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Homeopathy, Blacklisting, and the Misuse of Choice

15 Nov, 15 | by Iain Brassington

It seems that homeopathy might at last be facing some serious opposition from within the NHS, with the prospect of its being blacklisted being considered.

There’s any number of people who’ll be entirely on board with that. Homeopathy doesn’t work.  Of course, a lot of medicines turn out not to work, or not to work well.  But the difference between homeopathy and unsuccessful drugs is that the latter are at least more likely to have a plausible mechanism – roughly, one of throwing molecules at other molecules, or coaxing the body to throw molecules at molecules.  Homeopathy doesn’t even have that.  It relies on water having a memory.

At the very best, it contributes nothing. But it does cost money – not much, but more than none, and in the end, the taxpayer has to pony up for it.  Money is being wasted every time the NHS pays for homeopathic treatment, and that looks to be unjust.  (It’s not the most unjust thing in the world, but that’s neither here nor there.  Wrongs are wrongs, even if harms might vary.)

It might even get in the way of effective treatments, if patients use it rather than them.  That might mean that they’re worse off than they could otherwise be.  At the outside, it might mean that they’re a danger to others – they might be spreading illness by dint of not getting treated properly for it.

To that extent, Simon Singh strikes me as being bang on the money: more…

“Our lives are not actually our own”

23 Jul, 15 | by Iain Brassington

Long-term readers of this blog will know that, every now and then, I have a look at the CMF’s blog.  This is largely because of my interest in the ethics of assisted dying, and the blog is actually a pretty good way into developments on the other side of the lines.  There is rarely, if ever, anything new produced that’d move the argument on – but then, those of us who’re sympathetic to legalisation really aren’t doing any better.  It’s become rather a sterile debate.

I do tend to blank out the apologetics; bet every now and again, something catches my eye: a part of this recent post, about the latest attempt to introduce an assisted dying Bill into Parliament, is one such.  There’s a part where Peter Saunders claims that the Sermon on the Mount moved away from a literal take on the prohibition of murder to something more in keeping with the spirit of the law.  This, though, prompts a question for me: why can’t we accommodate a person’s desire to die within the general law against killing?  Might that desire mean that assistance is properly described as something other than murder?  It is tempting to infer from what Saunders says elsewhere that he is at least not too worried about some forms of intentional killing: writing about the Kermit Gosnell story a couple of years ago, his headline noted that Gosnell may face the death penalty – but the body text did not mention that at all, let alone take a position on it.  Yet if all deliberate killing is so straightforwardly wrong, we might expect that killing at least to be noted.  If deliberate killing by means of the death penalty doesn’t raise a peep of objection, then we might wonder why assisting in someone’s death at that person’s behest is more of a worry.

Saunders does have an answer to this query, though: more…

On the other hand…

20 Jul, 15 | by Iain Brassington

… the phenomenon of apologising for the wrong thing comes alongside people taking umbrage at the wrong thing.  Last week, the BMJ ran a head-to-head feature on the “question” of whether doctors should recommend homeopathy.  This was the latest in a series of articles in which a question is posed, apparently strictly on the understanding that it’ll accommodate a polarised debate, and one person is invited to give a “yea” response, and another to give “nay”.  I won’t bother here with a screed about homeopathy: Edzard Ernst does a good job in the BMJ piece, as have many others across the blogosphere.  (You could do worse, for example, than to have a wander through the Anomalous Distraction blog, which is written by an ex-schoolmate of mine, and which also has lots of pretty pictures of proteins and things.)  Since it’s a nice day, and I’m in a reasonably good mood, I’ll even admit that when Hahnemann was working, something like homeopathy was probably as good a punt as anything else that medicine had to offer.  But… y’know.

Aaaaaanyway…  A rather angry letter appeared.  I think it’s worth examining, because it makes a number of normative and value claims; and if norms and values aren’t the meat and veg of an ethicist’s life, then we might as well go home. more…

On Conflicts of Interest

28 Jul, 14 | by Iain Brassington

It’s only a few days since Richie’s paper on providing IVF in the context of global warming was published, but already there’s been a couple of lines of objection to it that have been fairly widespread; I thought it might be worth nodding to one, and perhaps offering an attempt of a defence against the other.

The first objection is that there’s no justification for the claim about same-sex couples in Richie’s paper – that she shouldn’t have treated homosexuality as a lifestyle choice and as “non-biological” infertility.  I think that there’s significant merit to this objection to the paper; and though neither Dominic nor I mentioned the objection explicitly, I think that it’s there between the lines of each of our commentaries.  (It’s certainly an aspect of the paper that’s picked up by the Telegraph‘s coverage of the paper, and it’s been mentioned a couple of times on Twitter and Facebook by people I know and follow.  (I note that the Telegraph also gave a highly bastardised version of my post here.  Ho hum.))  I think that Richie’s argument would have been at least as strong if she’d talked about providing IVF to anyone whatsoever – the qualifications about different “sorts” of infertility and lifestyle, I suspect, weakened the paper, inasmuch as that a paper with unnecessary and argumentatively weak aspects is more vulnerable to objections generally than one in which those aspects have been left out.  So, yeah: I think that that might count as having been – at best – a strategic error on Richie’s part.

Here’s the other claim that I’ve seen a few times about the paper: that it’s weakened by a conflict of interest because of the author’s affiliation.  This isn’t directly a claim about the quality of the argument in the same way that the previous objection is.  Rather, it’s a claim that there’s something unreliable about the very fact of the argument’s having been put.  (I’m not articulating the distinction very well, but I think you can see what I mean.)  In essence, the worry is this: Richie works for a Jesuit Institution; this isn’t clear from her affiliation in the paper; there’s something iffy about this; this iffiness is some form of conflict of interest and her argument is likely to be biased.

I’m not sure what to make of this. more…

While We’re Talking about Ambiguous Sex

16 May, 14 | by Iain Brassington

So: what is one to make of Conchita Wurst?  I’ve not heard the song that won Eurovision this year, but I’m willing to bet that the world would be a better place if every entrant had been thrown into the Køge Bay before a single note was struck.  But that might just be me.


Conchita Wurst. Wurst. Geddit? Wur… Oh, suit yourself

Writing in the TelegraphBrendan O’Neill has other concerns.  Why, oh why, oh why can’t people just use the pronoun “he” when referring to Wurst?  Wurst was born a man; therefore the male pronoun is more appropriate.  (He’s never one to duck the important issues of the day, is Bren.)  “Did everyone overnight transmogrify into a Gender Studies student and imbibe the unhinged idea that gender is nothing more than a ‘playful’ identity?” he asks.  More: the fact that people refer to Wurst with the feminine pronoun is a symptom of what he calls “today’s speedily spreading cult of relativism”, and allowing people to choose their identity is “narcissistic”.

Now, let’s just ignore for the moment that Conchita Wurst is a character, and so it makes perfect sense to call her “her” in just the same way that one might use “her” to refer to Dame Edna Everage.  (Thanks to someone I don’t know on Facebook for making that analogy – it’s a good ‘un.)  O’Neill sort-of-acknowledges that, but he doesn’t let that minor point get in the way of a more general rant against people preferring to be referred to by one pronoun rather than another.  For example, he takes this swipe at Chelsea Manning:


From the File Marked “This Can’t End Well”

25 Nov, 13 | by Iain Brassington

… and cross-referenced with the file marked “You Wouldn’t Let It Lie”.

Francesca Minerva has a paper in Bioethics in which she refers – none-too-obliquely – to the furore surrounding The Paper Of Which We Do Not Speak.  Her central claim is that there is a threat to academic freedom posed by modern communications, inasmuch as that a paper in a journal can now attract to the author intimidation and threats.  A case in point would be The Paper.  But, she claims, it’s vital to the academic exercise that people be able to knock ideas around.  This ability is limited by things such as the response to The Paper; academic freedom is therefore threatened.

Yeah, but no.  I think it’s reasonable enough to say that academic progress depends on the free exchange of ideas, and that there should be no sacred cows.  Sometimes conventional ideas turn out to be untenable or flat-out wrong; and we tend to take it as axiomatic that it’s desirable to have fewer wrong ideas.  (I suppose we could imagine a culture that is satisfied with its opinions as they are, and is not bothered by their truth so much as by some other value they might have, such as their ability to promote social cohesion; but I’ll leave such cultures aside for the moment.)  I’d go along with the idea that we shouldn’t back away from controversial claims, on the basis that repugnance is no objection to the truth of a claim; that if a claim’s true, we should accept it as best we can, like it or not; and that if a claim is false, we shouldn’t have cause to fear its articulation, because we can take it that it won’t survive scrutiny.

And I’d agree that some of the responses to the paper – and to Julian’s defence of publication – were indefensible, and that this is so irrespective of the merits or demerits of the paper or the defence.  But not all of them were.  While some were from obvious dingbats and keyboard warriors (Jonolan remains even now the sole occupant of the banned commenters list here – and I rather suspect that he rather enjoys that honour), other responses were from people whom one might think wrong, but whose response was nonetheless worth taking seriously because it was much more considered and at least on the face of it amenable to argument – which is what academic discourse is all about.

Does any of this tell us about threats to academic freedom, though?  I don’t think so. more…

Is the NIMH Turning its Back on DSM-V?

9 May, 13 | by Iain Brassington

Thanks to Brian Earp for bringing this release from the US’ National Institute of Mental Health to my attention; it concerns the Institute’s decision to move away from DSM as its diagnostic tool.  DSM has been enormously successful – in terms of having established itself at the centre of psychiatry – but it has been enormously controversial, as well; the NIMH moving away from it is very big news indeed.  Whether the new model that they’re going to be working on will be any better, of course, remains to be seen.

The important bit seems to be this:

NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system.

One or two things about the statement leap out at me. more…

Cochlear Implants and Minority Cultures

17 Jan, 13 | by Iain Brassington

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…

Passive Euthanasia: A Cri de Cœur

5 Oct, 12 | by Iain Brassington

Don’t worry: this isn’t another instance of me yammering on about the right to die or the right to induce death.

I’ve recently received a parcel; it contained a copy of this book by Leanne Bell, which happened to fall open at p 204.  On that page, you’ll find this passage:

Active euthanasia involves a deliberate act intended to kill […].  This is illegal in England and Wales because it satisfies the definition of ‘unlawful killing’ and will therefore either be murder or manslaughter depending on the mens rea (that is, the state of mind) of the doctor at the time.  He is likely to face criminal prosecution, regardless of whether the patient and/or the family requested or consented to it.  By contrast, passive euthanasia involves the withholding or withdrawing of treatment from the patient, i.e. an omission rather than an act, and, in certain circumstances, can be legal. [emphasis mine – IB]

No.  Wrong.  Wrong on two fronts.  Withholding treatment may be an omission, but withdrawing it isn’t.  More importantly, while the active/ passive distinction boils down to one between administration and non-administration, it is simply not true that non-administration is the same as passive euthanasia.

Euthanasia requires the intention to end life based on a motive of beneficence directed at the person who will die.  Neither withdrawing nor withholding treatment indicates the intention to end life.  Only if you’re withdrawing or withholding treatment with the intention that this should end life have you committed passive euthanasia.

There’s a simple test you can run here: When withdrawing or withholding treatment, would it be coherent to hope for the patient’s survival – however miraculous – without further intervention?  It would not be coherent in cases of euthanasia, because you can’t intend that life should end and yet hope that it doesn’t.  It could be coherent otherwise.

Or another version of the same test: If you are considering withholding or withdrawing treatment and the patient does not die, would you see this as contrary to your intention?  If yes, you’re considering passive euthanasia; if no, you aren’t.

Bell is by no means alone in getting PE wrong.  The mistake is all over the place – both in the clinical ethics literature, and in the wider public domain.  I’m not wholly sure where it’s come from, but I suspect it may derive from Rachels having made it in”Active and Passive Euthanasia“, and then a little more explicitly in “Killing and Letting Die“:

Many people believe that “passive euthanasia” – allowing terminal patients to die, rather than pointlessly prolonging their lives – is sometimes permissible; but they also believe that killing patients is always wrong.

I’ve got a lot of time for Rachels, and much of what he says on killing and letting die in these essays is good.  But this is wrong.  Even good essays can have wrinkles in them; and this is a big one.  And if it’s the source of the same mistake being made elsewhere, that’s quite serious. more…

An open letter from Giubilini and Minerva

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

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