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Tinfoil Hat

Autism, Mental Illness, Euthanasia and the WaPo

5 Mar, 16 | by Iain Brassington

There was a piece in the Washington Post the other day with a striking headline: Where the Prescription for Autism can be Death.

Normally, if we’re saying that the prescription for x is y, we mean to say that y is being suggested as a treatment for x.  Painkillers are the prescription for a bad back, a steroid cream the prescription for eczema, and so on.  Even if you find that phrasing a bit clunky, “prescription” implies the recommendation of a medical expert.  On that basis, the implication here is that somewhere in the world, doctors are seeing patients, diagnosing autism, and saying, “I wonder if the best thing would be to kill you”.  That would be uiruite a Big Deal.

The place in question is Holland.  But a quick look at the article shows – surprise, surprise – nothing of what’s hinted at in the headline.  Here’s the opening few sentences, edited slightly for formatting:

In early childhood, the Dutch psychiatric patient known as 2014-77 suffered neglect and abuse.  When he was about 10, doctors diagnosed him with autism.  For approximately two decades thereafter, he was in and out of treatment and made repeated suicide attempts.  He suffered terribly, doctors later observed, from his inability to form relationships: “He responded to matters in a spontaneous and intense, sometimes even extreme, way. This led to problems.”

A few years ago, 2014-77 asked a psychiatrist to end his life.  In the Netherlands, doctors may perform euthanasia — not only for terminal physical illness but also upon the “voluntary and well-considered” request of those suffering “unbearably” from incurable mental conditions.
The doctor declined, citing his belief that the case was treatable, as well as his own moral qualms.  But he did transmit the request to colleagues, as Dutch norms require.  They treated 2014-77 for one more year, determined his case was, indeed, hopeless and, in due course, administered a fatal dose of drugs.  Thus did a man in his 30s whose only diagnosis was autism become one of 110 people to be euthanized for mental disorders in the Netherlands between 2011 and 2014.

So, then, it’s a story about a man, who happened to be autistic, and who asked a psychiatrist for euthanasia.  After a little to-ing and fro-ing, that request was granted.  There is no reason to believe that this was a case of death being prescribed for autism.  It’s just that he happened to be autistic and to want to die, and a prescription for assistance was provided.  Phrasing is important.

Dutch law on assisted dying is famously liberal; in considering the permissibility of euthanasia for psychiatric as well as somatic illnesses, it is in the minority of the minority of jurisdictions that consider the permissibility of any euthanasia.  I have addressed the question of psychological suffering in relation to euthanasia elsewhere, and shan’t rehearse the details here; suffice it to say, I don’t see any reason in particular to think that mental illness and physical illness should be treated all that differently in principle: more…

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…

Oh, and while we’re talking about media hype…

1 Apr, 14 | by Iain Brassington

… there’s this, from last week’s Independent:

Thousands of unborn foetuses incinerated to heat UK hospitals

The bodies of more than 15,000 unborn foetuses have been incinerated in the UK, an investigation has found, with some treated as “clinical waste” and others burned to heat hospitals.

The practice was carried out by 27 NHS trusts, with at least 15,500 bodies burned over the last two years alone.

Ten of those trusts admitted to burning more than 1,000 sets of remains along with other hospital rubbish, while two said they were incinerated in “waste-to-energy” furnaces that generate energy used to power and heat hospitals.

Gasp!  One kind of human tissue is disposed of in the same way as other kinds of human tissue!

From the tone of the reporting, one would only be mildly surprised to find people employed to encourage abortions in order that hospitals can save money on fuel.

Except that that’s nonsense.  If clinical waste is incinerated in waste-to-heat plants, it doesn’t follow that it’s being incinerated to provide heating; rather, it’s that the heat from the incinerator is captured and put to use, rather than being wasted.  For sure, the physics is the same; but the emphasis makes a heck of a difference.  (And, as PZ points out, for abortus* to be an effective fuel would require them to be “the most energy-dense substance in the world”.)  So what we actually have is a situation in which an abortus is incinerated.

And the problem with that is…?


Well, I’m sure there must be one, because health minister Dan Poulter is reported as describing the practice as “totally unacceptable”, and Poulter is an honourable man.

Actually, there is a few things that might strike us as questionable – though as we’ll see, the fact that something prompts a question doesn’t really tell us much, since some questions can be answered easily.   more…

Even by the Mail’s Standards, this is Low

30 Nov, 12 | by Iain Brassington

The Liverpool Care Pathway provides a rubric for managing the care of the terminally ill as they approach death.  A helpful pamphlet explaining what it is and what it does is available here.  Ideally, I’d quote the lot; but for the sake of efficiency, I’ll make do with an edited quotation:

What is the Liverpool Care Pathway (LCP)?

The LCP is a pathway/ document that outlines this best care, irrespective of your relative/ friend’s diagnosis or whether they are dying at home, in hospital, in a hospice or a care home.

Medication/ treatment

Medication will be reviewed and any medication that is not helpful at this time may be stopped and new medication may be prescribed so that if a symptom should occur there would be no delay in responding.

It may not be possible to give medication by mouth at this time, so medication may be given by injection or sometimes if needed, by a continuous infusion by a small pump called a Syringe Driver, which will be tailored to individual needs.

It may not be appropriate to continue some tests at this time; these may include blood tests or blood pressure and temperature monitoring.

The staff should talk to you about maintaining your relative’s/ friend’s comfort; this should include discussion regarding position in bed, use of a special mattress and regular mouth care. You may want to be involved in elements of care at this time.

Diminished need for food and drink

Initially, as weakness develops, the effort of eating and drinking may simply have become too much and at this time help with feeding might be appreciated.

Your relative/friend will be supported to take food and fluids by mouth for as long as possible.

When someone stops eating and drinking it can be hard to accept, even when we know they are dying. It may be a physical sign that they are not going to get better. Your relative/friend may neither want or need food and/or drink and decisions about the use of artificial fluids (a drip) will be made in the best interests of your relative/friends for this moment in time. This decision will be explained to you and reviewed regularly.

This can be paraphrased further: medically futile treatment may be withdrawn; the main criterion for administering drugs will be symptom alleviation rather than life extension; some testing may be discontinued; it’s possible that there’ll come a point when artificial nutrition and hydration are no longer in the patient’s best interest, and they might be withdrawn if and when that point is reached.

None of this is particularly cheery; but death rarely is.  more…

A Very Small Amount of Relevance

20 Apr, 12 | by Iain Brassington

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…

Calling Charlton Heston…

27 Jan, 12 | by Iain Brassington

It’s been a while since the last post, and there’s a couple of serious entries on the way – but they’ve been displaced by a bit of silliness from Oklahoma.  State Senator Ralph Shortey (or SHortey, if you follow his Facebook style) has introduced a Bill demanding that

[n]o person or entity shall manufacture or knowingly sell food or any other product intended for human consumption which contains aborted human fetuses in the ingredients or which used aborted human fetuses in the research or development of any of the ingredients.

Robin Marty elaborates:

The Republican has proposed a bill that will ban the use of “aborted human fetuses in food,” despite his admission that he doesn’t know of any companies that actually…well..use them.

So where did Sen. Shortey get this idea?  According to him, from the internet.

The “internet research” Shortey is referring to likely is an ongoing anti-choice crusade that began months ago, when an activist group began demanding a boycott of PepsiCo, which works with a research and development company that uses a line of embryonic kidney stem cells created in the 1970′s to test “flavor enhancers.” The boycotters, led by a group called Children of God for Life, say that’s the same as using aborted fetuses.

Ah: teh interwebz.  I see.  (For the record, the LA Times reports that “[a] U.S. Food and Drug Administration spokeswoman told the Associated Press that the agency has never gotten any reports of fetuses being used in food production.”)

Since there’s never likely to be a better excuse to link to [SPOILER ALERT] the final scene of Soylent Green on this blog, that’s precisely what I’ll do; I only wish I could get the clip to embed.

But there’s more to this than lampooning a typographically-challenged Senator, because the Bill, in its brutal simplicity, is brutally simplistic. more…

Smoking in Cars and the BMA: The Counterwheeze

18 Nov, 11 | by Iain Brassington

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…

Reiki Research: Not Quite the Maddest thing on the Net.

18 Aug, 11 | by Iain Brassington

Right now, physicists are pondering the fallout from the collision of high-energy particles.  (Probably.)  And I, for my part, am pondering the fallout from the collision of high-energy nonsense.

Having had this brought to my attention, I’m led fairly quickly to this, then this, and, finally, this Mail on Sunday piece.  All the links refer to a story in which a hospital is apparently using £200k or so of Lottery money to fund research into spiritual healing based on Reiki.  I’m willing to bet dollars to doughnuts that the research finds that spiritual “healing” is utterly ineffective, except when it means people don’t avail themselves of real medicine – in which case, it’s very effective and its effects are undesirable.  Spiritual healing is bunk; one could reasonably think that a trial into it is a waste of money.  We oughtn’t to waste money, so, modus ponens, we oughtn’t really to be doing this kind of research.

In fact, there’re likely to be big problems with spiritual healing research of any sort, simply because participants may feel that there’s less need to continue using established treatments, and thereby end up worse off.  And when others continue with conventional treatments, it’s going to be hard to tell which of their outcomes was attributable to which – so the research’ll likely tell us nothing.  Hence I wonder whether the research will yield anything publishable: if not, then the whole thing will have been in vain, and there’s something problematic about enrolling people in trials that stand a chance of being, from a publication point of view, barren.

I’m not actually going to go down that route here, though. more…

Apparently, I Support Slavery

16 May, 11 | by Iain Brassington

I like the idea of free-at-the-point-of-use healthcare, and if you want to call that a right, that’s fine with me, too.  In the world of Tea Party-affliated Republican senator Rand Paul, that means I’m the sort of person who’d support turning up at a physician’s door with the police, and forcing that physician (and all the necessary support staff) to work for free.  Which means I support slavery.

Don’t believe me?  Watch him in action here…*

I particularly like the look on the face of the person sitting behind him; she seems to be trying to work out whether she’s dozed off and is dreaming all that.

In all seriousness, though: if there’re any American readers of this blog, could you let me know something?  I understand that there’re arguments to be made against public health care, or even the watered-down Obamacare stuff.  (Let’s not worry about whether they’re good arguments for the moment: it’s enough that there are arguments at all.)  But how is it that this kind of preposterous claim can be made, apparently with a straight face, by the opponents of a public option?  Is it a kind of political kamikaze?  I mean: Paul can’t expect to be believed… can he?

*One day, I’ll work out how to embed videos into this thing.  It’s only 80 seconds or so, though.  H/T ThinkProgress.

Hyperexpensive royal weddings – the opportunity costs in terms of health

29 Apr, 11 | by David Hunter

James Wilson (UCL) and I recently wrote a briefing paper for the Nuffield Council on Bioethics on the ethical issues surrounding hyper-expensive treatments – that is treatments which exceed NICEs usual cut off point of £30000 per quality adjusted life year (qualy). One factor that we kept coming back to was the need to consider the opportunity cost of funding relatively inefficient medicines (which has implications for example for Cameron’s Cancer Drug Fund).

I thought it was apt today to reflect on the opportunity costs involved in the tax payer footing the bill for part of the royal wedding – namely the security costs. These have been estimated now at twenty million pounds.

Hence if this public expenditure was instead used on health care, using NICEs cut off point we could at least save 666 quality adjusted life years – and of course it could be much more since many treatments cost less than £30000 per qualy.

Now of course things aren’t this clear cut, we have to factor in the probable tourist income due to the wedding, the tax income from people buying bunting and flags from the pound store and so on as well as the impact of all the good will and cheer the papers are nattering on about. And to counter balance this we need to consider any further tax earnings from the 666 Qualys generated, the economic costs of an additional public holiday and so on.

Nonetheless it is at least a sobering thought – there may well have been a public good based argument for the royal couple eloping…

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