4 Sep, 12 | by David Hunter
16 Aug, 12 | by Iain Brassington
So the JME has – finally – published the paper by Brierley et al concerning withholding and withdrawal of futile treatment from children in the face of doctrinally-informed objections by the parents. It’s taken a while, but it’s there now.
The essence of the paper’s claim is pretty simply put: if parental preferences run contrary to the medical best interests of the child, then we shouldn’t be too hesitant when it comes to discounting those preferences. Or, as the paper’s conclusion has it:
Traditional mechanisms for resolution of end-of life disagreements based upon local cultural, secular or religious values [are] not infrequently unsuccessful. Protracted dialogue [is] often unable to resolve these differences, while the child [is] subject to pain and discomfort from invasive ventilation, suctioning and multiple injections. We suggest it is time to reconsider current ethical and legal structures and facilitate rapid default access to courts in such situations when the best interests of the child are compromised in expectation of the miraculous. [Emphasis mine - IB]
And this, it seems to me, seems fairly straightforward – albeit quite a limited claim about legal process.
Granted, there is a couple of niggles that one might have with the paper. For example, the authors concede that those parents most likely to object to decisions to end treatment are those from African Evangelical churches. But since members of those churches are more likely to be immigrants, or from other less privileged parts of the community, I wonder whether it’s religion that’s the main signifier here: it might equally well be class. Or it might be other things. (Mark Sheehan makes a similar point – that religion may be a red herring – in his commentary on the paper.) Either way, what counts is a fairly straightforward question about what we should do when it comes to deciding best interests in life-and-death situations. (Steve Clarke offers suggestions about what to do in his commentary.)
I wonder whether the appeal to torture and the Human Rights Act might be a bit of overkill in at least some cases, too.
But a bigger worry might have to with a paradox of publicity. more…
23 Mar, 12 | by Iain Brassington
There’s a short paper in the latest JME about which I’ve been meaning to write something for a while – ever since I noticed it as a pre-pub: William Muirhead’s “When Four Principles are Too Many”. (Raa Gillon provides a commentary here.)
Anyone who’s ever heard me talk professionally for longer than about 35 seconds at once will know that I have little time for “Principlism”. This is not quite the same as a claim that I have little time for the principles themselves – but this itself is arguably because what those principles demand is vague, or trivial, or some combination of the two. (It’s one thing to say that actions should be just, for example, but that just leaves open the question of what justice demands; and who in their right mind would demur from the idea that actions ought to be just, especially when no substantive account of justice is entailed? Or what about respect for autonomy? That’s often taken to mean that autonomy is king – but giving something its proper respect doesn’t tell us that a great deal of respect is warranted…) But, anyway: a critique of Principlism is all groovy in my view.
Except… well, this one doesn’t quite seem to work for me; and it’s problematic for a few of reasons. more…
5 Mar, 12 | by Iain Brassington
I did mention last week that I’d post links to sites that mentioned Giubilini and Minerva’s paper as they crossed my radar; but it turned out very quickly that there’d be no way to keep up. And, to be frank, a lot of the blogosphere’s response has been fairly scattergun outrage rather than dispassionate engagement with the paper, and directed at Giubilini and Minerva themselves rather than at the argument they put forward. There’s been much more heat than light.
This is perhaps unsurprising, as considered responses are almost certainly going to take a while to materialise. However, they have begun to appear. Here’s the first that I’ve spotted; I’ll post links to more in this thread as and when. And if any readers have responses on academia.edu or SSRN that they’d like mentioning, or if anyone spots anything of interest, do let me know. more…
2 Mar, 12 | by Iain Brassington
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
2 Mar, 12 | by BMJ Group
Guest Post by James Wilson
The controversy over the Giubilini and Minerva article has highlighted an important disconnect between the way that academic bioethicists think about their role, and what ordinary people think should be the role of bioethics. The style of this dispute – its acrimony and apparent incomprehension on both sides – are a sure sign that we as bioethicists need to think harder about what we are doing, and who we are doing it for.
At the heart of tempest has been the authors’ claim that abortion and infanticide are morally equivalent. Nearly everyone will agree that the authors are wrong about this, and that infanticide is and should always remain beyond the pale.
The US Born-Alive Infants Protection Act 2002 stipulates that the category of person – and the full protection due to persons – must be extended to “every infant member of the species homo sapiens who is born alive at any stage of development“. The deep question – from the perspective of academic ethics – is why every human being that is born alive should count as a person.
Often in bioethics the most difficult task is to articulate just what it is that lies behind the sorts of intuitive moral certainties that we all have: that is, to make clear to ourselves, and to those who are inclined to hold opposing views, just what our confidence in our own intuitive moral judgments is based on. This is often extremely difficult to do.
Why Some Bioethicists Think that Birth does not Matter
At the heart of Giubilini and Minerva’s claim that infanticide is morally on a par with abortion is the premise birth by itself does nothing to change the moral status of a developing human.
According to them (and like minded philosophers such as John Harris, Peter Singer and Michael Tooley) what makes the difference between a person and something that isn’t a person must be something to do with the capacities and abilities that a person has. On such views, if we want to say that all human beings should count as persons then we need to provide some account of what feature or features it is that all human beings have that renders it appropriate to treat them as persons. The feature of being born alive to a human mother does not – according to them – fit the bill.
According to these philosophers, this definition of “person” is both too narrow, and too broad. It’s too narrow, because it’s clear that there could be intelligent alien species who had the ability to engage in moral thinking; but yet who clearly would not be born to a human mother. They need not be born at all: perhaps the aliens from the planet Zog assemble themselves out of flatpacks from an interplanetary Ikea. But so long as they are able to live and to value things as we do, why should we deny them the status of persons? To do so looks like a human-centred chauvinism, no more than speciesism.
But the feature of being born alive to a human also looks too broad: what if the brain of the infant has been irreparably damaged, so that it will remain in its intellectual functioning at a level far below that of a chimpanzee and will never be able to love, to form plans or even to recognize itself in the mirror? Why (and in what sense) does an infant like this count as an equal of a fully functional adult?
John Harris has argued that we should strike down the thought that it is being born that makes the difference. As he once put it, “the geographical location of the developing human, whether it is inside the womb or not, is not the sort of thing that can make a moral difference”. (Even here, he was careful to clarify – as he has on this blog, that he was neither advocating infanticide, nor arguing for a change in the law.)
A Poor Reply: Banging the Table
The cheapest and easiest response to this challenge is to merely bang the table and assert the sheer obviousness of the difference that birth makes. As an example of this approach, Richard Nicholson once accused John Harris of indulging in “a philosopher’s mind game”. He continued, “He is wrong in saying there is no moral change that occurs in the process of birth. That is a change that is recognised in the law. Most parents would recognise their views about their newborn baby are considerably different than their views about the foetus in the mother a day earlier.”
All this, one feels, may be true; but it is hardly intellectually satisfying. Just because most parents would feel differently, it doesn’t in itself follow that they are justified in changing their feelings this way. It’s weak to counter an argument that puts forward reasons by merely appealing to force of numbers – pointing out that most people judge the same way you do.
Explaining the Significance of Birth
If we want to defend the moral significance of birth, then we need to provide some positive account of why birth matters. I want to outline very briefly three possible positive accounts.
(1) The infant now counts as a person because he or she is now a separate living entity: he or she is viable and is not dependent on anyone else for existence.
Some worries: it seems that this explanation misfires, because ‘being a separate living entity’ is both too broad, and too narrow, to serve as the feature that makes the difference between a person and a non-person. It’s too broad because dogs and cats are separate entities in their own right, but this does not make them persons. But it’s too narrow, because there can be persons who are not viable separate living entities: both of a pair of conjoined twins can count as separate persons, but in a severe case it might be quite impossible for both to be able to survive separation.
(2) The infant was already a person, previously it was lodged in the mother’s body like a guest lodged in a house owned by someone else.
On this view, there were conditions under which it would have been legitimate to expel the foetus despite the fact that it was a person (in circumstances such as those that Judith Jarvis Thomson considers in her famous defence of abortion, for instance). The significance of birth is that all these reasons that the mother may have to abort the foetus are then defeated.
Some Worries: This approach seems initially promising, but it may only push the problem further back: (a) we now need to give some non-arbitrary account of why the foetus was already a person, and how it became a person. (b) On this view it turns out that it isn’t birth that is actually doing the work here in making an entity a person.
(3) Ethical vision beyond explicit arguments
Charles Taylor makes a useful distinction between two different modes of ethical argumentation, which he calls offering basic reasons and articulating a vision of the good. As he says in Sources of the Self, “It is one thing to say that I ought to refrain from manipulating your emotions or threatening you because that is what respecting your rights as a human being requires. It is quite another to set out just what makes human beings worthy of commanding our respect, and to describe the higher mode of life and feeling which is involved in recognising this.”
Ethicists often place a very high degree of value on explicitness and arguments from consistency, invoking basic reasons in Taylor’s sense. A key part of Giubilini and Minerva’s argument has the following structure, for instance:
1. Persons are creatures with feature F.
2. The newborn does not have feature F.
3. Therefore the newborn is not a person.
A large part of the acrimony of the dispute seems to arise from the fact that many feel that to adopt this kind of schema fundamentally misunderstands the foundations of ethical consciousness. For them, what is foundational is the fragility of the life of the infant, and that once that has been appropriately noticed or articulated, one should be called upon to respond. So on this view, the answer may not be to describe those valuable features of human beings in terms that are applicable to any potential being at all, but rather to draw attention to just what it is about human being that we mean when we talk about the intrinsic dignity and value of human life.
This is something that is extremely difficult to do within the confines of analytic philosophy. For such articulation of the phenomenology of our fundamental moral commitments, literature is far more powerful. I’ll conclude this post with a bit from Tolstoy’s Anna Karenin, which perhaps provides some of this vision. Levin is struck by wonder at the birth of his son:
Meanwhile, at the foot of the bed, in Lizaveta Petrovna’s skilful hands flickered the life of a human being, like the small uncertain flame of a night-light – a human being who had not existed a moment ago but who, with the same rights and importance to itself as the rest of humanity, would live and create others in its own image… Whence, wherefore had it come, and who was it? He could not understand at all, nor accustom himself to the idea. It seemed to him too much, a superabundance, to which he was unable to get used for a long time.
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.
28 Feb, 12 | by BMJ Group
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.)
28 Feb, 12 | by BMJ Group
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”
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
16 Feb, 12 | by BMJ Group
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…
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