Anyone who’s ever met him will also know that he’s one of the nicest anarcho-syndicalist black metal fans you’re ever likely to encounter; and he popped up on Radio 4’s Sunday programme this week to talk about the facebook campaign to get metal recorded as a religion on the 2011 census.  Zip forward to about 11 minutes…

(Thanks to Jurgen de Wispelaere for the pointer.)

“Attacking scientists and attacking doctors is dangerous,” he said. “This is about suppressing research, and it will fuel the controversy by bringing it all up again.”

What’s notable about this is the manner in which it seems to track the “teach the controversy” canard that’s dug out by creationists when it comes to the teaching of evolution.  That is to say: the fact that Wakefield’s research has been retracted does not, in this world, indicate that it’s been debunked, so much as it indicates that he’s being cruelly silenced.  You can see where this is leading: his paper being retracted strengthens the mania of the anti-vax lobby; its not being retracted would have been treated as a vindication that there’s something to his claims that merits further publicity.  Heads I win, tails you lose.

It’s hard to know how to respond to this kind of intransigence.  Chris Mooney also considers this problem in his post at Science Progress:

What would it take—beyond the overwhelming scientific evidence, which already exists—for this battle to finally go away? A Lancet retraction isn’t going to do it, that’s for sure. For vaccine skeptics, that’s just more evidence of corruption and collusion in the medical establishment. Indeed, I doubt any individual scientific development has the strength to move these folks—because we aren’t dealing with a phenomenon that’s scientific in nature.

Instead, I believe we need some real attempts at bridge-building between medical institutions—which, let’s admit it, can often seem remote and haughty—and the leaders of the anti-vaccination movement.

But this seems to me to be precisely the wrong way to go about things.  It is so for a couple of reasons.  One of them is articulated perfectly by Ophelia Benson, and has to do with Mooney’s conflation of the political with the epistmic.  But I think that there’s a straightforwardly political objection, too, and it’s simply this: that there are some things - creationism, antivaccinationism, the “birther movement” - in respect of which to attempt to build a bridge is de facto to concede defeat.

The reason for this is essentially that, in offering this sort of conciliation, one doesn’t encourage one’s opponents to come out and play on the sunny plains of science; rather, one gives them an incentive to stay in their fox-hole.  Bluntly, why should they move if we’re willing to abandon, or could be construed as being willing to abandon, our own position to move closer to theirs?  I can see the political attraction of a move like Mooney’s: it pours oil on the waters, and if you squint, it looks magnanimous.  But I think that it’s misguided: there are some waters on which oil should not be poured.

It takes a bit more courage, but I think that there’s a lot to be said for the medical establishment digging in its heels and insisting that the evidence is thus-and-so; that new evidence is always welcome, but that there are tight criteria of validity that have to be met.  This isn’t, after all, a mere academic spat about the classification of a galaxy or the manner in which Darwin has been married with Mendel; people’s lives and wellbeing are at stake here.  It’s worth having the fight.

The Wellcome Trust is pleased to invite applications for participation in a one-day meeting on the concept of community in bioethics. The meeting will explore different understandings of the concept of ‘community’ and the role it should play in normative decision making from different philosophical and cultural positions, using four case studies, two from the world of research ethics - biobanking and genomics research, and emergency health -related research - and two from the world of public health ethics - vaccination and resource allocation.

Whilst a particular focus of the meeting will be the different sets of assumptions that different conceptions of ‘community’ and its role carry and the implications of these assumptions, this meeting will also use ‘community’ as a focal point for broader discussions around the plurality of different approaches to doing normative bioethics.

Confirmed speakers
Dr Jane Kaye (University of Oxford)
Prof Terence Hua-Tai (National Cheng Kung University, Taiwan)
Prof Aasim Ahmad (Aga Khan University, Pakistan)
Dr Adnan Hyder (Johns Hopkins Bloomberg School of Public Health, USA)
Dr Angus Dawson (Keele University, UK)
Dr Hu Linying (Peking University Health Science Centre, China)
Dr Martin Wilkinson (University of Auckland, New Zealand)
Prof Zhang, Ellen Y (Hong Kong Baptist University)

This meeting will be of interest to a wide range of researchers at all levels in contemporary bioethics, including those interested in biobanking and genomics research ethics, international research ethics, public health ethics, global health ethics, feminist scholarship and political philosophy. There are approximately 40 places available for this meeting.

There is no registration fee for the meeting.
All successful applicants will have one night’s accommodation in Singapore paid for by the Wellcome Trust. Up to 20 delegates from low/middle income countries and a small number of doctoral level students from higher income countries will also receive travel grants paying the full cost of travel to and from the meeting. Up to 20 other delegates from higher income countries will receive travel bursaries paying up to 50% of the cost of travel to and from the meeting.

It will not be possible to register for this event via the World Congress of Bioethics website. Application forms will be sent out to those expressing an initial interest in applying - expressions of interest should be sent to a.retik@wellcome.ac.uk.

The closing date for applications is 19th March 2010.

Delegates are of course welcome to take the opportunity to stay on in Singapore for the World Congress of Bioethics (28-31 July 2010) or any of its satellites. Delegates considering attending this meeting may be particularly interested in also attending the joint meeting of the
International Association of Bioethics (IAB)’s Public Health Ethics Network (InterPHEN) and the Philosophy and Bioethics Network, ‘Human Rights and Public Health Ethics’, on 26 July 2010.

Please note that registration for the World Congress of Bioethics and the InterPHEN/Philosophy and Bioethics Network meeting or any other satellites is handled separately by the organisers of those meetings and delegates wishing to register for those events should contact them directly.

(It’s worth a mention, too, that he cites this 2007 JME paper.)

UPDATE: Thanks to Dr Gubernaculum for directing me to this shortened version of the lecture.

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.

the real puzzle for ADs isn’t metaphysical, it’s epistemic.  And barring physicians’ having the requisite degree of knowledge, a “better safe than sorry” mentality rules the day.

His exposition of the thought leads him to make a “modest proposal”:

advance directives should be restricted only to patients and physicians who are expected to have a continuing relationship through the time of the circumstances specified in the AD.  [...]  Thus, there could be an implicit (or explicit) “out” clause in the contract: if the patient finds herself in the specified circumstances with another physician at the helm, the contract may be overridden at the judgment of the physician.  This will restrict the range of viable AD’s rather severely, but it seems that it’s the only way to ease the epistemic burden produced by the current system.

It’s a provokative thought, and I recommend the post.  But it also reminded me of another post on the same site, ostensibly on a different topic.  Here, Ralph Wedgwood considered “Scheffler’s Paradox”, which relates to the manner in which deontologists are more likely to flinch at the thought of killing one innocent person to save five other persons than they are at the thought of killing one bear to save five other bears.  His way out of the problem is intriguing.

When no persons are involved, if you take the “interventionist” option of killing one bear to save five, you both actively do and intend harm to one bear; but you also both actively do and intend good to the five other bears. So it seems that in the case involving bears, the reason for the interventionist option and the reason against it are in the end fairly evenly balanced.

What is different in the case involving persons? The pattern of doing vs. allowing and intending vs. foreseeing is just the same as in the case involving bears. So I propose that the relevant difference is that when persons are involved, the values of the relevant consequences are different, on the grounds that these consequences involve relationships between persons.

That is, there is a “special range of values and disvalues exemplified by relationships between persons” that makes the difference.  Now, I’m not wholly sold on the idea that this’d satisfy all deontologists - at least some would protest that the nature of the relationships between agents is neither here nor there, and we should take a grim pride in having done the right thing and treat rightness as its own reward.  On the other hand, I’m not sure that those dour deontologists are correct, so their point might be moot.

What’s interesting, though, is the manner in which, in both these blog posts, it’s an appeal to the nature of the relationships between agents that carries a lot of the weight.  There’s something attractive about this view, and it’s a theme that’s been made by various Aristotelians, Humeans, virtue theorists and care ethicists for a long time.  But if there is something to this, it’s a threat to universalism - and, as Shoemaker all but points out, it might mean that there will be some people who satisfy all the metaphysical and moral requirements for their AD to be considered valid, but whose directive would still not be enforceable because of some prima facie contingent fact about the physician: if, for example, the doctor at time t retired due to a sudden and unforeseen illness and had been replaced by time t+1, those eventualities might drive a coach and horses through the AD.  And, while that’d be consistent with the precautionary approach that does seem to obtain in respect of at least some ADs, it’s also problematic from the point of view of justice: if a person is entitled to refuse treatment, that entitlement doesn’t seem to have anything to do with the identity of those who would or would not be treating.

But, then again, ditching an “ethic of justice” is precisely what at least some care ethicists want; they don’t see that as a problem for their approach, but as a virtue.

“‘New science’ ethicist As scientific advances speed up in areas like cloning, we may need a new breed of ethicist who understands the science and helps society make choices about what developments to allow. It won’t be a question of can we, but should we?”

It is heartening to realise that we or at least our successors will still be here in 20 years time, apart from the slightly pejorative implication that the current breed of ethicists do not understand the science and/or do not help society make choices.

So, come on our Masters programmes and be ready for the future!

I’ll tell them not to intervene.  I may even encourage them to join me in overdosing.

I’m not being foolish.  I’ve thought about this a lot.

Oh, yes.  I ought to mention.  It’ll be homeopathic remedies on which I’ll be “overdosing”, and the stunt is part of the 10:23 campaign’s attempts to show, graphically, that homeopathy is not only bollocks, but bollocks that is taking up NHS resources, and with is making people think that they can do without real medicine.  The idea is to gather people together in public places to have mass overdoses.  Follow the link to see if there’ll be any such events near you.

Meanwhile, James Garvey comments here, and seems to be on the money:

But there is harm [to things like homeopathy], the mental analogue of the cellular degradation associated with heavy background radiation.  These things don’t usually damage us directly — sometimes they even seem of use.  But all the while, almost imperceptibly, we all get a little more stupid as a result of having them around.

Still - it would be unfair to insist that homeopathy lacks any credibility at all - there’s this scientific rationale for homeopathy (WARNING: may contain parody, though it can only be a matter of time until it’s cited in all seriousness…):

This paper is a first step towards a full, quantum understanding of homeopathy. It is clear that quantum mechanics is the only way to understand the success of homeopathic medicine in a physical context. It is also immediately clear that doctors should avoid patients after treatment. Patients must also be aware of their responsibility in this respect. What is not yet clear is whether conscious observation of patient by doctor pre-treatment may result in the collapse of the wave-function as well. Double blind trials with doctors either seeing or not seeing their patients should be carried out in a strictly controlled environment to ascertain the importance of total patient-avoidance by homeopaths.

(Thanks to Legless for the pointer.)

Lastly, The Times has a nice little article on just how much active ingredient there is in the average homeopathic “remedy”.  It’s a real jaw-to-the-floor thing.

UPDATE: I’m still here.  Obviously.

I generally agree with Daniel, it seems difficult to justify criticism of elderly mums on grounds other than potential harm to the child - and as Daniel notes these grounds are problematic due to the non-identity problem. (And well done to Daniel for managing to make Parfit understandable to the general public in his piece)

Daniel references other potential arguments and it is one of these I want to discuss - resource allocation. If (and it is a big if) the IVF was being provided via public funding then it might be considered more objectionable - since other things could be done with that money than give someone a baby, such as save lives and so on. However even this argument doesn’t clearly cut against Elderly Mothers, since arguably it would apply to all cases of publicly funded assisted reproduction rather than just those cases.

Is it not the case that, short of legislation, the role of bioethicists is to put a check on the potentially unethical behaviors of those who practice medicine on humans?

Why have the rights of male children been subordinated to such issues as cultural habit and medically superfluous parental preference or belief?

Why aren’t bioethicists, including yourself, relentlessly shaming and using any other tool at your disposal to correct the behavior of medical practitioners who modify the genitals of children without meeting the ethical standards developed to protect the rights of minors?

For context, I suppose I ought to say why I made the post I did: it’s not because circumcision is something that interests me in particular, but I do know that it is an area of interest for some bioethicists and people in related fields, and the Freethinker article caught my eye.  More generally, I’m interested in it insofar as it’s something that’s always controversial, and I quite like watching the debates from the sidelines.

So: to IBD’s questions.  The second question is one for the anthropologists, and I’ll leave it unanswered.  In respect of the others, I think that he/ she/ it/ they are probably starting from the wrong premise, confusing the role of the bioethicist with that of the campaigner.  qua bioethicist, I don’t think that my (or our) role is really to campaign at all - it’s to analyse.  The point of this analysis is to get rid of misapprehensions and poor arguments, but the process is, I think, ideologically neutral; we go - or aspire to go - where the arguments take us.  That’s why we aren’t “relentlessly shaming” anyone: that’s not what we’re about.

Moreover, the questions take it as read that ritual circumcision is obviously indefensible, and I don’t accept that.  There’s a number of reasons why.  If it was as clear-cut an issue as that, noone would do it.  Indeed, I find it hard to make sense of the idea of a moral agent who acts for reasons other than those he thinks right, good, or justified - call this my justification thesis.  The fact that it does happen indicates that at least some people think that, whatever the reasons not to circumcise, there are also reasons to do so; they might accept that circumcision is bad in its own terms, but justified by some larger consideration.  Now, the argument to be had here is twofold: first, are they correct to identify a larger justification?  Second, have they located the pivot between the reasons for and the reasons against in the right place?  (And, I suppose, second-and-a-halfth, have those who take an opposite view identified the correct reasons in the correct place?)

For those bioethicists who are doing work on circumcision, these will be the major questions.  The most that anyone could say, I suspect, is that they hold ritual circumcision to be acceptable or unacceptable based on this evaluation of the reasons why it’s performed.  But - and this is worth repeating - even this strong line really has to take account of there being, at the very least, some reason to go through with the procedure.  mutatis mutandis, the same will apply to any other procedure as well.  When we say that someone is behaving in a morally problematic manner, we aren’t - I don’t think - saying that they’ve woken up and chosen the obviously wrong in preference to the obviously right; we’re saying that they’ve misidentified the right.

And, of course, it works the other way: when someone says that pis a clear violation of someone’s rights, can we be sure that those rights have been correctly identified?  Either way: the interesting moral questions are precisely those where matters are not as clear as they seem at first.  And, granted the justification thesis above, it strikes me that almost all situations will be ones in which much is unclear.

That’s why the question of “correcting” behaviour is a tricky one.  That’s why I think that IBD’s questions are, perhaps, starting from the wrong assumptions.  Indeed, rather too big an assumption about the moral clarity of the world seems to be what motivates the question.