There’s a great little article recently published in the BMJ about what it’s like to be the medic considering withdrawal of feeding from a neonate.

Survival is often much longer than most physicians think; reflecting on my previous patients, the median time from withdrawal of hydration to death was 10 days.

I had no idea it’d be that long.  I had no idea it’d be that long even for healthy adults who stopped drinking, let alone already-ill neonates.  (My scientifically-naïve intuition would have been that an adult body could stand up to more than an infant one.)

The fact is ethically neutral; and we need to be careful about skipping over the fact/ value boundary too easily.  But value claims bounce off, and are informed by, factual claims, and this is the sort of thing that might well be important when considering questions about withholding and withdrawing treatment, and about killing and letting die, and all the rest of it.

And, of course, the infant isn’t the only morally relevant actor in all this:

It is draining to be the most responsible physician. Everyone is looking to me to preside over and support this process. I am honest with the nurse when I say that it is getting more and more difficult to make my legs walk me on to this unit as the days elapse, that examining the baby is an indescribable mixture of compassion, revulsion, and pain.

I can see how that’d be.

And he’s going to blog about the experience.

On Tuesday 6th November at around 7.30am I’ll be in a hospital room while a surgeon uses a marker pen to draw a line behind my ear. Soon after that, I’ll be wheeled into an operating theatre where they’ll make a small incision behind my ear, following the line of marker pen ink.

Once they’ve opened a flap of skin behind my ear, they’re going to drill into my skull, until they reach my inner ear. They’ll then hollow out a small cavity in the flesh beneath the ear flap, where they will insert a piece of technology worth about £10,000. Into the hole in my skull goes a tiny electrode extending all the way into my inner ear, with around 20 or more individual contacts stimulating my cochlear. Hopefully the general anaesthetic will do its job and I won’t feel any of this while it’s happening, because I’ve seen pictures of this procedure and it looks pretty painful.

[...]

When I’m switched on six weeks after the operation, I have no idea what will happen. Either I’ll feel a faint buzzing in my skull, or hear consonants for the first time. Either way, the hard work starts after that.

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He’s a film-maker in real life: so while you’re waiting for the next post, have a look at some of his films.  This one takes only a couple of minutes to show how there’s really very little that deaf people can’t do… er… so long as the… um… support is… as long as…  Yeah.  Watch it, anyway.

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…

[IB: I'm taking the liberty of copying in its entirety Jon Cogburn's post on NewAPPS about submitting papers to journals, because it's worth reading.  He directs it to graduate students - but I think that the same point applies to anyone, especially if they're new to the field in which they're writing.  Since a lot of people writing for journals like the JME - especially on topics in clinical ethics - are medics before they're ethicists, or are coming at ethics from a non-standard direction, I think that the advice is particularly pertinent.]

A Plea to Graduate Students Submitting Papers

Submissions (of 300 words max) are invited for inclusion at the TILT authors’ workshop on the theme of “Neurotechnological Interventions: Therapy or Enhancement” in Tilburg on 15-16th November 2012.  The workshop is part of the FP 7 RoboLaw project, and will lead to the publication of a volume with papers.

Abstracts shoud describe briefly how the paper that you intend to submit will shed new light on the traditional distinctions and arguments in the debate on human enhancement.  The use of casuistry from cognitive enhancement, neurotechnology or robotics is welcomed, but not a necessary condition.  Contributions from law, ethics, philosophy of technology, science and technology studies, economics and general regulation studies are especially appreciated, but scholars in the social sciences, science and technology should not hesitate to submit.

Although individual papers may take casuistry from the fields of neurotechnology and robotics as their starting point, the workshop papers and the volume to be published will primarily focus on some often returning fuzzy distinctions and arguments in the debate on human enhancement in general.  The distinction between therapy and enhancement itself is exemplary in this respect.  The distinction is often not meant to merely serve the theoretical purpose of creating definitional clarity; it is also often implicitly used to depict a class of actions  as morally unproblematic (therapy) and a class of actions as morally problematic (enhancement).  The distinction has of course been criticized  because of the blurred lines between therapy and enhancement as it builds on a presupposed vague notion of normal health conditions.  The implicit normative connotations, however, also tend to cause a lot of confusion.  In addition, many of the ethical concerns explicitly put forward in the general debate on human enhancement, especially those in which notions such as unnaturalness, cheating,  injustice, dignity et cetera occur, appear to be multilayered and often overlapping with other arguments.  In their clustered compound guise they can easily obfuscate original intuitions or emotions of indignation, but also block possibilities of resolution and agreement.  When they are meticulously analyzed and reduced to underlying constituents these arguments often become more persuasive or at least manageable.

Authors should email an abstract of their paper (relating to the theme and its elaboration) before 15 September, and upon acceptance on the basis of the abstract, a draft of the full draft paper (in .doc, .docx, or .pdf format) before 1 November 2012, so that the papers can be circulated in due time and the reviewers/ commentators can prepare themselves appropriately.  Only a limited number of external invited contributors to the volume can be reimbursed for their costs. Whether a paper will be included in the volume to be published will be decided after receiving the very final version of the paper after the author’s workshop.

Important Dates

Before 15 September: Send an email to anton.vedder{at}uvt.nl with a 300 words abstract of the paper you intend to submit

22 September: Notification of acceptance

Before 1 November: Submission of full paper

Before 8 November: Circulation of papers

15-16 November 2012: Workshop

7 December: Selected final papers to be handed in.

via Sheelagh McGuinness

Via MedicalTranscription.net, here’s a rather fabulous little infographic about the value – well, the price – of transplant organs.
(Update: moved below the fold, because otherwise you have the time to grow a liver in a petri-dish before the page has loaded.) more…

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…

I did mention last week that I’d post links to sites that mentioned Giubilini and Minerva’s paper as they crossed my radar; but it turned out very quickly that there’d be no way to keep up.  And, to be frank, a lot of the blogosphere’s response has been fairly scattergun outrage rather than dispassionate engagement with the paper, and directed at Giubilini and Minerva themselves rather than at the argument they put forward.  There’s been much more heat than light.

This is perhaps unsurprising, as considered responses are almost certainly going to take a while to materialise.  However, they have begun to appear.  Here’s the first that I’ve spotted; I’ll post links to more in this thread as and when.  And if any readers have responses on academia.edu or SSRN that they’d like mentioning, or if anyone spots anything of interest, do let me know. more…