Jeremy Bentham and social distancing

H/t bioedge

Since utilitarianism is a frequent topic on BioEdge, readers will no doubt be interested in what its founder, Jeremy Bentham, has to say about the Covid-19 pandemic. Not too much, actually, since he passed away in 1832.

But at the moment what remains of him is promoting social distancing at University College London where his body has been preserved as an auto-icon at the entrance to the UCL student centre. The head is a wax effigy (the real head, now mummified, is stored elsewhere).

Pranksters recently fitted it with a mask and posted a photo on Twitter. This provoked a range of responses, most of them complaining that it was disrespectful to ridicule human remains: 

• This is stupid and disrespectful.
• I believe being dead is grounds for a mask exemption. He is most unlikely to be emitting any aerosols and his all-encapsulating display case serves in lieu of a visor. Also, notwithstanding the bizarre nature of his exhibition as an auto-icon, I think this is a tad disrespectful.
• Social distancing like a pro - the greatest good for the greatest number.

However, it was Bentham’s wish that his body be put on display. The auto-icon was created in accordance with his last will and testament, which specifies that it should be exhibited in “an appropriate box or case”. It seems that he wanted to participate in UCL activities, which nowadays include mask-wearing:

“If it should so happen that my personal friends and other disciples should be disposed to meet together on some day or days of the year for the purpose of commemorating the founder of the greatest happiness system of morals and legislation my executor will from time to time cause to be conveyed to the room in which they meet the said box or case with the contents therein to be stationed in such part of the room as to the assembled company shall seem meet.”

Michael Cook is editor of BioEdge

Once again, the Vatican slams euthanasia

h/t Bioedge

 

If anyone were unsure of where the Catholic Church stood on assisted suicide and euthanasia, they can have no doubts now. In a lengthy document titled Samaritanus Bonus (“the good Samaritan”), the Vatican has released a lengthy response to the spread of “assisted dying”.

Assisted suicide or euthanasia or both are permitted in the Netherlands, Belgium, Luxembourg, Canada, Colombia, Switzerland, eight states in the United States plus the District of Columbia, and two states in Australia. A number of other countries are considering legalisation.

The document is clear and emphatic: euthanasia is “an intrinsically evil act, in every situation or circumstance”.

As well, anyone who cooperates is guilty as well, even those who defend legalisation. 

“Euthanasia is an act of homicide that no end can justify and that does not tolerate any form of complicity or active or passive collaboration. Those who approve laws of euthanasia and assisted suicide, therefore, become accomplices of a grave sin that others will execute. They are also guilty of scandal because by such laws they contribute to the distortion of conscience, even among the faithful.”

The Church’s opposition is hardly news. More than 50 years ago the Second Vatican Council condemned euthanasia. Long before the Netherlands legalised it in 2002, Pope John Paul II forbade it in an encyclical, Evangelium Vitae (“the Gospel of Life”). However, the disagreeable reality of legalisation presents problems for Catholics – and other Christians who oppose it in theory. Should people who request assisted suicide or euthanasia receive the Church’s last rites? Should they be given a Christian funeral?

Some bishops appeared to lean toward a policy of demonstrating compassion by “accompanying” a person who chooses to die in this way.

Samaritanus Bonus puts the kibosh on this. People who request assisted suicide or euthanasia may not receive the Church’s sacraments. Even membership in an association organising “assisted dying” is forbidden. They “must manifest the intention of cancelling such a registration before receiving the sacraments”.

Whilst this sounds harsh, the document acknowledges that in extremis people may be so distressed that they are not fully responsible for choosing this kind of death. It urges priests to look for “adequate signs of conversion”. But in principle, there should be no cooperation whatsoever:

Those who spiritually assist these persons should avoid any gesture, such as remaining until the euthanasia is performed, that could be interpreted as approval of this action. Such a presence could imply complicity in this act. This principle applies in a particular way, but is not limited to, chaplains in the healthcare systems where euthanasia is practiced, for they must not give scandal by behaving in a manner that makes them complicit in the termination of human life.

Familiar stuff, perhaps, for friends and foes of Catholicism.

What’s different about this document is that it also offers a perceptive bioethical analysis of euthanasia, along with theological prescriptions.

The principal justification for euthanasia is autonomy. It’s my life; I can do what I want with it. Nobody can tell me what to do. We have to respect a patient’s autonomous decision. Choosing the time and place of death is the ultimate affirmation of autonomy, etc. The arguments are nearly always drawn straight from the playbook of the 19th century British philosopher John Stuart Mill.

The philosophy underlying the secular arguments deployed in Samaritanus Bonus is completely different. Instead of departing from the autonomy of the patient, it emphasises the universal experience of vulnerability.

For the fully autonomous man, think of lron Man in the Marvel Universe. Zipping around in his suit of armour, he is invulnerable. But what makes him interesting is the fact that Tony Stark is vulnerable. He suffers from PTSD, narcissism and loneliness. It’s not the strength of Iron Man’s armour that makes him human, but the fragility of Tony Stark’s character.

Which is more or less what the Vatican says:

“The need for medical care is born in the vulnerability of the human condition in its finitude and limitations. Each person’s vulnerability is encoded in our nature as a unity of body and soul: we are materially and temporally finite, and yet we have a longing for the infinite and a destiny that is eternal. As creatures who are by nature finite, yet nonetheless destined for eternity, we depend on material goods and on the mutual support of other persons, and also on our original, deep connection with God.“

Given this vision of what a human being is, the appropriate response to illness is not to kill a patient, but to care for him.

“Our vulnerability forms the basis for an ethics of care, especially in the medical field, which is expressed in concern, dedication, shared participation and responsibility towards the women and men entrusted to us for material and spiritual assistance in their hour of need.“

Furthermore, the document points out that measuring a patient’s dignity by his autonomy leads to the contradiction which has always bedevilled Mill’s theory. How can the highest expression of autonomy be to extinguish it? If that were true, couldn’t we choose to sell ourselves into slavery to settle our debts? No. “Just as we cannot make another person our slave, even if they ask to be, so we cannot directly choose to take the life of another, even if they request it,” it points out.

“Therefore, to end the life of a sick person who requests euthanasia is by no means to acknowledge and respect their autonomy, but on the contrary to disavow the value of both their freedom, now under the sway of suffering and illness, and of their life by excluding any further possibility of human relationship, of sensing the meaning of their existence, or of growth in the theologal life. Moreover, it is to take the place of God in deciding the moment of death.“

The document also makes some very shrewd observations about the implications of pretending that we are Iron Man instead of acknowledging ruefully that underneath we are really Tony Stark.

In fact, if autonomy is the highest value, people whose autonomy is impaired are in trouble.

“Those who find themselves in a state of dependence and unable to realize a perfect autonomy and reciprocity, come to be cared for as a favor to them. The concept of the good is thus reduced to a social accord: each one receives the treatment and assistance that autonomy or social and economic utility make possible or expedient. As a result, interpersonal relationships are impoverished, becoming fragile in the absence of supernatural charity, and of that human solidarity and social support necessary to face the most difficult moments and decisions of life.”

In short, the proper response to Tony Stark’s end-of-life existential crisis is not to end his life, but to lavish care upon him, to treat him as unique and precious (which is what happens in Avengers: Endgame)

Should we sacrifice older people to save the economy?

h/t Bioedge

A senior Republican politician from Texas sparked a media firestorm this week after suggesting that older people should consider sacrificing their lives for the economy in the face of the coronavirus crisis. 

Dan Patrick, a former radio talk show host who is now Lieutenant Governor of Texas, made the comments on Monday night while talking to Fox News presenter Tucker Carlson. 

In response to a question about lifting social distancing measures, Patrick said, 

“Let’s get back to living...Let’s be smart about it. And those of us who are 70-plus, we’ll take care of ourselves, but don’t sacrifice the country.”

Patrick expressed grave concern that the COVID-19 crisis could “bring about a total economic collapse” and “potentially the collapse of our society”, and said that many “grandparents” like himself would be willing to expose themselves to a higher level of risk to save the economy. 

The comments made headlines across the US, with ethicists and commentators labelling Patrick's views "simplistic" and "odd". 

Peter Wehner, a senior fellow at the Ethics and Public Policy Center, said that Patrick’s comments were premature, and were inconsistent with the pro-life values of the Republican Party. 

“There’s an attitude toward the elderly of ‘Let them eat cake,’ ” said Wehner, who has worked in three Republican administrations. “This is very odd for the pro-life party that for so long it pushed a certain ethic”. 

Ashish Jha, a professor of global health at Harvard University, accused Patrick of setting up a false dichotomy between public health and the economy. 

“It is possibly the dumbest debate we’re having...People are being incredibly simplistic and are not thinking through this beyond the next two weeks. The number of people who have emailed me and said, have you thought about the economic effects? You know, it turns out, I’ve thought about that!”

Patrick’s comments were followed the next day by a statement from President Trump that he would like to see “the country opened” by Easter. “You’re going to lose more people by putting a country into a massive recession or depression,” Trump told reporters during a White House News Conference on Tuesday.  

US ethicists issue utilitarian manifesto for coronavirus rationing

h/t Bioedge

As the US braces itself for an exponential increase in COVID-19 cases, several US doctors and ethicists have published an article arguing forcefully for utilitarian healthcare rationing. 

The new article -- published in the New England Journal of Medicine on Monday -- deals with the complexities of the current COVID-19 crisis in the United States, and considers how scarce resources such as ventilators and vaccines should be allocated in light of our current understanding of the disease and pandemic modelling. 

The lead author of the article, academic and influential healthcare policy commentator Ezekiel Emanuel, has previously written at length about the allocation of scarce lifesaving resources, and, specifically, the allocation of vaccines in a pandemic. 

In this article, Emanuel and colleagues argue that healthcare rationing in the COVID-19 pandemic is inevitable: “...unless the epidemic curve of infected individuals is flattened over a very long period of time — the Covid-19 pandemic is likely to cause a shortage of hospital beds, ICU beds, and ventilators”. 

The real question, the authors suggest, “is not whether to set priorities, but how to do so ethically and consistently”. 

But what should our ethical framework for resource allocation look like? 

“In the context of a pandemic, the value of maximizing benefits is most important”, the authors argue.

Where we are allocating ventilators, for example, we should prioritise those patients who have the greatest likelihood of survival if given access to a ventilator, but who would be unlikely to survive otherwise. This would likely mean prioritising younger patients: 

“Operationalizing the value of maximizing benefits means that people who are sick but could recover if treated are given priority over those who are unlikely to recover even if treated and those who are likely to recover without treatment. Because young, severely ill patients will often comprise many of those who are sick but could recover with treatment, this operationalization also has the effect of giving priority to those who are worst off in the sense of being at risk of dying young and not having a full life.” 

The authors also note that rationing may mean withdrawing treatment from some patients who have a poorer prognosis than others. 

“Because maximizing benefits is paramount in a pandemic, we believe that removing a patient from a ventilator or an ICU bed to provide it to others in need is also justifiable and that patients should be made aware of this possibility at admission”.

The withdrawal of treatment is not the same as killing, they argue: 

...many guidelines agree that the decision to withdraw a scarce resource to save others is not an act of killing and does not require the patient’s consent. We agree with these guidelines that it is the ethical thing to do.” 

The authors also consider how we should allocate a coronavirus vaccine, should one be developed. The moral calculus is inverted in this case, they suggest. While younger, healthier patients should be given priority access to ICU, older patients with chronic illnesses should be given priority access to a vaccine: 

“...younger patients should not be prioritized for Covid-19 vaccines, which prevent disease rather than cure it, or for experimental post- or pre-exposure prophylaxis. Covid-19 outcomes have been significantly worse in older persons and those with chronic conditions. Invoking the value of maximizing saving lives justifies giving older persons priority for vaccines immediately after health care workers and first responders”. 

In an op-ed in the New York Times, Emanuel and two co-authors of the study stressed the importance of high-level ethical reflection on pandemic rationing, and warned of the risk of front line clinicians making “well-intentioned, but ad hoc choices under extreme pressure”.  

But some commentators are concerned that the high-level ethical reflection so far has missed some of the most serious ethical challenges presented by the COVID-19 crisis. In a letter to the Times, Former Democratic Congressman Tony Coelho said some medical professionals were trying to marginalize seniors and the disabled: 

“Even in a crisis, self-designated “experts” are trying to marginalize people with disabilities and seniors. Instead, let’s develop policies that “flatten the curve” and prepare to treat all those who may find themselves vulnerable to Covid-19”.  

Xavier Symons is Deputy editor of BioEdge 

Is euthanasia an essential service?

h/t Bioedge

Is euthanasia an essential service? That is the question that Canadian health officials are grappling with in the coronavirus epidemic.

At least two clinics in Ontario have stopped providing euthanasia (or medical assistance in dying, as it is called in Canada) to prevention transmission and to free up health-care resources. Others regard it as essential and are relaxing the rules to allow “virtual assessments of eligibility”.

“It’s not a decision that we have taken lightly,” said Andrea Frolic, of Hamilton Health Sciences, which has shuttered its program. “It’s heartbreaking for us, as it is for patients and families seeking this care."

“I think it’s really unfortunate. I don’t know their rationale for having shut it down completely," Chantal Perrot, a Toronto MAID provider, told the Globe and Mail. “I don’t understand how they could not see MAID as an essential service for people who are at end of life.”

The University Health Network in Toronto is continuing to provide MAID to inpatients during the pandemic. “We had to make some very difficult decisions with respect to other services and programs that were put on hold or shuttered during this pandemic," said Mark Bonta, who is in charge of euthanasia at UHN. "Given that MAID is something that is listed as a human right for our patients … we recognized it was important that this be deemed an essential service.”

Stefanie Green, a Victoria doctor and the president of the Canadian Association of MAID Assessors and Providers (CAMAP,) said the health authority on Vancouver Island has also deemed assisted dying an essential service. Officials there are even providing protective equipment to doctors who are still willing to help patients access euthanasia.

Michael Cook is editor of BioEdge

In defence of Peter Singer

by Michael Cook | 22 Feb 2020 |

Australia’s most famous – or most notorious – philosopher, Peter Singer, has been de-platformed in New Zealand. He was scheduled to speak about “effective altruism” at an event in Auckland in June. The disability community was outraged.

The venue, SkyCity, a casino and entertainment venue, released a statement saying, "Whilst SkyCity supports the right of free speech, some of the themes promoted by this speaker do not reflect our values of diversity and inclusivity." The organisers are scrambling to find a different venue.

The anger of the disability community is hardly surprising. Singer is a utilitarian ethicist and contends (this is a very rough summary) that consciousness is the touchstone of dignity. This compels him to support the infanticide of disabled infants. In a book that he published in 1979, Practical Ethics, he wrote:

[Being a member of he species] Homo sapiens, is not relevant to the wrongness of killing it; it is, rather, characteristics like rationality, autonomy, and self-consciousness that make a difference. Infants lack these characteristics. Killing them, therefore, cannot be equated with killing normal human beings … (Practical Ethics, 2nd ed. p 182)

If the fetus does not have the same claim to life as a person, it appears that the newborn baby does not either, and the life of a newborn baby is of less value to it than the life of a pig, a dog, or a chimpanzee is to the nonhuman animal. (p 169)

Singer is and always has been an uncompromising opponent of the unique sanctity of human life – which is why the disabled community in New Zealand opposes his presence. Even back in the 1990s Singer was persona non grata in Germany and Austria. After the Holocaust, medical experimentation by Nazi doctors and involuntary euthanasia, his ideas were unspeakably repugnant there.

But why shouldn’t Singer be allowed to speak? I have no sympathy for Singer’s ideas. In fact, I have published about a dozen articles in MercatorNet critiquing them.

But denying him the freedom to express his abhorrent ideas will only give them more credibility. For some young people, there is nothing more attractive than transgressive ideas expressed with his serene logic (however specious). And Singer is transgression on steroids. Take this excerpt from an interview with a Swiss newspaper a few years ago:

Would you go as far as to torture a baby if this were to bring about permanent happiness for the whole of mankind?

Singer: … I may not be capable of doing it, as it is in my evolutionarily developed nature to protect children from harm. But it would be the right thing to do. Because if I didn't, thousands of children would be tortured in the future.

Sunlight is the best disinfectant. If Singer’s ideas are deplorable, surely it must be possible to demonstrate that they are. De-platforming people for expressing wicked ideas is nearly always a wicked idea.

“Diversity and inclusivity” is meaningless wokery to mask the fact that the casino is worried about reputational damage, aka losing money. But there is no one more inclusive than Peter Singer – and that’s partly why his ideas are dangerous. He wants to include animals like the great apes, pig and dolphins in the expanding circle of beings whose lives we value.

In any case Singer was not invited to Auckland to defend his ideas about abortion, euthanasia or infanticide. The organisers of his tour asked him to speak about “effective altruism”, his plan for saving the world from poverty. I heard him spruik effective altruism in Melbourne a few years ago and I left the lecture room thinking that it was such an implausible parody of Christian charity that it called his whole ethical theory into question.

Besides, Singer, however awful his ideas, is consistent. He defends free speech not only for himself, but for his opponents.

Consider this. In 2012 students at the University of Sydney tried to prevent a pro-life club from starting up on the campus. They wrote to Singer to enlist his support, no doubt expecting him to damn their opponents. But Singer declined.

"I have been an advocate of legal abortion since I was an undergraduate myself, when abortion was illegal; but I am also a strong supporter of freedom of speech," Singer wrote. "A university, in particular, should be a place where ideas are able to be freely expressed. Students should be challenged to defend the ideas they take for granted."

I sympathise with New Zealand’s disability advocates. But de-platforming Peter Singer can only harm their cause.

Michael Cook is editor of BioEdge

Gender dysphoria soars in Sweden

by Michael Cook | 23 Feb 2020 |

The number of teenagers born as girls who have been diagnosed with gender dysphoria has increased by almost 1,500 percent in ten years in Sweden, according to a report from the Board of Health and Welfare (Socialstyrelsen).

The report examines mental health and the rise of gender between 2008 and 2018. In that time the number of natal men aged 18-24 diagnosed with gender dysphoria grew by 400 percent. The biggest increase was amongst natal girls between 13 and 17, which grew by 1,500 percent. Nearly 6,000 people were diagnosed with some kind of gender dysphoria in Sweden in 2018.

"There is no doubt that there is a clear increase, but we do not know what causes the increase," Peter Salmi, an analyst at the Board of Health and Welfare, said in a statement.

The government figures show that people with gender dysphoria are more at risk of death by suicide than the general population. But they also show that people with other psychiatric diagnoses are at even higher risk of suicide than people with gender dysphoria.

"People with gender dysphoria who committed suicide also had very high incidence of concurrent difficult psychiatric diagnoses, making it difficult to distinguish one from the other in terms of suicide risk," said Salmi.

Michael Cook is editor of BioEdge