You don't need to be signed in to read BMJ Group Blogs, but you can register here to receive updates about other BMJ Group products and services via our Group site.

The Art of Medicine

Drugs and Sex – or Drugs and Less Sex

10 Apr, 12 | by Iain Brassington

Two slightly curious stories about drugs and sex.  Or, rather, two stories about drugs and sex curiously juxtaposed.

First, this story from Sunday’s Independent was inspired by this paper in The Journal of Sexual Medicine.  Quite how much weight we should put on the JSM‘s paper is a moot point – it’s a case study involving one person, rather than a full RTC – but I’m interested in the way that it was represented by the Indy:

Oxytocin, a hormone traditionally used to induce labour, is as sexually arousing to men as Viagra, according to new research.

Studies conducted in the US found that a married man who sniffed a nasal spray containing oxytocin twice daily became more affectionate to friends and colleagues and recorded a marked improvement in his sexual performance.  According to the actual breakdown of results, the man’s libido went from “weak to strong”, while arousal went from “difficult to easy”. Ego certainly wasn’t hurt either: sexual performance, according to feedback from his wife, was classed as “very satisfying”.

Let’s take it at face value, and ignore the leap from the experience of one man to all men, and the post hoc ergo propter hoc fallacy, and all the rest of it: a man who was apparently having some sex-related difficulties was helped by oxytocin.  Bravo for him. Hurrah.  Oxytocin for all!

Or maybe not. more…

Why Is Infanticide Worse Than Abortion?

2 Mar, 12 | by BMJ Group

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.

Of Tusks and Tuskegee: A Problem in Research Ethics

1 Mar, 12 | by Iain Brassington

Xtaldave, by his own admission, has the horn.  Well, if you’re being accurate about it, he has the tusk.  But what’s important is that he has a whopping great piece of ivory to play with.

Dave works in the labs here in Manchester, doing clever things with chemicals and science and crystalography and that sort of thing.  The ivory has been confiscated by customs; it found its way into his lab because the dentine in a great big tooth is a useful medium on which to carry out research that may generate significant benefits.  In his words, the tusk is

an acceptable substitute for human bone in the sorts of assays that our lab does to test the effect of various substances on cells called Osteoclasts that are responsible for bone resorption (basically bone destruction).  During growth and development of the skeleton, bone is formed (by Osteoblasts) and broken down (by Osteoclasts) – it is thought that the bone disease Osteoporosis is caused by an imbalance of bone formation and destruction – i.e. too much Osteoclast activity.

If we can find a therapeutic agent that inhibits Osteoclast activity, we might be able to halt or slow the progression of Osteoporosis.  The upshot of all this is that our lab has obtained a section of Elephant horn that has been confiscated by the UKBA.  We will recycle this and use the dentine in our bone resorption assays.

Why’s this of interest here?  Well, the ivory trade is (a) illegal, and (b) deeply morally problematic.  The fact that it’s illegal means that the UK Border Agency confiscates ivory as it’s imported into the country in most cases.  (There are situations in which importation is legal, but they’re rare, and needn’t concern us here.)  And this confiscation means that the Agency ends up with a load of ivory on its hands.

One option might be to sell it; but that’s ruled out by the same considerations that make importation illegal to begin with.  Another is simply do destroy the lot.  A third is to allow labs like Dave’s to make use of it.  This is where the moral claims come in.  It would be, he says, immoral (as well as legally problematic) to sell the ivory, and

if someone has already killed the elephant and removed the Ivory, better that we use it to further medical research and perhaps save or improve some lives, than turn it into a bauble that sits on a shelf gathering dust.

Or, to put it another way: that the elephant has been killed is bad; but we can at least salvage something from the moral wreckage.

Is this correct?  Well, the structure of the argument seems to follow quite closely that which is sometimes presented in relation to the use of – for example – data derived from the morally repugnant experiments of the past.  If there is, in Stan Godlovich’s words, “demonstrably important and beneficial information gathered methodically through means completely unacceptable to us”, what should we do with it? more…

Exporting and Using Medical Equipment

20 Sep, 11 | by Iain Brassington

A student writes:

I am a 5th Year Medical Student involved in a charity organisation that collects medical goods that are recycled/past expiry dates but still in good condition for re-use/excess from stocks, and aims to provide more impoverished clinics and hospitals abroad with these goods through students’ electives.

I have been trying to find ethical guidelines on this on the Net but have failed to find anything useful. 

Would you be able to help me on this matter?

We have already excluded any drugs/saline/liquid form of anything as I know that they will most definitely not be permitted.  However, the kind of equipments we collect include items such as sterile surgical tools such as scalpel blades, forceps, syringes, gloves, bandages, blood sugar monitors, catheter bags, etc.

I would very much appreciate your help!

I’m throwing this out to readers, because you may be able to suggest things.

For my part, I have a slightly sneaky feeling that whatever problems there might be with this are regulatory rather than stricto sensu ethical; I don’t think that there’re any standout ethical problems, but there’s a few things that’ve crossed my mind as possibilities that I suppose might be raised.

In no particular order, I suppose that some people might have worries like these: more…

Spineless in Saudi?

21 Sep, 10 | by Iain Brassington

A little while ago, Richard Ashcroft alerted me to this story: a judge in Saudi Arabia was considering surgical paralysis as the sentence for a man who had caused a similar injury to someone else in a fight.  The BBC’s story came via a report on Amnesty’s website, which you can find here.  The story was widely picked up across the blogosphere, too: for example, PZ Myers wrote that

I don’t know how you find a doctor willing to commit such a violation of medical ethics, but then, I don’t understand how we can have doctors to carry out the death penalty, either.

It’d be easy to catalogue the lunacy of at least some aspects of the Saudi judicial system, but that’s not what I want to do here; Myers’ post points to a deeper and wider problem concerning what medics ought to do in respect of judicial decisions that are, arguably, morally indefensible.

There’s at least two quite distinct facets to the problem. more…

Who Ya Gonna Call?

11 Aug, 10 | by Iain Brassington

Here’s a short story about the evolution of modern science: we used to understand very little about the world, and lacked the means to understand it.  But we wanted to know how it worked, and we invented things like gods and demons to explain phenomena.  As we gradually learned more and more about the way the world works, the god-and-demon beliefs got ditched and replaced by better – that is, more truth-tracking – beliefs.  Some of these truth-tracking beliefs were actually true, too.  Sometimes this progress is halted or even temporarily reversed, perhaps as a result of poverty or trauma – think of the widespread belief in witches in parts of West Africa – but the trend is to abandon the supernatural; and the supernatural has no place in modern medicine.

The story is a bit simple, and a bit simplistic, but it’s the kind of thing that a lot of people accept as being, at least in essence, correct – and trivially correct.  Sophisticated people don’t do demons; we know there’re things we don’t know, but that’s why we have science; and the fact that we don’t know why x happened doesn’t warrant the belief that the spirits did it.

Why am I rehearsing all this?  Well, because Asleepius over at Religion versus Medicine has drawn my attention to a fairly remarkable document on the Christian Medical Fellowship’s website that appears to take seriously the idea that demons might well play a part in explaining some disorders, particularly in psychiatry.

No, really.  Look: more…

Sporting Chances and the Justification of Surgery

16 Jul, 10 | by Iain Brassington

There’s an interesting story on the front page of the Manchester Evening News about an 11-year-old who has asked that her right leg be removed so that she has a better chance of becoming a paralympian. more…

Acronym Overload: HoC S&TC report on homeopathy published…

22 Feb, 10 | by Iain Brassington

The House of Commons Science and Technology Committee’s report on homeopathy was published today (and is available here).  The findings have not been diluted; the Committee didn’t sugar the sugar pill. more…

A Very Small Post about Homeopathy

12 Jan, 10 | by Iain Brassington

I know I keep stressing the distinction between ethics and activist – and how it’s usually just before I witter on about something vaguely activistic.  However, I do think it’s worth popping over to look at the 10:23 Campaign, which takes a robust and sceptical attitude to homeopathy.

If you’re not sure about why it’s worth making a fuss, I’d recommend having a look at Martin Robbins’ account of the evidence about homeopathy presented to the House of Commons Science and Technology Select Committee; having a look at xtaldave’s skewering of the “evidence” that homeopaths sometimes cite in their own favour; and having a look at what is probably the most remarkable of the lot: the details of UCLAN’s BSc in homeopathy as reviewed by UCL’s David Colquhoun, which is of particular interest from an ethicist’s point of view, referring as it does to to code of ethics of the Society of Homeopaths.

Have fun!  But don’t forget to dilute it…

 

UPDATE: Oh, all right.  Have some Tim Minchin, in what is probably the best jazz-poetry take-down of this nonsense you’re likely to see today.  Well worth ten minutes of your time.

Teaching Ethics in Medical Schools

18 Dec, 09 | by Iain Brassington

My attention has wandered recently to this editorial in Clinical Medicine, concerning the place and content of ethics education in the undergraduate medical curriculum.  There’s nothing Earth-shattering in there, but the piece does draw out a few persistent problems with teaching ethics within the medical degree: more…

JME blog homepage

Journal of Medical Ethics

Analysis and discussion of developments in the medical ethics field. Visit site

Latest from JME

Latest from JME

Blogs linking here

Blogs linking here