinguish between two lines of opposition that focus on the extension of the euthanasia legislation to minors in the Belgian debate.

First, there is an Open Letter signed by (mostly) paediatricians and there are various arguments in the press against the extension of the legislation: We should never grant euthanasia requests to minors, because such decisions are too weighty for minors, minors are not capable of discernment, the pressure on minors is too great, minors are particularly sensitive to such pressure, and there is sufficient palliative care for minors.

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My One Appearance in “Cosmo”…

28 Apr, 15 | by Iain Brassington

… and they go and screw it up.

A few weeks (months?) ago, I got a call from Cosmopolitan to ask if I’d talk about home-testing kits for genetics – stuff like what 23andMe offers.  We talked, and I like to think that I said something useful… and promptly forgot all about it, until just now, when the University of Manchester press office sent me a link to this: a story about HIV self-testing kits in the UK.

It’s a piece that quotes me.  It quotes me from that interview I did about genetic – genetic! – tests:

Iain Brassington, Healthcare Ethics professor at the University of Manchester told Cosmo Body:

“People invest a lot in genetic information and it could have a serious psychological impact. Someone could feel anxious, distraught, even suicidal if they find out they are carrying a gene associated with particular diseases.”

Can you see the problem here?

Apart from the fact that I’m not, and am unlikely soon to be, a Professor, I mean?

OK: for clarity’s sake (and just in case there are any Cosmo readers who’ve drifted here): genetic tests and HIV tests are VERY DIFFERENT THINGS, and raise CORRESPONDINGLY DIFFERENT PROBLEMS.  I don’t think that HIV is a genetic condition.  Only idiots think that.  Some of the problems with one might well be problems with the other.  But we can’t leap between the two so easily.  I don’t know what I think about home HIV tests; I’ve not thought about them much, and noone’s asked me to have an opionion on them yet.  THIS QUOTATION MAKES ME LOOK LIKE AN IDIOT.

Also, they put words in my mouth.  I can’t remember what I said, but I doubt it’d’ve been anything as fatuous as “Someone could feel anxious, distraught, even suicidal if they find out they are carrying a gene associated with particular diseases.”  That’s simply not the kind of thing I say.

Yes, I’m posting here shamelessly, because I don’t want that particular piece to appear if people Google me without some kind of balancing act.  And I’m posting a screengrab just below the fold for posterity’s sake, just in case Cosmo deletes the page.

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Incentives, Penalties, and Vaccination.

13 Apr, 15 | by Iain Brassington

This popped up on my FB feed yesterday: a proposal from the Australian government that certain child welfare payments should be withheld from parents who refuse to vaccinate their kids based on “conscientious objection”.

Parents who do not vaccinate their children will lose welfare payments of up to $2100 per child under a federal government policy set to be announced before the May budget.

Under changes that could save more than $50 million a year, Social Services Minister Scott Morrison is preparing to scrap a “conscientious objection” provision which allows anti-vaccination parents to still claim welfare benefits including childcare assistance and Family Tax Benefit A.

Fairfax Media understands the Family Tax Benefit A is worth up to $2100 per child.

What to make of the idea?

Well, I think that certain things can be taken more or less as read.  The first is that vaccination is a good thing, and is quite possibly a prima facie duty.  The second is that governments may, and perhaps must, encourage vaccination.  So it looks as though an argument in defence of the idea could be valid.  Measures to increase levels of vaccination are desirable; this is a measure that (if it works) would increase levels of vaccination; therefore this is desirable.  We’d have to do a bit of work to see whether the argument actually does work – formal validity won’t guarantee that – but in the meantime, the policy may be justified on the basis that it’s reasonable to believe that it would work.

But that is not, of course, the whole story.  Effectiveness is a necessary condition for a policy being justified, but it ain’t sufficient.  It’s likely that there’s more to say. more…

The Death of Sidaway: Values, Judgments and Informed Consent

15 Mar, 15 | by BMJ

Guest post by Kirsty Keywood (University of Manchester)

On 11th March Nadine Montgomery won her case before the UK Supreme Court to gain compensation for the failure of her obstetrician to warn her of risks associated with the vaginal delivery of a large infant – a risk which she would have averted by requesting a caesarean section.[1] Shortly after his birth, her son was diagnosed with cerebral palsy and a brachial plexus injury, resulting from the occlusion of the placenta during a “very stressful” vaginal delivery.

Nadine Montgomery had diabetes, which increased her chances of giving birth to a larger than average-sized baby. This, in conjunction with her small stature (she was 5 feet tall), indicated a risk that a natural delivery would bring with it a 9-10% chance of shoulder dystocia. Were dystocia to occur, attempts to dislodge the infant’s shoulders through mechanical manoeuvres would generate a risk of occlusion of the umbilical cord resulting in death or cerebral palsy of 0.1%. According to the obstetrician, Dr McLellan, the risk of shoulder dystocia did not merit specific mention in discussions with diabetic patients, because the risk of an adverse event associated with shoulder dystocia was very small indeed.

Mrs Montgomery’s case before the UK Supreme Court hinged on the question of the nature of the obstetrician’s duty to the patient. more…

Flogging and the Medic

3 Mar, 15 | by Iain Brassington

You must, by now, have heard of the Saudi Arabian blogger Raif Badawi.  Just in case you haven’t (really?), here’s a potted biography: having set up the secularist forum Free Saudi Liberals, he was arrested for insulting Islam and showing disobedience.  Among the formal charges he faced was one for apostasy, which carries the death penalty in Saudi.  The apostasy charge was dropped, but he was convicted on other charges and sentenced to seven years in prison and 600 lashes.  He appealed, and this sentence was changed: it became 1000 lashes and 10 years in prison.  Why?  Does it matter?  Because Saudi Arabia.  The latest update is that the apostasy charge may be renewed, so for a second time, he faces beheading.  Part of the evidence against him is that he “Liked” a post on a Facebook page for Arab Christians.  (Remember: Saudi is one of our allies against religious extremism.)

The lashes were to be administered in batches of 50, weekly, after Friday prayers.  As I write this, he has only been flogged once; doctors have attested that he is not well enough to be flogged again.  And – with thanks to Ophelia for the link – it’s  not hard to see why:

Dr Juliet Cohen, head of doctors at Freedom from Torture, explained: “When the cane strikes, the blood is forced from the tissues beneath… Damage to the small blood vessels and individual cells causes leakage of blood and tissue fluid into the skin and underlying tissue, increasing the tension in these areas.

“The more blows are inflicted on top of one another, the more chance of open wounds being caused. This is important because they are likely to be more painful and at risk of infection, which will cause further pain over a prolonged period as infection delays the wounds’ healing.”

There is also the long-term damage done to the victim’s mental health caused by flogging.

“Psychologically, flogging may cause feelings of fear, anxiety, humiliation and shame. Anticipation of the next scheduled flogging is likely to cause heightened emotions especially of fear, anxiety and difficulty sleeping… pain and fear together over a prolonged period have a deeply debilitating effect and recovery from such experiences may take considerable time,” said Cohen.

At the beginning of February, Vincent Iacopino had a post on the main BMJ blog in which he claimed that health professionals should play no part in Badawi’s flogging: more…

Bye-Bye Saatchi Bill?

1 Mar, 15 | by Iain Brassington

It would appear that Lord Saatchi’s Medical Innovation Bill is toast.

The Lib Dems, who are reportedly the ones to have vetoed it, are nevertheless being mealy-mouthed about something they should be proclaiming from the rooftops: the Bill is/ was needless at best, and possibly dangerous.  But, hey: there’s an election coming up, and cancer treatment is politically important; meanwhile, the party isn’t popular, and could probably have expected a set of “Lib Dems veto miracle cure” headlines had they made that move.

Which, when you read the Graun‘s article, isn’t a million miles away from Saatchi’s response:

“By killing the bill they have killed the hopes of thousands of cancer patients. It is as simple as that. Nick Clegg has handed down a death sentence to cancer patients.”

Which is, of course, untrue.  But, hey: whatever else he may be, Saatchi’s a great ad-man, and there’s an election coming up…

Strange Happenings in Belgium

3 Feb, 15 | by Iain Brassington

There’s a part of me that recognises this story as having been in the news before – but I don’t think I’ve written on it, so here we go.  It’s from the Telegraph, under the headline “Son Challenges Belgian Law after Mother’s ‘Mercy Killing'” – which is a reasonably pithy summation of what’s at issue.  A man, Tom Mortier, is attempting to bring a case before the European Court of Human Rights that would have Belgian laws on euthanasia scrutinised and – he hopes – declared contrary to the ECHR:

A Belgian man is going to the European Court of Human Rights after his depressed mother was killed by lethal injection under the country’s liberal euthanasia laws. […]

Mr Mortier is trying to take his mother’s case to the Strasbourg court under the “right to life” legislation in the European Convention of Human Rights. He hopes, at the very least, to trigger some debate in his country, and secure greater oversight in the way the existing rules are applied.

OK – so it’s not clear whether he’s actually got the Court to agree to hear his case (which is what “going to the ECtHR” suggests in ordinary usage), or whether he’s still attempting to get it to agree to hear it.  If it’s the latter, then he might be going to the ECtHR in the sense of being physically present – but that’s not going to achieve much.  The Telegraph isn’t clear on this.  Oh, well.  But is there anything of substance to his case?  It might have substance and still fail, of course – it’s perfectly possible for a court to say that they can see a person’s point, but that it’s not sufficiently powerful; but if it has no substance, then it ought to fail.

Based on the Telegraph‘s report, it seems that there really isn’t much substance to it.  This is not to say that there’s none – but there’s not much.  And, as we’ll see, it’s a bit strange in some ways. more…

Free Speech and the CMF

5 Jan, 15 | by Iain Brassington

Despite a slight reticence when it comes to quoting Mill approvingly, I do have to admit that sometimes he does articulate a thought clearly and pithily, and sometimes it’s a thought in which all right-thinking people ought to see the merit.  Like, for example, this, from the opening paragraph of chapter III in On Liberty:

An opinion that corn-dealers are starvers of the poor, or that private property is robbery, ought to be unmolested when simply circulated through the press, but may justly incur punishment when delivered orally to an excited mob assembled before the house of a corn-dealer, or when handed about among the same mob in the form of a placard.

The general point ought to be clear: whatever your prima facie right to say what you want, it doesn’t mean there’re no limits on the circumstances in which it can be said.  Mill is concerned about excitable mobs, but the basic principle could, I think, be extended without too much difficulty: if your free speech causes severe inconvenience or distress or inconvenience to others, you ought to moderate it or take it elsewhere.  Having the freedom to make a point is, and ought to be, compatible with others’ freedom not to be bothered by your making it.

I think that that’s pretty reasonable: your liberty is one thing, but it’s not the only thing.  There’s the liberty of others to avoid you to consider, for one thing.  Pushing things a bit further, we might be inclined to argue that liberty is a good because of its relationship with, and contribution to securing, the general welfare – but that there’re other things that contribute to that, too, which therefore ought also to be considered good things worth protecting.  Basic civility might be one such good.  Mill doesn’t make much of that, but there’s no reason why we couldn’t say that that’s a good worth preserving – and why we couldn’t fit that into a modified Millianism, should we so desire.  On Liberty isn’t Holy Writ: its good ideas might be extendable.

Keep that in the back of your mind for a moment.

Many readers will have seen the video posted a few weeks ago by Sunny Hundal in which a woman berates a group of pro-life protesters outside an abortion clinic.  The background detail is that there is reportedly an increasing prevalence in the UK of pro-life protesters congregating outside such clinics.  Sometimes those protests take the form of prayer vigils; sometimes – as in the video – they’re more direct, with posters of babies and foetuses, sometimes quite graphic.  Occasionally there’s barracking; I think that this is more common in the US, but I suspect that the trend may appear here soon enough, not least because these things do tend to escalate.  Yvette Cooper has apparently mulled the idea of buffer-zones around abortion clinics, within which pro-life protesters would not be allowed to protest.

Writing on the CMF blog, Cheryl Chin is not happy about Cooper’s idea; she thinks that “It would appear that once again, liberties are under threat of being curtailed by the proponents of the pro-abortion brigade”.* more…

A Bit More on Nonhuman Persons

23 Dec, 14 | by Iain Brassington

A bit of a followup to my last post: sometimes, nonhumans are granted habeas corpus:

Orangutans have been granted the status of “non-human persons” with legal rights in a landmark court ruling in Argentina. The decision clears the way for Sandra, a shy 29-year-old, to be freed from Buenos Aires Zoo after spending her entire life in captivity. […]

The ruling came after animal rights campaigners filed a habeas corpus petition – a document more typically used to challenge the legality of a person’s detention or imprisonment – on behalf of the Sumatran orangutan, who was born at a German zoo and was transferred to Buenos Aires two decades ago.

Sandra will, unless there’s a successful appeal, be moved from the zoo to a sanctuary.

In practice, this might not make all that much difference.  She’ll still be confined in a sanctuary; it would be utterly indefensible just to turf her out onto the streets, and she wouldn’t last long.  And in some cases, it’s quite possible that a well-run zoo is the best possible place in which to look after her or others like her.  Zoo, sanctuary: tomayto, tomahto.  Meh.

What matters primarily is that a point of principle is established, and secondarily that there would be some guidance about the kind of facilities that would be minimally decent.  It’s likely to be wholly acceptable, morally and legally, to keep great apes in some form of captivity if it’s in their interests, in rather the same way that we might provide a human child or an adult with an intellectual disability with sheltered or supervised accommodation, and might even limit their time away from it.  (The family home is a kind of sheltered and supervised accommodation!)  If a creature – human or orang or chimp or whatever else – can’t deal with the world around them, that seems to be morally required.  Let’s call this “soft captivity”, as opposed to the “hard” captivity of some zoos, prisons, laboratories, and so on.  The point is that, rather as we wouldn’t deny that a child or adult disabled human is a person and thus protected by the law, it does seem reasonable to extend that protection to members of other species.

I wonder how much further we could push it: it’s one thing to have a great ape in soft captivity for its own protection; and it’s one thing to say that if a great ape is in captivity, it ought to be soft captivity.  But could we make a similar claim about keeping a member of a species in soft captivity for the sake of protecting the species?

Orangs are under threat.  Now, a threat to the species is almost always a threat to the members of the species, too – and so we would almost always be unable to distinguish acting to protect individual orangs and the species as a whole.  But this needn’t be the case.  Imagine that there are two small colonies of the animal left; a genetic bottleneck means that neither is viable on its own, but, if they were combined, the species may be rescued and flourish in the future.  Furthermore, each colony is in a confined area that cannot support a bigger population.  There is no direct threat to either colony, though.  It so happens that a busy road separates the colonies, which means that they are to all intents and purposes isolated.

Would it be permissible to swing into action to take all these orangs into a sufficiently big sanctuary, and maybe to keep them there for the sake of increasing the population?  It wouldn’t obviously be in the interests of any particular living orang; but it could be in the interests of the species.  Even if the captivity is soft, it is still captivity.  Would it be justified?

Part of me thinks that it might be; but this does rely on thinking that the species qua species has a moral value and interest, aside from the value and interest of its members.  And that does seem like a bit of a stretch – especially if (as seems plausible) individual orangs have no concept of species with which they can identify.

 

Admittedly, this isn’t a medical ethics post in the strict sense – but it’s a nice story, so ner.

Rights, Duties, and Species

19 Dec, 14 | by Iain Brassington

A little earlier this year, there was a case brought before the New York courts concerning a chimpanzee called Tommy: the matter was the lawfulness of keeping Tommy confined.  Acting on Tommy’s behalf was an organisation called the NonHuman Rights Project.  The legal documentation filed is available here.  The basis of the case was not so much that Tommy was being harmed by his treatment as that he was wronged by it: to keep a chimpanzee in such conditions s a violation of certain rights, and ought not to be allowed granted a plausible application of habeas corpus, even the most comfortable of cages still being a cage – or so the claim went.  Essentially, the legal question under consideration was this: does a chimpanzee have any of the legal rights that a human has; and, if so, which?

Perhaps predictably, the suit was rejected; Justice Karen Peters found that habeas corpus did not apply to chimpanzees, and the other judges agreed.  Whatever legal restrictions there may be on primates, they do not fall under the rights paradigm.

The reasoning here strikes me as being a touch… well, wonky.

A significant part of the argument revolves around what kind of thing counts as a person, and so ought to have the rights of a person.  It’s not difficult to see why this is important in bioethics, because it’ll impinge on what happens in laboratories, and – potentially – on what happens in a human uterus or neonatal unit.  If the definition of “person” extends to chimps, the suit goes, then habeas corpus should apply.  If it doesn’t, then there’s no reason to suppose that it would.  The judgement is that personhood does not apply to chimps.  The term has, the court found, never been explicitly defined; and habeas corpus relief has never been granted to any nonhuman.  This wouldn’t mean that it shouldn’t be; the question then would move on to examining the ought question.

For Peters, there is no ought here, and this conclusion is based on an appeal to a particular definition of “person”.  It’s worth quoting the ruling at length here: more…

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