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Petty feuding

Chappell on Midwives and Regulation

2 Feb, 17 | by Iain Brassington

Richard Yetter Chappell has drawn my attention to this – a blog post in which he bemoans the Nursing and Midwifery Council’s rules about indemnity insurance, and the effects that they’ll have on independent midwives.  (I’d never heard of independent midwives – but an IM – according to Independent Midwives UK – is “a fully qualified midwife who has chosen to work outside the NHS in a self-employed capacity”.)  In essence, what’s happened is that the NMC has ruled that the indemnity cover used by some IMs – around 80, nationwide, according to some reports – is inadequate; these 80 IMs (out of 41000!) are therefore barred from working.

I’ve got to admit that this seems like a bit of a storm in a teacup to me.  For sure, there may have been infelicities about the way that the NMC handled its decision.  That may well be unfortunate, but it may not be all that much to get excited about.  However, Chappell makes two particularly striking points.  The first is his opening claim, in which he refers to this as “a new low for harmful government over-regulation”.  Well, it’s not really government overregulation, is it?  It’s the NMC.  Governing bodies are not government.  And whether it’s overregulation at all is a moot point: we need more information about what the standard is by which we should assess any regulation.  That leads us to the second striking thing that Chappell says, to which I’ll return in a moment.  Whether it’s harmful is also a moot point.  I mean, it may be true – as he points out – that the decision will have an undesirable impact on the relationship between some women and their chosen midwife.  But that won’t tell us anything about whether the policy is desirable all told.  It’s certainly not enough to warrant calling it “unethical” – and to dub something unethical is not a moral argument.

The second striking thing is this: more…

Professionalism, or Prying?

3 Jan, 17 | by Iain Brassington

“Professionalism” is a funny thing.  About this time last year, I was struggling to get a new course written for the coming semester; it was on professional ethics for lawyers.  A colleague made a comment along the lines that I must be spending a lot of time looking at the professional codes; I replied that I’d be spending almost none doing that; she looked baffled and wandered off, presumably convinced that I was joking.

I wasn’t joking.  I did look a little at the professional codes, but only as a jumping-off point.  My schtick was more like, “Here’s what the SRA says about client confidentiality; now let’s spend the remaining 98% of this lecture looking at why it might say that, and whether it ought to say something different”.

Yet, as I wrote the lectures, professionalism – not professional codes, but professionalism – did keep cropping up.  After all, if you’re going to talk about lawyers’ ethics, or doctors’ ethics, or engineers’ ethics, the implication has to be that there’s something quite specific that applies to each of those professions, otherwise it just collapses into… well, ethics; and it might be that there is a clear way to define who belongs to the profession, and a clear hierarchy, and that it is proper (or, at least, it may be proper) that there is some sort of pressure exerted by that hierarchy that shapes behaviour in a way that neither the law nor standard social norms do.  There are some things that are regulated by professional ethics that aren’t regulated by bog-standard ethics.  To return to the lawyers’ example, there might be certain things that are acceptable or even required from a lawyer that wouldn’t be in other cases, and other things that are unacceptable that are trivial outside the profession; and the same might apply to medics.  (In passing, I think that that might be one of the fault lines in academic medical ethics: those of us that come from a philosophical background understand “ethics” to mean one thing, and those of us who come from a medical or, in at least some cases, a social science background understand it to mean another.  We normally rub along fine, but sometimes we are talking at cross-purposes.)

A range of problems arises from that, though.  For example, though codes of ethics might attempt to codify what it is that’s demanded by professionals, they’re often rather vague, or presuppose a heck of a lot that’s actually rather important.  That can lead to situations in which it’s impossible to tell what’s required on the ground.  “Maintaining the reputation of the profession” is a concern of some of the professional codes I’ve seen, though quite what that means is anyone’s guess, since it might collapse to “doing whatever keeps the public on side, no matter how senseless”; and while that might maintain esteem in one sense, it does so only by undermining the concept of professional integrity.

A second problem comes from the need to know what things are properly within the “professional” remit, and what professional bodies have any business talking about.  The difficulty here is that “professionalism” implies living a kind of life; being a professional involves being a certain kind of person.  One doesn’t stop being a professional when the end-of-shift klaxon goes.  And yet there’re certain things that do have nothing to do with professional regulation: whether or not to be teetotal is not a professional matter, and a professional body that tried to involve itself in such decisions would be stepping over the line.  Still, where the line should be drawn may not be obvious.

All of this brings me to this blog post over on the BMJ blog, in which Niro Kumar considers doctors and dating apps. more…

How to be a good (consequentialist) bioethicist…

6 Jul, 15 | by David Hunter

There has recently been a pattern of papers (and I am not going to identify which ones) which I take as being slightly embarrassing to academic bioethicists because they portray us in a less than flattering light because of the naive mistakes they seem to make, or the outlandish poorly argued claims they make. I have noted a trend for these to have come from relatively new, consequentialist bioethicists and being the helpful sort that I am, the aim of this blog post therefore is to help consequentialist bioethicists from falling into these pitfalls.


Would the Falconer Bill Increase the Suicide Rate?

8 Dec, 14 | by Iain Brassington

This is just a quickie – I promise.

A tweet this morning from Kevin Yuill raises what he sees as a scary prospect:

The Falconer bill will treble suicides amongst the terminally ill, according to Dignity in Dying. Is that what we want? Reject this bill.

He bases his claim on two things, both from Dignity in Dying: first, this document, which estimates that 332 of the 4513 suicides in the England in 2012 (p 1); second, this document, which estimates that there would be 1000 assisted deaths in England and Wales under an Oregon-like law (p 10).

Dignity in Dying has disputed his interpretation of the figures, and I’ve spotted a couple of problems with them.  Some of those who committed suicide while terminally ill may not have committed suicide because they were terminally ill; that might skew the figures.  So might the leap from “England” to “England and Wales”.  And, most importantly, we don’t know how many people would have killed themselves but for the current legal setup.  (Neither does DiD.)  Hence the trebling rate is at best an educated guess, but probably not even that.

But I’m going to allow that Yuill’s interpretation is reasonable for the sake of the argument.  I’ll also allow – in keeping with the Falconer Bill – that all legal assisted deaths in the UK would be assisted suicides, rather than allocides.  It occurs to me, though, that his claim still doesn’t do quite what he thinks it does, or wants it to do.  Importantly, he assumes that an increase in suicides would be a bad thing – and that DiD has therefore blundered in admitting that the rate would rise.

I’m not so sure.  Suicide may be a bad thing, but it isn’t necessarily bad in the way Yuill thinks.

Here’s one consideration.  Assume that some people who are terminally ill would take assistance to kill themselves were it available, but don’t kill themselves under the current regime.  Maybe they’re housebound and can’t procure the means, for example.  Something like the Falconer Bill would make suicide easier for them; and so we’d expect the rate to increase.  But we oughtn’t to forget the alternative, which is not not dying, but dying from a different cause.  This being the case, it isn’t necessarily going to matter too much to a defender of assisted dying that the suicide rate would increase, since his whole position would be that being able to end your own life in the way you choose is preferable to dying without any control.

In other words, the defender of assisted dying could, I think, accept that the suicide rate’d increase, and point out that, in a way, that is the whole point.  An increase in the suicide rate may be, in a certain light, a welcome development, not something to be feared.  I don’t know whether DiD would endorse that view, but it seems coherent, and not obviously vicious; hence Yuill seems to have committed an ignoratio elenchi.

And this leads to another consideration, which is that you don’t – as far as I can see – have to deny the badness of suicide to defend assisted dying.  All you have to think is that there are circumstances in which it’s less bad than the alternative.  Being the better option doesn’t mean it’s a good option, in just the same way that amputation of a limb may be preferable to dying from gangrene without that meaning that amputation is a particularly good thing in its own right.

Even if Yuill’s use of the figures is statistically sound, his claim doesn’t have any of the normative punch he thinks it does.


How Not to Argue against a Proposed Law

5 Jun, 14 | by Iain Brassington

Yes, yes: it’s tedious and internecine, but it’s almost a year since I had a pop at Kevin Yuill’s book on assisted dying; how about an update?  Well, conveniently, there’s this, in which he tries “to convince my fellow liberal minded atheists to reconsider their support for legalized assisted dying”.  OK, then.  First up, this isn’t a pro-legalisation post: I’m much more interested in looking at the arguments presented in their own terms.  I think they’re bad; but that is to do with their form rather than their content.  Indeed, one of Yuill’s opening moves is something to which I’m sympathetic: in respect of Lord Falconer’s latest Bill to legalise assisted dying, he points out that

the chief sponsoring agency (Dignity in Dying) lamely differentiates between the dying (those with six months or less to live) and those with more time.
If the latter ingest poison in a room by themselves – well, that’s suicide.  But if those with less than six months take poison with the intent to end their lives, that is not suicide at all but <ahem> assisted dying. Nope, me neither.

I agree that the six-month time limit is arbitrary, and probably morally indefensible.  But…

*deep breath*

But note how Yuill botches even this point. more…

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