Some very strange papers have just appeared in Bioethics regarding homeopathy.  Not so long ago, the journal published a paper by Kevin Smith that advanced the claim that homeopathy is not only ineffective, but ethically problematic.  The position taken was that homeopathy “ought to be actively rejected by healthcare professionals”, and that it is in fact ethically unacceptable, not least because of concerns about it reducing the likelihood that people would seek effective healthcare, and wasting resources.  The analysis is overtly utilitarian, but I don’t see any particular reason why a non-utilitarian theory wouldn’t come to essentially the same conclusions about using homeopathy, especially by public bodies.  (For example, there seems to be a reasonable justice-based claim that could be made on behalf of taxpayers, that it’s wrong to spend their money on stuff that lacks an evidence base: it should either be redirected to stuff that has evidence in its favour, or refunded.  This doesn’t have to be utilitarian in flavour.) 

But while I have no particular dispute with Smith’s paper, neither do I have any dispute with homeopaths getting a right to reply in the same journal.  They should have this right.  Papers could be wrong or need refining, and disinterested argument is a good way to correct errors.

Still: scientifically speaking, homeopaths have their work cut out.  And without the science, the ethics is going to be tricky. more…

This may be of interest to readers…

MANCEPT Workshops in Political Theory – Ninth Annual Conference
Manchester Centre for Political Theory (MANCEPT), University of Manchester
5th – 7th September 2012

Workshop on Well-being and Public Policy: Call for Abstracts

David Cameron, in a recent speech on introducing national measures of well-being to inform public policy, claimed that the UK government is aiming to measure the progress of the nation, “not just by how our economy is growing, but by how our lives are improving; not just by our standard of living, but by our quality of life.” In short, the UK government is looking to measure the nation’s well-being in order to “help make a better life for people.” Other governments and international organizations are also increasingly focusing upon well-being as a policy goal.

This workshop will focus on whether, and how, public policy can and should be informed, in some way, by considerations of the public’s well-being. There will be up to 12 speakers in total, who will be invited to give a 30 minute presentation, followed by a discussion. Potential areas of interest include (but are not limited to):

• The role of well-being in public policy
• The limits of political utilitarianism
• Paternalism and well-being
• The implications of different theories of well-being for public policy
• The interaction between different measures of well-being and public policy

If you are interested to present during this workshop, please send to one or both of us an abstract of no more than 500 words with your full name and institutional affiliation before May 15th.

Convenors:
Sam Wren-Lewis (University of Leeds): samwrenlewis@gmail.com
Tim Taylor (visiting research fellow, University of Leeds): phltet@leeds.ac.uk

Further details about the conference available at
http://manceptworkshops2012.wordpress.com/.

BioNews asked me to write something about Matthew Liao, Anders Sandberg and Rebacca Roache’s paper on engineering humanity to minimise global warming.  I’d been meaning to for a while, so this was the prod I needed.  Anyway: my take on their paper is here; but I thought I’d also reproduce it on this blog.  What follows is the version I submitted; it’s substantially the same, save for a few tweaks that BioNews made to conform with their house style.  (They didn’t like the Latin…)  I am massively grateful to the student who made the point about small people taking more steps to get anywhere.  I’d also like to think that the idea of making people smaller led me to Lilliput, thence to Gulliver, thence to the voyage to Laputa.  It didn’t.  I’m not that clever.  Laputa made its appearance quite unbidden.  But – hey, it works.

 *     *     *     *     *

There’s a part of Gulliver’s Travels where Gulliver visits the grand Academy at Lagado, wherein one of the academicians is trying to derive sunbeams from cucumbers.  It’s tempting to wonder at first glance whether there’s something of the Academy to Liao, Sandberg and Roache’s proposed strategy for combating climate change: that we could engineer humanity to be less of a drain on the environment.  Their paper, “Human Engineering and Climate Change” (forthcoming in Ethics, Policy and the Environment, with a pre-publication version here), has already attracted a reasonable amount of media interest, and it’s not hard to see why.  The headline proposal is that we could engineer people to be smaller, on the grounds that smaller people require less food and fuel: a population that is smaller on the whole would have less environmental impact.  (A small part of this – and I’m genuinely fond of this idea – is that heavier people wear out shoes and carpets more quickly, so are more resource-hungry.  On the other hand, as one of my students has pointed out, short people take more steps to get across the room; the carpet might actually suffer more.  Moreover, a small person has a greater surface-to-volume ratio, and so would lose heat more quickly, possibly requiring more central heating and more food.) more…

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…

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

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.

There’s been a couple of things that’ve appeared on the net over the last few days that have revivified something that’s been niggling away at the back of my mind for quite a long time now: the status of bioethics as an academic discipline.

First there was Brian Leiter’s blog post.  Commenting on the oddness that has been overtaking the American Journal of Bioethics for the last couple of weeks (Not been keeping up?  Christian Munthe and Carl’s posts on the Fear and Loathing in Bioethics give a pretty good account), he points out that “[b]ioethics already has a fairly dim reputation in academic philosophy” – and he’s right: it does, even without the alleged strangeness at the AJoB.

And then there’s this interview with Hilde Lindemann in 3:AM Magazine, with this eye-catching passage:

A few years ago I was at a metaethics workshop, and over breakfast a male colleague and I made a game of ranking the different specialties in philosophy according to how prestigious they were – a ranking with a precise inverse correlation to gender. Here’s the list we came up with:

Philosophy of Mind, Philosophy of Language, and Metaphysics: The alpha-dominant philosophy, done by Real Men

Epistemology and Philosophy of Science: Done by manly enough men

Metaethics: Done by men who aren’t entirely secure in their masculinity

Ethics, Social and Political Philosophy: Done by girls

Bioethics: Done by stupid girls

Feminist philosophy, of course, is not philosophy at all.

The status of bioethics isn’t the primary concern of the interview, but it’s what jumped out at me; and – speaking as someone whose PhD was in metaethics in a very mind-and-language department, and who subsequently got work in bioethics - the ranking seems to be about right.  (I was warned at the start of my career that setting out down a bioethics path would make it hard to get a job in a “proper” philosophy department in future – a prediction that I think has something to it.  David Hunter’s recent move to a proper philosophy department is the exception that proves the rule, notwithstanding that his previous job was with a very good bioethics place.)

Bioethics employs philosophers, and makes use of philosophy; but it’s not enormously highly regarded as a discipline by philosophers.  Why should that be?  Does it matter?

more…

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…

Guest post by Dominic Wilkinson

(Cross-posted from Practical Ethics)

In a provocative article forthcoming in the Journal of Medical Ethics (one of a new series of feature articles in the journal) philosophers Walter Sinnott Armstrong and Franklin Miller ask ‘what makes killing wrong?’ Their simple and intuitively appealing answer is that killing is wrong because it strips an individual of all of their abilities – acting, moving, communicating, thinking and feeling.

So what, you might ask? If this is right, say Sinnot-Armstrong and Miller, it means that it would be just as bad to commit an act that caused someone to be in a permanent vegetative state, as it would to kill them. more…

Comment on “Bedside detection of awareness in the vegetative state: a cohort study” by Damian Cruse, Srivas Chennu, Camille Chatelle, Tristan A Bekinschtein, Davinia Fernández-Espejo, John D Pickard, Steven Laureys, Adrian M Owen

Published in The Lancet, online Nov 10.

Cruse and colleagues founds evidence of some kind of consciousness in 3 out of 16 patients diagnosed as being permanently unconscious. They used an EEG machine, capable of being deployed at the bedside. Is this good news?

This important scientific study raises more ethical questions than it answers.  People who are deeply unconscious don’t suffer.  But are these patients suffering?  How bad is their life?  Do they want to continue in that state?  If they could express a desire, should it be respected?

The important ethical question is not: are they conscious?  It is: in what way are they conscious?  Ethically, we need answers to that.  Life prolonging treatment has been and legally can be withdrawn from patients who are permanently unconsciousness.  We need guidelines for when life-prolonging treatment should be withdrawn in these minimally conscious states.  Paradoxically, it could be worse for some than being permanently unconscious.  And in countries like the Netherlands, we need guidelines on whether and when active euthanasia should be performed.  For some of these patients, consciousness could be the experience of a living hell. more…