Remember a little while ago there was a rash of proposals in the US that’d force women to see a sonogram of the foetus, or to listen to detailed descriptions of it, before having an abortion?

Yeah: them.  Well, via Ophelia, here’s an account of what really happens.

Halfway through my pregnancy, I learned that my baby was ill. Profoundly so. [...] “I’m worried about your baby’s head shape,” she said.  “I want you to see a specialist—now.”

[... B]efore I’d even known I was pregnant, a molecular flaw had determined that our son’s brain, spine and legs wouldn’t develop correctly.  If he were to make it to term—something our doctor couldn’t guarantee—he’d need a lifetime of medical care.  From the moment he was born, my doctor told us, our son would suffer greatly.

So, softly, haltingly, my husband asked about termination.  The doctor shot me a glance that said: Are you okay to hear this now?  I nodded, clenched my fists and focused on the cowboy boots beneath her scrubs.

She started with an apology[...]

That’s not a good start, is it?  An expression of sympathy, maybe.  But an apology?  It’s as if she knows that things are about to get worse.  And they are. more…

It’s just been reported that Tony Nicklinson has won the right to have his right to die case heard before the courts.  This is the result of a hearing in which the Ministry of Justice’s contention was that any such case would potentially re-write the murder laws, and that this is a matter for Parliament, rather than the courts.

Nicklinson has had “locked-in syndrome” since a stroke in 2005: he’s capable of communication, but little else.  (His wife was interviewed on the Today programme this morning: it’s well worth a listen.)

As I understand it, what makes his case different from that of, say, Diane Pretty is that his argument rests on an appeal to necessity: his wife claims that ”the only way to relieve Tony’s suffering will be to kill him.  There’s absolutely nothing else that can be done for him” (skip to about 3:30 in the interview for that bit).  There’s also a dignity aspect to the petition.

This being news that’s only broken in the last couple of minutes, further details are slightly sketchy.  (I suspect there’ll be a statement from the MoJ, but I can’t see anything on their website just yet.)  However, I’m prepared to stick my neck out to make a prediction.  It’s this:  more…

When we decided to write this article about after-birth abortion we had no idea that our paper would raise such a heated debate.

“Why not? You should have known!” people keep on repeating everywhere on the web.  The answer is very simple: the article was supposed to be read by other fellow bioethicists who were already familiar with this topic and our arguments.  Indeed, as Professor Savulescu explains in his editorial, this debate has been going on for 40 years.

We started from the definition of person introduced by Michael Tooley in 1975 and we tried to draw the logical conclusions deriving from this premise.  It was meant to be a pure exercise of logic: if X, then Y.  We expected that other bioethicists would challenge either the premise or the logical pattern we followed, because this is what happens in academic debates.  And we believed we were going to read interesting responses to the argument, as we already read a few on this topic in religious websites.

However, we never meant to suggest that after-birth abortion should become legal.  This was not made clear enough in the paper.  Laws are not just about rational ethical arguments, because there are many practical, emotional, social aspects that are relevant in policy making (such as respecting the plurality of ethical views, people’s emotional reactions etc).  But we are not policy makers, we are philosophers, and we deal with concepts, not with legal policy.

Moreover, we did not suggest that after birth abortion should be permissible for months or years as the media erroneously reported.

If we wanted to suggest something about policy, we would have written, for example, a comment related the Groningen Protocol (in the Netherlands), which is a guideline that permits killing newborns under certain circumstances (e.g. when the newborn is affected by serious diseases).  But we do not discuss guidelines in the paper.  Rather we acknowledged the fact that such a protocol exists and this is a good reason to discuss the topic (and probably also for publishing papers on this topic).

However, the content of (the abstract of) the paper started to be picked up by newspapers, radio  and on the web.  What people understood was that we were in favour of killing people.  This, of course, is not what we suggested.  This is easier to see when our thesis is read in the context of the history of the debate.

We are really sorry that many people, who do not share the background of the intended audience for this article, felt offended, outraged, or even threatened.  We apologise to them, but we could not control how the message was promulgated across the internet and then conveyed by the media.  In fact, we personally do not agree with much of what the media suggest we think.  Because of these misleading messages pumped by certain groups on the internet and picked up for a controversy-hungry media, we started to receive many emails from very angry people (most of whom claimed to be Pro-Life and very religious) who threatened to kill us or which were extremely abusive.  Prof Savulescu said these responses were out of place, and he himself was attacked because, after all, “we deserve it.”

We do not think anyone should be abused for writing an academic paper on a controversial topic.

However, we also received many emails from people thanking us for raising this debate which is stimulating in an academic sense.  These people understood there was no legal implication in the paper.  We did not recommend or suggest anything in the paper about what people should do (or about what policies should allow).

We apologise for offence caused by our paper, and we hope this letter helps people to understand the essential distinction between academic language and the misleading media presentation, and between what could be discussed in an academic paper and what could be legally permissible.

Alberto Giubilini and Francesca Minerva

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

It’s been a while since the last post, and there’s a couple of serious entries on the way – but they’ve been displaced by a bit of silliness from Oklahoma.  State Senator Ralph Shortey (or SHortey, if you follow his Facebook style) has introduced a Bill demanding that

[n]o person or entity shall manufacture or knowingly sell food or any other product intended for human consumption which contains aborted human fetuses in the ingredients or which used aborted human fetuses in the research or development of any of the ingredients.

Robin Marty elaborates:

The Republican has proposed a bill that will ban the use of “aborted human fetuses in food,” despite his admission that he doesn’t know of any companies that actually…well..use them.

So where did Sen. Shortey get this idea?  According to him, from the internet.

The “internet research” Shortey is referring to likely is an ongoing anti-choice crusade that began months ago, when an activist group began demanding a boycott of PepsiCo, which works with a research and development company that uses a line of embryonic kidney stem cells created in the 1970′s to test “flavor enhancers.” The boycotters, led by a group called Children of God for Life, say that’s the same as using aborted fetuses.

Ah: teh interwebz.  I see.  (For the record, the LA Times reports that “[a] U.S. Food and Drug Administration spokeswoman told the Associated Press that the agency has never gotten any reports of fetuses being used in food production.”)

Since there’s never likely to be a better excuse to link to [SPOILER ALERT] the final scene of Soylent Green on this blog, that’s precisely what I’ll do; I only wish I could get the clip to embed.

But there’s more to this than lampooning a typographically-challenged Senator, because the Bill, in its brutal simplicity, is brutally simplistic. more…

I’m currently working my way through the recently-released report by the Commission on Assisted Dying – it’s a long and appropriately life-sapping document, but a number of commentators has been quicker than I to get through it.  Douglas Noble, writing at the BMJ blog, isn’t impressed.  Based on what I’ve read so far, I’m tempted to agree – though for different reasons.

Anyway: Noble makes a claim that’s a bit puzzling:

In political terms this issue is a dead duck – so why the continual fascination by a minority of vocal campaigners?  The answers are complex.  Perhaps, though, it is ultimately because of an inability to accept that suffering is an integral part of our world, common to all who share the human condition. Dealing a fatal injection and dressing it up as dignity is not a solution to suffering and pain. High quality palliative care is part of the answer, but so too is the effect of the affection, love, and commitment (sometimes over long periods of time) that we can show to one another when the worst hand is dealt.

He may be right in the dead-duck bit.  But his comments about suffering are odd. more…

A story that has had a little airtime on the news over the last 24 hours or so concerns requests by US officials that details of research into a bird flu variant be held back from publication on the grounds that it might be of use to terrorists:

The National Science Advisory Board for Biosecurity recommended that the “general conclusions” be published but that final manuscripts not include details that “could enable replication of the experiments by those who would seek to do harm”.

The BBC’s health news blog reports that

Professor John Oxford from Barts and the London School of Medicine [says], “They should definitely publish. The biggest risk with bird flu is from the virus itself. We should forget about bio terrorism and concentrate on Mother Nature.”  [He and Prof Wendy Barclay from Imperial College London] agree that the influenza virus would make a pretty poor bioterrorist weapon, unless your aim was to spread the infection across the world. Influenza has no respect for borders, so introducing a virus in one country would inevitably spread it globally.

But Michael Parker, Professor of Bioethics and Director of the Ethox Centre at the University of Oxford, disagrees.  ”The position that everything should be published is not tenable. There must be some scientific information which contains an immediate threat to public safety if it fell into the wrong hands.”

Parker’s worries reflect those articulated by Tom Douglas and Julian Savulescu in the JME a little while ago; they argued that synthetic biology raises significant new ethical problems, not least because of the potential for “dual use”.

I have to admit that I have yet to be convinced by the biosecurity worries.   more…

There’s a flurry of papers on conscientious objection in the latest JME: Giles Birchley argues, taking his cue from Arendt, that conscientious objection has a place in medicine here; Sophie Strickland’s paper on medical students’ attitude to conscientious objection (which I mentioned in July) is here; and Morten Magelssen wonders when conscientious objection should be accepted here.

All this is coincident with the recent passing of the “Protection of Life” Bill by the American House of Representatives.  This also has a significant clause about conscientious objection: I’ll come to that  in a little while.

Magelssen claims that conscience is important for integrity, and there is a social interest in protecting integrity.  His position is that objections should be accepted if

1. Providing health care would seriously damage the health professional’s moral integrity by (a) constituting a serious violation (b) of a deeply held conviction.

2. The objection has a plausible moral or religious rationale

3. The treatment is not considered an essential part of the health professional’s work

4. The burdens to the patient are acceptably small ((a) The patient’s condition is not life-threatening; (b) Refusal does not lead to the patient not getting the treatment, or to unacceptable delay or expenses (c) Measures have been taken to reduce the burdens to the patient)

5. The burdens to colleagues and healthcare institutions are acceptably small

As elaboration, he claims that ”[a]n objection does not have a plausible rationale if it is based on erroneous factual premises”.  more…

You can tell libertarians from the sound they make: it’s the faint rattle of a tiny intellect untethered in an otherwise empty mind.  Cheap and all-too-easy insults aside, though, I’d been wondering how long it’d be, in the wake of the BMA’s recommendation that smoking be banned from cars, before we got a response from the libertarians.  The answer, it seems, is a couple of days.  The Libertarian Alliance, for example, has had a go (it’s a totalitarian tax ruse, I tells ya!  Thank goodness tax is low on tinfoil hats…); but the example that really caught my attention – by which I mean rendered me slack-jawed in amazement – was this piece by Rob Lyons in Spiked, the online journal of choice of the bewildered. more…

When John Sentamu stood up in the House of Lords a couple of weeks ago and spoke about the need for the NHS to concern itself with “spiritual” needs – and illustrated his claim with an anecdote about something resembling an exorcism – the response from a lot of the blogosphere was, at its friendliest, one of pointing and laughing.  It’s very easy to see why.  Not only is it slightly embarrassing that in the UK you can be made a Member of Parliament for being good at believing in the right kind of god in the right kind of way, but the NHS – and healthcare generally – is successful when and because its clinical procedures are based on science and reason, not spooky ghosty stuff.  (In fact, I struggle to see what Sentamu actually meant.  He was empatic that the spiritual is not the same as the psychological, but this just prompts a question: what, then, is it – if anything?  If you remove the psychological from the spiritual, does anything remain?  And if it does, how do we know?)

Anyway: I was prepared to go along with the pointing and laughing.  But then, on Saturday, I saw a DVD of The Exorcist for a couple of quid and impulse bought it; and, that evening, I turned off the lights and watched it.*  You’ll have to bear with me on this, but it made me wonder if there might be something interesting about the idea of “spiritual” care on the NHS.  Not that I believe for a moment that there’s such a thing as demonic possession, or such a thing as a soul or spirit.  Of course there isn’t.  But it doesn’t follow from that that such terms have no place in respect of some forms of care. more…