In the replies to this thread, The Witch Doctor asks this:

A Scenario:

Apparently there are some sites on the web just now claiming that the world is going to end in 2012. Some teenagers are becoming agitated.

I don’t want to be around when the world ends, so I’m going to drink some poison and present to my local A and E department on Halloween 2011. If conscious I will refuse treatment but ask to be kept pain free and as comfortable as possible while I make a “dignified exit” anticipating the end of the world.

I will also carry an AD in case I become unconscious before arriving at A and E.

If conscious, I will be assumed to be competent until proven otherwise. I will pass the competency test. I do not have a mental health problem. I have just been spending too much time surfing the web.

Should the medical staff allow me to die when the time comes and if not, why not?

It’s a good question - though I’d rephrase it slightly to “if so, why; and if not, why not?” at the end.

I’m curious to know what the readership here thinks.  Since I’ve posted my reply in the old thread, I’ll keep out of it as much as possible.

This year marks the tenth anniversary of my first wife’s death. Kerry Anne (KAS to her friends) had cystic fibrosis and passed away after a good hard fight on the 12th of September , 1999 a year and a half after we married.

Kerry taught me many things and was really my main impetus for becoming interested in medical ethics. It was a natural extension of the many discussions we had had.

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The Department of Health today launced Exercise Prometheus, an

exercise for the social care sector to assess and develop its resilience planning in readiness for a second wave of the pandemic swine flu. Designed as an ‘off the shelf’ package primarily for use by local authorities in partnership with their local  providers of social care, the exercise has been developed by the Health Protection Agency from experience gained in previous pandemic influenza exercises.

I like this a lot - although I have to admit that the main attraction for me is the choice of “Prometheus” as the title.  It’s nice to see that someone in the DoH has a classical education and a nerdy obsession with etymology.

One thing I’ve been pondering lately is what we might use to refer to a gathering of bioethicists?

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It’s all very well to vanish off to a conference and put faces to names… but that can’t help with the important questions, like What does the internet think of you?.  Fortunately, this little app can tell you.  Type in your name, and it’ll do the Google version of a genetic fingerprint.

In the interests of openness, here’s what the internet thinks of your humble editors:

Possibly by virtue of having a more frequently-occuring name than either of the other two, David seems to have the most interesting “genome”, and I’m really rather dull compared to both - although I’m about as illegal as social, which must be because of all those parties.

“I’m surprised,” said the German philosopher whose name I’ve forgotten but next to whom I was walking towards the ice-cream parlour, “how little argument there is here.”

I have to admit it - had he chosen his parallel sessions unluckily, he could easily have been left with the notion that the ESPMH is an argument-free zone: I, too, was struck by that.  And anyone who thought or dared hope that principlism might one day fade would have been disappointed, too - it seems to be alive and well.  I agreed with the claim of one paper that I heard that we ought to move away from B&C - but not with the suggestion that we ought to move towards another principlist system.

But enough carping - every conference has papers that don’t impress, and contributors that don’t impress either; but every confernce also has papers that are interesting, challenging, and provocative.  The same applies here.  more…

I’ve reached an important milestone: the first case of Pig Aids swine flu among people I know.  It’s quite exciting.

She’s been told to stay in, avoiding contact with others, for five days by one person, for 10 by another.  I’m wondering why this is.

In the early days of the illness, there might have been a point.  When we were dealing with a few tens of sniffly people, it might have been possible to contain the virus (assuming, of course, that we were willing also to close all ports and build a big glass dome over the UK just in case).  For the sake of public protection, there might have been some warrant for this.  Let’s not forget, of course, that not so long ago we were much more worried that’d it’d be a really serious illness - much more serious than it would appear to be at the moment.

But, at this stage, I’m wondering whether quarantine is any use - or justified at all.  Apparently, there were an estimated 50 thousand new cases in the UK last week.  Why quarantine someone to contain a disease that’s infecting fifty thousand a week?  That does seem a bit pointless.  Even if the worst predictions about the disease come true - the Chief Medical Officer for England and Wales predicts up to 65 000 UK deaths, but even that’s deaths associated with , not from, H1N1 - it’s hard to see how keeping people sort-of-isolated (until they’ve run out of coffee and have to nip to the shops, at least) would make any difference at all.

Actually - it will make a difference, come to think of it.  It’ll cause unnecessary worry and distress.

Besides - isn’t quarantine 40 days, by definition?

Obviously, a lot of the world’s attention is currently on Iran and the political turmoil there.  I don’t think that this blog is the place to make comments about the disputed presidential election - but I am reminded of a story from a couple of years ago, and it’s worth airing here.

One of the characteristics of the Islamic Republic is that it’s much more complicated than a lot of the Western media would have us believe.  (For example, I once ended up in conversation in a Tehran park near the old American Embassy Den of Espionage with a member of the Baseej* about the comparative merits of British and Persian women - I’d tried to explain political correctness to him, but he didn’t get it.  Wouldn’t you know it: even the fanatics are human.)  Nevertheless, you’d expect the Ayatollahs to have a certain set of fairly predictable ideas about sex, and for those ideas to be fairly rigid and unforgiving.

Not always.

Consider the case of Maryam Khatoon Molkara.  She used to be a man.  Remarkably, her sex-change operation came with the blessing of the religio-civil authorities, who

[are] starting to recognise people with sexual-identity disorders and allowing them to have sex-change operations and obtain new birth certificates. Some [people] are now even recommended for treatment by clerics and the government helps fund operations.

It’s not quite the vision of Islamic theocracy that we might have expected, is it?

[W]hen the chance to have gender-swap treatment arose in the 1970s, she went to see Ayatollah Behbehani, one of the leading religious figures in the country. He performed a typical Iranian religious ceremony, an istikhareh - letting the Koran fall open and interpreting her problems according to the page that was revealed. It was the sura of Maryam, the verses in the Koran that tell the story of Jesus’ mother Mary. Ayatollah Behbehani said he thought this meant that her life would be like Maryam’s - a struggle.

“He said it meant I should have the operation but he said I should write to Ayatollah Khomeini, who was then in Iraq and was one of the leading Shia religious experts. Khomeini decided then that it was a religious obligation for me to have the sex change because a person needs a clear sexual identity in order to carry out their religious duties. He said that because of my feelings, I should observe all the rites specific to women, including the way they dress.”

It wasn’t until the late 1990s that surgery became even a possibility, but - all the same - the story is surprising and gives a glimpse into the regime in Iran.  Grim and stony-faced it may often be, but that’s not the whole story.  And even if you think that the Ayatollah’s judgement was based on the silliest of arguments - and, frankly, I do - it’s still interesting to see someone coming to the right sort of decision for the wrong sort of reason.

And, of course, the story gives us a nice example of the danger of ad hominem reasoning.  People - even Koranic literalists - are often very surprising.

There’s more on transsexuality in Iran here, here, and here, and lots more via Google and YouTube.

*ERRATUM: It was a member of the Komitè, the religious police.  Meh.  Tomayto tomahto.

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.

Keith Taylor Tayler (sorry!), in a reply to the Purdy post below, raises the question of why journals are so expensive and inaccessible to those who don’t have institutional access.  It’s a very good question - and one that Brian Leiter’s recently been mulling, too.  (UPDATE: This is a point that applies equally well to those who the non-academic and the would-be academic.  There’re plenty of members of the public who would like access to journals… and there’s no shortage of people like me, either.  Five years ago, I was on the dole with a PhD that wasn’t going to generate any papers; I really could have done with online access to journals to keep up with the field and to be able to do some research in my ample spare time.  No job, no access; no access, no new papers; no new papers, no job; no job, no access…  I got lucky enough to be able to break the cycle, but I didn’t like having to rely on luck.  Nor did the person in the dole office understand my predicament.)

Not that I’m complaining about anything published by the gods of the BMJ.  Oh, no.  They’re all beyond reproach, obviously.