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Philosophy

Consigned to the Index

28 May, 14 | by Iain Brassington

There’re probably times when all of us have had a solution, and just had to find a problem for it.  It’s an easy trap; and it’s one into which I suspect Gretchen Goldman may have fallen in an article in Index on Censorship about scientific freedom and how it’s under threat from disputes about Federal funding in the US.  No: I’m not going to be arguing against scientific freedom here.  Only against a certain use of the appeal to scientific freedom in response to a particular problem. First up, let’s note the points on which Goldman may well be correct.  She notes that the disputes in the US about federal funding that have led to big cuts and a short-but-total government shutdown are very bad for science.  She points out that political machinations even meant that researchers working in government-funded areas couldn’t access their emails.  This had direct and indirect consequences, all of which were pretty undesirable.  For example,

[m]any government scientists were not allowed to access email, much less their laboratories. One scientist noted that his “direct supervisor … confiscated all laptop computers on the day of the shutdown”.

Without access to work email accounts, federal scientists were also prevented from carrying out professional activities that went beyond their government job duties. Several scientists pointed out that their inability to access emails significantly slowed down the peer-review process and, therefore, journal publication.

In the wider sense, to have science and funding bodies that are vulnerable to political shenanigans isn’t good for science, and is probably not good for humanity.  You don’t have to think that research is obligatory to think that it’s often quite a good thing for science to happen all the same.  And shutdowns are particularly bad for students and junior researchers, whose future career might depend on the one project they’re doing at the moment; if a vital field trip or bit of analysis or experiment is liable to get pulled at almost any moment, they don’t have a reputation yet to tide them over.

So far, so good.  However, things are iffier elsewhere. 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-sausage0

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:

more…

Rescuing the Duty to Rescue

1 May, 14 | by BMJ

Guest post by Tina Rulli and Joseph Millum

It is commonly thought that individuals have a moral duty to rescue others in peril. Bioethicists have leveraged this duty to rescue for a variety of purposes—including to criticize the use of placebo controls in trials in developing countries; to defend duties of researchers to return urgent incidental findings and provide ancillary care; to argue for a duty to become an organ donor; to defend allocating resources to develop drugs for rare diseases and to fund costly end of life care.

Despite their widespread use, there are serious problems with the two most cited duties to rescue: the individual duty of easy rescue and the institutional rule of rescue. The latter—the psychological tendency to support allocation of large amounts of money to rescuing identifiable victims at the opportunity cost of helping anonymous others—is indefensible.  (See Peter Singer’s opinion piece in the Washington Post criticizing donations to Make-a-Wish). The former can be defended, but has its own problems. One concerns its force: does it really apply only to very low-cost rescues? Consideration of physicians’ duties to warn suggests otherwise. Another problem concerns its scope: whom do I have to rescue? If it applies to everyone who needs rescue, even low-cost rescues may place enormous demands on individuals (cf Peter Singer’s famous essay: “Famine, Affluence, and Morality”).

We identify two further conceptions of the duty to rescue that have received less attention. An institutional duty of easy rescue would justify spending institutional dollars on rescue cases that are not too costly, while leaving room for institutions to fulfill lesser, but still important needs of others. A professional duty to rescue recognizes the more demanding duties certain medical professionals have. Both provide traction in answering some outstanding rescue dilemmas. We conclude our paper by proposing research priorities for bioethicists to help researchers and doctors sort through the obligations they have to people in need of medical rescue.

Read the full paper in the JME here.

Winston Churchill and the Spirochaetes

29 May, 13 | by Iain Brassington

Did you hear the programme about syphilis on Radio 3 on Sunday?  If not, you can catch up on it here – and I’d thoroughly recommend doing so: it was superb.

One bit in particular caught my attention; it had to do with the use of penicillin to treat the illness during World War II.  (It’s from about 38:40 on the iplayer version.)  Astonishingly, in 1942, more men were out of action in North Africa because of syphilis than because of battlefield wounds.  Obviously, penicillin would be of immense help to both groups; but the problem was that there was not enough of the drug to meet both demands.  Giving it to the wounded obviously had some moral gravity… but so did giving it to the syphilitic: after all, they’d be cured and battle-ready very quickly, whereas the wounded might never be battle-ready again.

You can doubtless see why this might be problematic: 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…

JME Special Edition on Infanticide and “After-Birth Abortion”

2 May, 13 | by Iain Brassington

It’s going to be a little while before regular blogging resumes here – I’m aiming to get back up to speed in the next 10 days or so – but, in the meantime, the special edition of the JME devoted to The Paper Of Which We Do Not Speak is now out and available here.  Some of the papers are open access; others aren’t.

For better or worse, part of being unable to do much blogging at the moment is that I’m not going to be around much to mod any comments that come in – as I’m sure they will – over the next few days.  Don’t go thinking you’re being blocked: it’s much more likely that I’m marking essays.

Are Biomedical Ethics Journals Institutionally Racist?

25 Mar, 13 | by Iain Brassington

So there’s this letter published in the Journal of Bioethical Inquiry that moots the idea that the top biomedical ethics journals might be institutionally racist.  In it, Subrata Chattopadhyay, Catherine Myser and Raymond De Vries point out that the editorial boards of a good number of journals are dominated by members who are located in the global North – countries officially listed as being high or very high on the development index, with only 1.3% drawn from countries classed as least developed.

Developing World Bioethics has the highest proportion of its editorial board located in the least-developed nations; but even there, the figure is only just over 11%.  On the face of it, this doesn’t look too good, especially given the proportion of the world’s population in general that lives in the poorest countries.  The JME, by comparison, draws 100% of its editorial board members from people located in highly and very-highly developed nations.

Still: this isn’t likely to be the whole story.  Udo Schucklenk – a founding editor of DWB, of course – takes issue with the letter on a number of grounds.  For one thing, he he suggests that Chattopadhyay et al might be performing a sleight of hand with their metrics; by lumping together countries ranked as high and very high on the development index, they’re lumping together the UK, Germany, and the US with Iran, Malaysia, and Jamaica.  Neither Iran nor Jamaica is a classic basket-case economy; but, still, “high” and “very high” development covers a vast range of income levels.  Treating all these countries in the same way obscures that there’s a huge range of locations from which editorial staff may be drawn.

I’ll come back to this in a moment. more…

Gay Conversion “Therapy”: Might the CMF have a point?

5 Feb, 13 | by Iain Brassington

Spoiler alert: Almost certainly not.  But hear me out for a bit.

The Christian Medical Fellowship blog had an article posted yesterday about what it praised as a balanced documentary concerning “sexual orientation change efforts” – gay conversion therapy to you and me – on Radio 4 on Sunday.  Actually, it wasn’t a documentary – it was a short article on Sunday, the station’s religious-affairs-quota-filling hour (go to about 30:50 here), and it’s no more a documentary than is the sports bulletin - and the balance is “BBC balance”, which means giving equal airtime to the fireman and the fire.  But anyway, that’s not what struck me.

Neither am I particularly bothered for the sake of this post about whether or not psychotherapy can make any difference to sexual orientation.  I’ll simply allow, for the sake of the argument, that it can at the very least make a difference to sexual behaviour, and maybe to orientation tout court.

What struck me was a couple of things that Peter Saunders says on his CMF blog post about the use of such “therapies”.  One of the striking things was this: more…

Cochlear Implant: On!

14 Dec, 12 | by Iain Brassington

A few weeks ago, I linked to a post on William Mager’s blog in which he said (a) that he was about to have a cochlear implant fitted, and (b) that he’d write about the experience as it progressed.

I don’t know how many readers of this blog followed the link or subscribed; for those who didn’t, I thought I’d just point you in the direction of the latest update.  In short: the implant was fitted; it was turned on; it was… unexpected.  Not completely pleasant from the word go, and a little odd.  But also… well:

I spent an hour yesterday walking round the house tapping different surfaces with a wooden drumstick. Before, with a hearing aid, I’d have heard these taps simply as a ‘tap’ sound. But I had a eureka moment when I realised that tapping a wooden stick on a wooden surface sounded different in pitch and tone to tapping on a glass surface, or a metal surface. Of course, I knew that was the case – but this was the first time ever, EVER… that I’d actually heard that and been able to distinguish so clearly between the different sounds.

That has to be a little bit magical, doesn’t it?

On the other hand, what he can hear is limited.  And so

[n]ow I’m sitting in a world of silence, punctuated by random, violent bursts of sounds that I’ve never heard or experienced quite in the same way before.

What I’m experiencing now isn’t hearing as I imagined it, or as I’ve known it for the last 30 years. It’s completely different, and it’s making me feel really tired and disconnected from everything. I’m finding it really hard to concentrate, to hold on to a specific thought for a long time. [...]

Most disconcerting of all is the dawning realisation that what I thought I was hearing for the last 30 years of my life wasn’t actually hearing. It was just compressed, distorted garbage noise through a hearing aid. What I’m feeling in my head now is much, much closer to actual sound, but it isn’t sound.

I’m fairly confident in my hunch that being able to hear is on the whole preferable to not being able to hear; though there might be times when not hearing is preferable, being able to do so at least gives you the choice – which raises the intriguing possibility that someone with a device that he could used to switch his own hearing on or off might be, in that sense at least, very well off indeed: better off than someone with no ability to hear and someone with no ability not to.  (In just the same way, having a car is good all else being equal, even if there’re times when walking is preferable, because you have the option of using it.)

But still: it’s worth keeping in mind that the process of restoring – or instilling – hearing isn’t a straightforward leap from position A to more desirable position B.  There’s an ambiguity about it.  Even granted confidence that B is more desirable, we can’t take it for granted.

 

Double Effect in the Halappanavar Case

5 Dec, 12 | by Iain Brassington

In the wake of Savita Halappanavar’s death, a statement was issued by the Irish Catholic Bishops’ Conference.  The whole thing is available here.  However, I think that a couple of paragraphs is particularly worth picking out:

Where a seriously ill pregnant woman needs medical treatment which may put the life of her baby at risk, such treatments are ethically permissible provided every effort has been made to save the life of both the mother and her baby.

Whereas abortion is the direct and intentional destruction of an unborn baby and is gravely immoral in all circumstances, this is different from medical treatments which do not directly and intentionally seek to end the life of the unborn baby. Current law and medical guidelines in Ireland allow nurses and doctors in Irish hospitals to apply this vital distinction in practice while upholding the equal right to life of both a mother and her unborn baby.

I think that the first of these paragraphs is pretty unexceptionable, and describes something approaching the default setting for medical interventions anyway.  We might want to talk about “reasonable efforts” rather than “every effort”, since the latter does perhaps tend towards the onerous; but the general gist seems OK to me – almost trivially so.

Note, though, how a great deal rides on a distinction between different kinds of pregnancy-terminating procedure (PTP, from now on).  Notably, there’s a line drawn around abortion as a particular form of PTP.  The statement admits that certain PTPs may be permissible: what matters is that there should be no intention to kill.  Thus certain PTPs may be permissible notwithstanding foetal death if that death is not intended.  I take this to mean that, should the foetus survive, permissible PTPs would be those in which there is no sense that the procedure had gone wrong.  Abortion would be the kind of PTP that is impermissible, precisely because the intention is to kill.  (At the extreme, successful delivery is a kind of PTP, too, since it does end the pregnancy – it’s just that it’s the kind of PTP that we celebrate, rather than tolerate.)

Fairly clearly, the Bishops’ statement relies on some form of the Doctrine of Double Effect: the idea that there’s a moral difference to be had between intending some outcome, and foreseeing it.  If the Doctrine holds water, it would provide a way to say that acting in order to shorten a life may have one moral value or require one moral argument, but acting despite a foreseen shortening may have or require another.

Now: put that slightly to one side, but keep it simmering while we look at something else. more…

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