Rev Prof Ken Boyd, Associate Editor, Journal of Medical Ethics, writes:

Coming up to me at a meeting the other day, an ethics colleague waved a paper at me. “Have you seen this ?”she asked,  “It’s unbelievable!” The paper was ‘After-birth abortion: why should the baby live?” by two philosophers writing from Australia, Alberto Giubilini and Francesca Minerva. Well yes, I agreed, I had seen it: in fact I had been the editor responsible for deciding that it should be published in the Journal of Medical Ethics; and no, I didn’t think it was unbelievable, since I know that arguing strongly for a position with which many people will disagree and some even find offensive, is something that philosophers are often willing, and may even feel they have a duty, to do, in order that their arguments may be tested in the crucible of debate with other philosophers who are equally willing to argue strongly against them. Of course for that debate to take place in the Journal of Medical Ethics, many of whose readers, doctors and health care workers as well as philosophers, may well disagree, perhaps strongly, with the paper’s  arguments,  we needed first to make sure that the paper, like any other submitted to the Journal, was of sufficient academic quality for us to publish; and the normal way in which we determine this is to invite academics in relevant disciplines to review the paper critically for us, so that we can eventually make an informed decision about whether or not to publish it, either in its original or (as in this case) a form revised in the light of the reviewers’ reports. Satisfied by the reviewers’ reports and my further editorial review that the paper was of sufficient academic quality to be published in the Journal of Medical Ethics, and being charged with making the decision as an Editor with no conflict of interest in the matter, since unlike my fellow-editors in the relatively small world of international academic medical ethics I have never met the authors, and indeed personally do not agree with the conclusions of their paper, I decided that it was appropriate to publish it in the interest of academic freedom of debate.  It has subsequently been suggested to me that people whose lives might have been ended by ‘after-birth abortion’ were this legal, might be deeply offended by this paper. If that is the case I am sorry, but I am also confident that many of these people are equally capable of mounting a robust academic reply to the paper which, again subject to peer-review, the Journal of Medical Ethics will be very willing to consider for publication.

(IB adds: the paper in question is here; Julian Savulescu defends publication in the next post down.  I’ll add relevant links, both pro and contra, as I find them.)

Bit quiet around here, isn’t it?

Don’t worry (just in case you were): we’ve not gone away; real life has made a temporary intrusion, and I think the same is true for David.  We’ll be back soon.

This is the third of the dilemmas considered here.

To allow childbirth, it is necessary to surgically open an infibulation.  After delivery, women (and their husbands) ask for restoration of the infibulation (re-infibulation), which involves re-suturing. MSF opposes re-infibulation and works to ensure that it is not undertaken in its delivery facilities.  Although MSF opposes this practice, not performing re-infibulations risks jeopardising community trust, which could lead to women no longer attending the only safe childbirth service in the region.  Should the staff break MSF’s policy, honour the request of the mother, and avoid the risk of losing community acceptance?

Apologies for the drop-off in blogging rates recently: I’ve been snowed under with real work and stuff.  I – or Søren or David – wi’ll be back on track in the near future.

By far the biggest response that this blog has had came when I had a bit of a rant about Nadine Dorries a couple of weeks ago.  I’m back on her case today; she’s the gift that keeps on giving.

This video* provides footage of her speech to the Commons on Tuesday night; there’s a transcript available here.  It’s a fascinating insight into the way that the anti-abortion lobby (I refuse to call them pro-life) has appropriated the language of choice, and tries to present itself as the true defenders of women.

Dorries’ speech has two distinct parts.  The gist of the first is that the law should guarantee that women give informed consent prior to having an abortion.  On the face of it, that seems eminently sensible.  But there’s a couple of things that don’t quite stack up. more…

There’s an interesting piece that’s been floating around some of the newspapers (Telegraph coverage here; The Australian here) over the last few days about the “DNA Dozen” – 11 scientists and one lawyer who’re having their genome published online in order to demystify the process and tame some of the public’s perception.

Fair dos to them.  My hunch is that genetic privacy arguments are often bunk, and anything that helps storm the citadel is fine by me.  What we think of as our genomes aren’t really our genomes at all, so much as a genome that’s overwhelmingly the same for everyone save for a couple of quirks here and there.  The notion of ownership of the genome, and of privacy, is much slipperier once you begin to get your head around that.  If we’re to make sense of genetic privacy at all, we need to do so with a different set of tools from those that we apply to other kinds of information – using conventional notions about the control of information generates some deeply counterintuitive results.

Anyway: I’m taken by a comment from  Helen Wallace of GeneWatch UK:

Your DNA contains very personal information about you, and in the longer term we can’t be certain this won’t be used by insurance companies. I don’t think scientists should be encouraging this.

It’s not clear whether she’s saying that scientists shouldn’t be promoting the use of genetic information by insurance companies – which is OK, because that’s not what they’re doing – or shouldn’t be making their genomes public – which is unexplained: the objection would here seem to be that people shouldn’t make genetic information public because that’d mean it was public.  GASP!

But the insurance claim is interesting in its own right.

Putting my own (increasingly loony-lefty) politics to one side for the moment, I don’t see the problem with insurance companies getting hold of information.  They didn’t enter the market for the benefit of the customers; they did so to make a profit – and there’s nothing self-evidently wrong about that.  They seek profit by offering a price for insurance on an open market.  For people to be able to withhold their genetic information (which is much less useful than Ms Wallace thinks anyway) implies that they could buy insurance without having to tell the seller some important piece of information – and that looks like cheating.

On the other hand, worries about insurance disenfranchisement seem to me to be overblown.  If there’s a free market in insurance, that requires maximal information.  But it also suggests that there’ll be competition, and so companies won’t be able to penalise people with a certain gene unjustly for fear of being priced out of the market.  Premia ought therefore to fall to a level representative of real risk, rather than prejudice.  If some people pay a higher premium because of their genetic inheritance, then that’s not necessarily unjust: they often pay a higher premium for many insurance products because they represent a bigger risk.  At the same time, a market will grow up to serve that particular section of the community, just as there’re car insurance firms that specialise in different demographic groups.

If you want a free market in goods and services, then I suspect you’ll have to bite the bullet in respect of making genetic information public – but, assuming the market functions correctly, then it doesn’t matter much.  The other option is to abandon the free market.  I’m all ears on that front: I’ll carry the banner with you.  But in that case, publicising the genome doesn’t make any difference either.

The comments moderation system here has changed over the last few days and I don’t know how to work it yet.  If a comment you’ve tried to make since about Friday has disappeared, could you let me know via the email address in my profile?

I worry about this because we usually get 5 or 6 spambots a day trying to post, and there’s been nothing for ages.  It might be that the new filter is very efficient and noone real has anything to say – or it might be that you’ve been trying to communicate, but can’t.

UPDATE, 17.viii.10: Yay!  I think I’ve sussed it!  All comments should now be showing.

An item on Sky news the other day caught my attention.  It concerned a new wave of legal highs being manufactured in China.  The thrust of the report is that, in the wake of mephedrone having been banned a few weeks ago, enterprising Chinese chemists are working on a new set of chemicals designed to get around the legislation. more…

… available here.

It’s very easy for a European to feel very smug about socialised medicine.  Maybe the American system isn’t as bad as all that.  Maybe we should be a bit more open about its merits.  And maybe we should, in the process, ignore cases like that of JoAnn Knutson.

Knutson was 72, and had a fall at her home in Des Moines, Iowa.  Her husband, Richard Toews, couldn’t lift her.  For four days, he provided care for her as best he could while she lay on the floor.  And then she died.

Now: there’s an obvious question here.  Why the hell didn’t he call an ambulance?  And the answer is simple: Toews was concerned that he wouldn’t be able to afford it.  Capt. Steve Brown of the Des Moines Fire Department told the Des Moines Register that

an ambulance costs about $575, plus $8 per mile.  People who can’t pay the fee on time can set up a payment plan. Taxpayers pick up the tab for trips that go unpaid.

So Toews was wrong about the price – in part.  But the fact remains that he still had to worry about it to begin with.  Presumably, to get the taxpayer to cough up, there’d have to be some process of proving his inability (otherwise noone’d pay).  And, in a situation like his, that’d perhaps not be the first thing on his mind.

OK, OK.  Four days should have been plenty of time to sort that kind of thing out.  But that still leaves untouched the supposition that it needs to be sorted in the first place.  For the time being – well, the availability of a payment plan for an ambulance doesn’t seem like much of a reassurance.  I’m going to retreat back into smugness about socialised healthcare for a while.