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…

Today’s blast of righteous indignation is directed towards New Mexico.  House Bill 206 says, in essence, that… well, it’s short, so here it is in full:

HOUSE BILL 206

51ST LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, 2013

INTRODUCED BY

Cathrynn N. Brown

AN ACT

RELATING TO CRIMINAL LAW; SPECIFYING PROCURING OF AN ABORTION AS TAMPERING WITH EVIDENCE IN CASES OF CRIMINAL SEXUAL PENETRATION OR INCEST.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

SECTION 1.  Section 30-22-5 NMSA 1978 (being Laws 1963, Chapter 303, Section 22-5, as amended) is amended to read:

“30-22-5.  TAMPERING WITH EVIDENCE.–

A.  Tampering with evidence consists of destroying, changing, hiding, placing or fabricating any physical evidence with intent to prevent the apprehension, prosecution or conviction of any person or to throw suspicion of the commission of a crime upon another.

B.  Tampering with evidence shall include procuring or facilitating an abortion, or compelling or coercing another to obtain an abortion, of a fetus that is the result of criminal sexual penetration or incest with the intent to destroy evidence of the crime.

C.  Whoever commits tampering with evidence shall be punished as follows:

(1)  if the highest crime for which tampering with evidence is committed is a capital or first degree felony or a second degree felony, the person committing tampering with evidence is guilty of a third degree felony;

(2)  if the highest crime for which tampering with evidence is committed is a third degree felony or a fourth degree felony, the person committing tampering with evidence is guilty of a fourth degree felony;

(3)  if the highest crime for which tampering with evidence is committed is a misdemeanor or a petty misdemeanor, the person committing tampering with evidence is guilty of a petty misdemeanor; and

(4)  if the highest crime for which tampering with evidence is committed is indeterminate, the person committing tampering with evidence is guilty of a fourth degree felony.”

SECTION 2.  EFFECTIVE DATE.–The effective date of the provisions of this act is July 1, 2013.

The new bit is section B.

In a statement, the congresswoman who introduced the Bill, one Cathrynn Brown, said that her intention was to punish the person who commits incest or rape and then procures or facilitates an abortion to destroy the evidence of the crime.

Hmmm.  Except that that’s not what it says, is it?  Maybe she should read the text of her own Bill.  It talks about procuring an abortion, as well as compelling or coercing another person to have one.

I think that the second bit is actually fairly unobjectionable.  To compel someone to have a medical procedure, whomever that someone is, and whatever the procedure, is to wrong them; and if you compel them to have the procedure in order to remove evidence of another wrong, then the wrongness is multiplied.  But, y’know… that first bit… um… more…

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…

On his blog in The Independent, John Rentoul has a long-running feature called “Questions to which the Answer is No“.  In it, he examines the kind of screaming rhetorical-question headline much beloved of certain middle-market tabloids: “Is this photographic evidence of Nessie?”, “Does coffee cure cancer?”, “Does coffee cause cancer?”, “Does MMR bring down house prices?“* and so on.

Here’s the first in an intermittent parallel series from me: “Questions to which the Answer is Eh?  What are you on about?  No, really: what?“.  For the inaugural post, step forward Dan Sokol, the BMJ”s “ethics man”, who asks in his latest column, “Is Bioethics a Bully?”.  The answer to this is Eh?  What are you on about?  No, really: what?.

(A warning before I start: I’m about to go off on one.  Even by my standards, this is big.  You might want to go and make tea.)

The general thesis of the article is this:

Bioethics, in its current form, has bullying tendencies. Ironically, it often adopts a paternalistic attitude towards clinicians, treating them as an ethically deficient species.  Although bioethics should not shy away from pointing out ethical concerns in medical practice, sometimes forcefully, it must not give way to negativism or, worse still, to a zeal to condemn.  Clinicians are easy targets and, without a command of the fancy theories and language of the accusers, possess few means to respond formally.

Is the thesis true? more…

Søren Holm sometimes jokes that, if you want your conference well-attended, you should have a paper on the ethics of circumcision.  I don’t know how well-attended the recent IAB satellite on the topic was – the first half clashed with Peter Singer doing his thing, which can’t have helped it, and I couldn’t go to the second because I was giving a paper of my own.

Anyway: though I mentioned the decision of the German court that ritual circumcision constituted assault, I’ve wanted to stay clear of saying more about it.  Partly it’s because I’ve been busy; but there’s another reason: it seemed too potentially toxic.  For example, Jonanthan Sacks’ column about the decision in the Jerusalem Post noted that many attempts to ban circumcision have been motivated by antisemitism; the not-so-subtly made claim is that there’s an undercurrent of antisemitism here.  (An appeal to human rights is, he claims “is the only form in which an assault on Jews can be stated today”.)  Of course, that won’t show that such attempts have to be motivated by antisemitism, or that thinking the court’s decision correct is an indication of latent antisemitism: they don’t, and it isn’t.  Even if it’s true that the only way to launch an assault on Jews is to use the language of human rights, it doesn’t follow that every human-rights claim is an assault on Jews – even when it touches on something that is associated with Judaism.  I didn’t want to open myself to an accusation of antisemitism, so thought it best to keep quiet.

But the debate is rumbling on (it was featured on the Today programme today, for example); and one of the notable things is the poor quality of most of the arguments brought against the decision.  This doesn’t in itself mean that the decision is correct – poor arguments might accidentally bring you to the correct answer – but if the general direction of the poor arguments is the same, and there haven’t been many decent arguments produced that go the same way, then that does raise questions about the conclusion in which they’re headed.  Having said that, there has been one better argument against the decision that I’ve come across; I’ll come to that later.  It’s some of the poor arguments, rather than the position in the service of which they’re advanced, that I have in my sights here. more…

I know it’s not long since I last posted about the Christian Medical Fellowship’s blog, and I would ordinarily leave it a bit longer… but I’m about to go off on one.  Forgive me.  I’ve had a hard week marking exam scripts, and I’m tired and stressed and cranky, and this is just… well…  Look: I hear that ginger is quite a good anti-emetic.  You might want to go and find some.

You will, of course, be aware of the recent killings in Houla: 108 civilians shot at close range or stabbed in what the UN says may amount to a crime against humanity.  You may also have read about the arrest of Mick and Mairead Philpott, suspected of the murder of their six children in a housefire.  Peter Saunders, on the CMF blog, under the title “There are Few Things More Horrifying than the Slaughter of Innocent Children”, writes that

Every child’s death is a tragedy but there are few things more reprehensible than the killing of children by adults. Children are rightly seen as amongst the most vulnerable and defenceless members of society and deserving of special protection.

It is therefore not surprising that Western governments are acting quickly at the highest level to expel Syrian diplomats and impose sanctions and the police are giving high priority to investigating the Derby fire for which the children’s own parents are now suspects.

Whether or it turns out that the Syrian government was directly involved in the latest atrocities, or whether or not the parents are charged with starting the fire, it is nonetheless deeply ingrained in the human psyche that public authorities have a duty to protect the vulnerable and that the strongest advocates for children should be their own parents.

As I read that, I had a horrible feeling about what was going to come next.  I suspect many people reading this now will have the same feeling.  The same creeping nausea.  He’s used the phrase “slaughter of innocent children”.  He’s not going to say… is he?

Reader, he is. more…

The McMillian Cancer trust has published a report described on the radio as I drove to Manchester this morning as a damming and shameful report about the NHS and discrimination. The report alleges that more than 14 thousand elderly cancer sufferers are allowed to die in the UK because of age based discrimination.
more…

You can tell libertarians from the sound they make: it’s the faint rattle of a tiny intellect untethered in an otherwise empty mind.  Cheap and all-too-easy insults aside, though, I’d been wondering how long it’d be, in the wake of the BMA’s recommendation that smoking be banned from cars, before we got a response from the libertarians.  The answer, it seems, is a couple of days.  The Libertarian Alliance, for example, has had a go (it’s a totalitarian tax ruse, I tells ya!  Thank goodness tax is low on tinfoil hats…); but the example that really caught my attention – by which I mean rendered me slack-jawed in amazement – was this piece by Rob Lyons in Spiked, the online journal of choice of the bewildered. more…

Today’s dose of righteous anger comes, via Ophelia Benson and Marie Myung-Ok Lee writing in The Atlantic, from the fifth annual Congress on Aesthetic Vaginal Surgery, held just outside Tuscon at the end of last year.

The affable organizer of the Tucson event, Dr. Red Alinsod, was an early entrant into cosmetic-gyn, and is recognized for inventing the procedure in which the labia minora are completely amputated to create a “smooth” genital look known in the field as “the Barbie.” Though he began his career by winning a prestigious fellowship in gynecology-oncology at Yale in 1990, Alinsod now spends his days making genitalia “look pretty” for the wealthy patients who flock to his Southern California practice from all over the world. He is also an evangelist for the field, spreading its lucrative gospel to fellow doctors tired of toiling in the time-intensive and high-liability fields of traditional obstetrics and gynecology.

Cosmetic gynaecology, it appears, has been pretty much rejected by mainstream medicine – which means that it’s all-but-unregulated.  It’s a deeply weird business, though.  Actually: scrub that.  It’s really rather sinister. more…

I’ve set my RSS to receive updates from Secondhand Smoke, which is one of the blogs at First Things.  It’s written by Wesley Smith, who is affiliated to the Discovery Institute, the creationist thinktank in Seattle: that gives you an indication of the sort of position he occupies – not just on bioethics, but also on global warming, socialised medicine and probably a lot else – so it’s no surprise that I disagree with a lot of what he posts.

I mention this now because I’m currently thinking about the way that euthanasia, and medical killing more generally, get represented in the media, and I’m interested in how the blogosphere handles it.  My general hypothesis is that a lot of the coverage is distorting, and is so in a way that harms public debate, and causes unnecessary fear among vulnerable groups.  (I mentioned my suspicion here a while ago.  For the record, I don’t think that the anti-euthanasia lobby is uniquely open to criticism here, either: the defenders also sometimes seem to have a habit of focusing on isolation, indignity and so on as being inescapably the overwhelming and plainly undesirable characteristics of certain lives, particularly among the old and disabled, such that not considering death is seen as bizarre.  Though I’m sympathetic to the legalisation of euthanasia, I think it’s possible to overplay a good moral hand.)

A recent post by Smith is a nice illustration of what I mean (and suspect).   more…