sábado, 19 de diciembre de 2015

ETHICS IS ALL WE NEED || BioEdge: Interview: David S. Oderberg

BioEdge: Interview: David S. Oderberg

Interview: David S. Oderberg

David S. Oderberg is Professor of Philosophy at the University of Reading, UK, and has written extensively on bioethical issues such as abortion, euthanasia, genetic engineering, animal rights, and capital punishment from a natural law, anti-consequentialist viewpoint. He is also the editor of Ratio, an international journal of analytic philosophy. Xavier Symons, Deputy Editor of BioEdge, asked him to comment on the state of contemporary bioethics.

Xavier Symons: In your opinion, what are the main philosophical concepts that bioethicists tend to misunderstand?

David S. Oderberg: There’s a lot of misunderstanding in the bioethics industry (because it is something of an industry), although I’d prefer to put it in terms of simple mistakes or confusions. I don’t think most bioethicists misunderstand what they believe or recommend at policy level, since most have a clear agenda, which is to pull apart as many “taboos”, i.e., commonsense traditional prohibitions, as possible.

A lot of the time, the ends justify the means inasmuch as bioethicists will use whatever argument they have to hand, whether good, bad, or indifferent, to advance a prior agenda. In that sense, I suppose you could say they misunderstand the function of argument, which is to get to the truth, not to advance a previously-adopted policy.

I recall reading, a number of years ago, a report by the UK’s Human Fertilisation and Embryo Authority, produced by a handful of bioethicists and devoted to defending human embryo experimentation. It was abundantly clear from the report that the authors (most of whom I had barely heard of as far as the philosophy profession is concerned) were intent on recommending embryo experimentation to the government as morally permissible, and they used whatever argument or “theory” they could to defend it.

As a result, you had a bit of Kantianism on one page, utilitarianism on another, virtue theory on another, and bits and pieces of philosophical thought, many of them totally irreconcilable with each other, thrown into the mix to achieve a supposedly rational conclusion that, sure enough, it was just A-OK to experiment on embryos, as long as we’re careful.

At a more conceptual level, I have seen a few significant confusions cropping up again and again. One is that between “killing” a patient’s condition and killing a patient, as though you could cure a person of their problem by getting rid of the person, e.g., end the pain by ending the patient. You can certainly do that, of course, just as you can eliminate a headache by cutting off someone’s head. But this should never be confused with curing someone, or caring for them, which are the primary duties of health professionals.

If bioethicists think they can “cure” someone of their suffering by euthanasia, then they are not really interested in cure (or care) at all, but in some other objective.

Which brings me to the confusion between what is good for a person and what is good for someone else, be it their family, the community, or society as a whole. Given that care and cure are the primary duties of medicine and health care generally, what is best for someone other than the patient can never be the primary objective of the health care professional as health care professional.

The idea that a patient could be a “burden” on society, their continued existence “distressing” to their family, their plight a “drain” on the health care system, can never trump the primary duty of care, which means looking after the patient and curing them where possible, or else making their situation as comfortable as possible. Unfortunately, under the malign influence of the bioethics industry, too many patients are now seen as commodities, units of production (I can’t find a better term) in the system, anything but individuals with a right to life, care, and dignity.

If I had to pick a last confusion among many, it would be the deliberate medicalisation of normal duties of care. The classic example is “artificial nutrition and hydration”, once called food and water. Now feeding people and giving them water, when they needed it, used to be a good old-fashioned human duty. But once bioethicists and their willing dupes in politics, economic, and the law, medicalise it - indeed, once it becomes the acronym ANH - then the common human duty is hidden behind jargon and they can coldly discuss “withdrawal of ANH”, as though it were a medical procedure rather than plain starvation.

The same sort of distancing practice is found in the use of terms such as “foetus”, “conceptus”, “termination”, “euthanasia”, “vegetative state”, and so on. History has plenty of precedents for this.

XS: How would you say the field of bioethics relates to the field of moral philosophy?

Oderberg: There is no bioethics without moral philosophy. Bioethics just is the application of moral philosophy, or ethics, to problems of life and death broadly construed. In that sense, there is no such thing as bioethics conceived as an autonomous discipline with its own experts working from a set of sui generis bioethical principles.

Yes, to be a bioethicist you need expertise in moral philosophy (something not shared by many bioethicists) and a command of the specific medical, scientific, and technological issues you are pronouncing upon. Preferably you should have up-close experience of those issues rather than mere ivory tower “experience”.

To be a bioethicist, then, you need to be a moral philosopher, and to be a moral philosopher you need to be a philosopher, able to distinguish good and bad arguments, and to separate reasoned thinking from fad, fashion, societal pressure, prejudice, and government policy.

And to be a philosopher, you need first to be a human being, with human concerns, love for your fellow man, care for society and its future, and that most uncommon resource - common sense. In other words, bioethics is not what you do when you can’t get a “real” philosophy job and like getting big grants from foundations and think tanks.

XS: What kind of novel contribution might a so-called “natural law approach” bring to the field of bioethics?

Oderberg: Well, natural law bioethics is not very well developed, despite its semi-advocacy in some circles. Being, say, pro-life doesn’t make you a natural law bioethicist. Nor does worrying about the sinister developments in biotechnology, or going on about the “culture of death”.

Being a natural law bioethicist means having a deep knowledge of, and respect for, a tradition of thinking that goes back to the ancient Greeks and Romans, that emphasises the role that nature has in guiding morality. Only ignorant sophists think that natural law ethics means believing that whatever is natural is good or right and whatever is unnatural is wrong or bad. Rather, it is about identifying what it is that fulfils our human nature, makes us be what we are supposed to be according to our natures as rational, embodied, but finite creatures.

I think we can be pretty sure that, as far as fulfilment of our nature is concerned, being killed generally doesn’t help. So attacks upon innocent life - innocent life, not the life of those who might forfeit their right due to the harm they have caused to others - are prohibited by natural law, whatever other considerations may apply.

I have yet to see a good argument to the effect that life itself is nothing but a means to the pursuit of other goods, and hence loses its value when one is, say, in a coma or persistent non-responsive state.

When it comes to topics such as genetic engineering, surrogate mothers, human “enhancement” or whatever issue bioethics and technology have managed to get before the media, what is needed is a careful, refined natural law analysis of the issue at hand. The guidance has to come from what is good for individual human natures and natural human groupings such as family, community, and state. But what is good for a group of humans depends wholly on what is most conducive to the fulfilment of each and every individual, which is why sacrificing some innocent people for the benefit of others is wrong. What is good for the group is not the same as the “best outcome” on a utilitarian or consequentialist weighing up of good and bad effects of some behaviour.

To this end, natural law theory cannot and must not work in a vacuum: it must be informed by authentic and credible empirical work on human nature and the common good, all of this balanced against common sense. To take one example, the self-mutilation that goes by the name “cosmetic surgery”, where the purpose is not to remedy a defect that inhibits the natural function of the human body (and perhaps also natural human functions such as friendship and social relations), is arguably morally wrong in all its forms.

Now, it’s not that there is something “unnatural” about it in a vague sense, but that its elevation of bodily perfection above the acceptance of inevitable imperfection given the kind of creature we are is itself an unnatural reversal of the proper hierarchy of human goods, placing a bodily good above what one might call a psychic good.

XS: A number of Catholic ethicists (Grisez, Finnis, George) have attempted to apply New Natural Law Theory to modern bioethical problems. Do you agree with the New Natural Law approach

Oderberg: Well, in general I do not agree with the approach, but I do agree with many of their ethical positions, albeit not all (and they don’t all hold the same ethical positions, either). The approach of “new natural law” emerged from the cultural revolution of the 1960s, when some Catholic philosophers, taking on many of the untraditional and contemporary views of the time (most of which persist), decided that good old-fashioned Aristotelian-Thomistic metaphysics just didn’t “cut it” any more.

We moderns, in other words, could see through the assumptions of Aristotle and Aquinas (and their followers) and their metaphysical “prejudices”, especially the view that there actually is such a thing as human nature, and that from human nature one could argue philosophically for a system of ethics. So a metaphysic of human nature, and everything that goes with it, was thrown out the window in favour of a focus on the subjective, first-person viewpoint, on the agent’s perspective on their reasoning about what to do and what is good or bad.

Now, somewhat miraculously, the NNL theorists managed to arrive, by this wholly new and hitherto unknown method, to a set of views that largely coincided with the ones they sought to uphold. Yet, as far as I can tell, the only times when they seem to have a view backed up by a penetrable and perhaps plausible argument are when they appear to be falling back on just the sort of “outdated” metaphysics they tend to disapprove of.

So, in my view, the NNL project as such is and always has been a failure, and is never, ever going to persuade liberal bioethicists to abandon a single one of their positions, whether on abortion, euthanasia, surrogate motherhood, “gay marriage”, or whatever. Now I’m not saying that the traditional, metaphysically-driven approach is, psychologically speaking, more likely to convince liberal bioethicists; but I do think it’s the only one that, intellectually speaking, has even a hope of doing so.

XS: Where do you see the field of bioethics heading in the next few decades?

Oderberg: Well, probably not heading in a wonderful new direction in which science and technology are put in their place and authentic human values are placed back in control, where society and government allow only those developments that genuinely benefit individuals and the common good. In fact, my views are pretty apocalyptic on that score, but I won’t go into it here.

What I will say is that the future of bioethics is tied to the future of society (or societies). Don’t expect bioethicists to lead the way in restoring sanity to an otherwise insane society. In fact, don’t expect philosophers to do so.

The cultural forces at work are what drive future developments, and whilst it’s true that bioethics has been very much in the vanguard, it is not the driver. We need to look at the wider society: where is it going? What will it be like in, say, thirty years? Answer that question and you will have answered the question as to what bioethics will look like.

I’m more than a little afraid, albeit more for my children than for myself. If everyone kept their children free from the brainwashing effects of the media and the biotech boosters (as the great Wesley Smith calls them), bioethics would end up looking very different indeed.

Professor Oderberg’s website is  www.davidsoderberg.co.uk.
- See more at: http://www.bioedge.org/bioethics/interview-david-s.-oderberg/11695#sthash.OewpKhOG.dpuf

BioEdge: When Ebola breaks out again, whose fault will it be?


When Ebola breaks out again, whose fault will it be?

The West African ebola outbreak has been largely contained. Now the world can sit back, breathe a sigh of relief and mutter, “that was a wake-up call”.


The message of two ethicists from the University of Toronto is that the Ebola epidemic signals a profound moral failure on the part of complacent Western nations. Like an alarm clock at the bedside, they keep hitting the snooze button rather than grapple with the hard questions of developing emergency plan and fixing battered healthcare systems. “We either have collective amnesia or collective narcolepsy,” write Maxwell J. Smith and Ross E.G. Upshur in an Oxford University Press blog, based on their article in Public Health Care Ethics.

“In practice, this translates into not only investing in global outbreak surveillance infrastructure, but also strengthening health systems in the worst-off countries. This latter crucial point has been acknowledged, but unfortunately has largely received only lip service.”
The SARS and H1N1 influenza outbreaks taught public health experts and governments valuable lessons. But once learned, they were quickly forgotten.

By failing to adequately engage communities in outbreak response, instituting travel bans and restrictions, and declining to share valuable data and tissue, this outbreak saw the adoption of policies and practices that fostered distrust and ran antithetical to the ethics lessons we have purportedly ‘learned’ from past outbreaks. It is as if past lessons have been wiped from our collective memory.

They point out that the main obstacle to successfully combating epidemics is moral, not technical. There is simply not enough commitment. “We cannot entirely prevent infectious disease outbreaks from occurring,” they write, “however, we can strive to ensure our moral failures are not repeated.”
- See more at: http://www.bioedge.org/bioethics/when-ebola-breaks-out-again-whose-fault-will-it-be/11699#sthash.Ve1KJixS.dpuf

BioEdge: Hammering out the details in Canada’s new euthanasia regime

Hammering out the details in Canada’s new euthanasia regime

Last February Canada’s Supreme Court declared that denying patients access to assisted suicide and euthanasia is a violation of their human rights. The federal, provincial and territory governments were given a year – until February 6, 2016 -- to enact legislation consistent with its decision.

This week the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying released a report with points which should be incorporated into legislation throughout Canada. The changes to the legal system and medical practice are massive and unprecedented. There are only two months to go before the Supreme Court’s deadline, although the federal government has requested a six-month extension to ensure "a thoughtful, sensitive and well-informed response."

It’s hard to predict whether all of the Advisory Group’s 43 recommendations will be implemented in all of Canada’s 11 jurisdictions. But if they are, Canada will have the world’s most advanced euthanasia legislation – even more progressive than the Netherlands and Belgium, which are currently the world leaders.

Another panel, appointed by the Federal government when conservative Stephen Harper was prime minister, has also submitted a report, which has not yet been made public. Two of its three members argued against assisted dying before the Supreme Court, and its recommendations are bound to be quite different. However, October’s election brought in a new government which supports assisted dying, so the report may end up in the dustbin.

The Supreme Court held that a competent adult person who clearly consents and has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition may be offered physician-assisted dying. With these conditions as a foundation for legislation, the Advisory Group hammered out its recommendations. It acknowledges that “the idea of physician-assisted dying remains ethically challenging for some”. But it does not appear that it tried to accommodate the dissenters.

Here are some of the more contentious recommendations.

  • The unfamiliar term of “physician-assisted dying” (PAD) includes both euthanasia and assisted suicide. It should become an integral part of Canada’s palliative care system. It should be publicly funded.
  • Although the “P” in PAD refers to physicians, a registered nurse or a “physician assistant”, a Canadian term for a trained health professional, can also should be able to write a prescription for a lethal drug or give a lethal injection.
  • There should be no age limits for PAD: “eligibility for physician-assisted dying is to be based on competence rather than age.” This means that a 12-year-old could request euthanasia. Or a 7-year-old. 
  • The terms “grievous and irremediable” should not be defined in legislation or regulations. The patient will define what constitutes intolerable suffering.
  • Two physicians must approve a request for PAD, but neither of them need special qualifications in psychiatry or in the disease from which the person is suffering.
  • Canada is a vast country and physicians are not always readily available. Therefore virtual assessments over the internet should be available.
  • There should not be a cooling-off period. “Rather, the time between initial request and declaration will vary according to the time it takes for the attending and reviewing physician to be confident that the declaration is free and informed and made by a competent individual.”
  • The death certificate should list the cause of death as the underlying medical condition, not PAD. However PAD should be listed as “the manner of death”.
  • Neither the Supreme Court nor the Advisory Group are sympathetic to conscientious objection. A doctor who refuses to provide PAD must refer. A faith-based institution will not be required to provide PAD, but must transfer the patient’s records to another institution. It must also allow PAD to take place on its premises.
  • Provinces and territories should provide public education about PAD. This is a broad and ambiguous recommendation which could encompass classes in schools as well as information provided to patients and doctors.
Unsurprisingly, the report provoked very different reactions. In the Globe and Mail, André Picard described it as a refreshing step forward. “iI doesn't rehash age-old arguments about whether assisted death is right or wrong, moral or immoral, legal or illegal. Rather, the starting point is that, given the Supreme Court ruling, this is going to happen, so it should happen in a clear, coherent fashion.”

But in the National Post, Andrew Coyne decried “the absurd logic of assisted suicide”. He points out that the rationale for the decision and subsequent legislation is “unlimited personal freedom”. PAD is being sold “as a release from suffering; not as an evil to be prevented, but as a service to be provided (indeed, the panel recommends it be done at public expense). This presents the right to die, not as a limited one, such as the right to drive, but as an unlimited one, inhering in all persons — rather like the right to life.”
- See more at: http://www.bioedge.org/bioethics/hammering-out-the-details-in-canadas-new-euthanasia-regime/11700#sthash.iK6EmLkA.dpuf


Happy Christmas! The staff of BioEdge will be taking a break over the holiday. Our next newsletter will be on January 8.
Thanks for all your support and suggestions during the year. We hope that BioEdge will continue to grow in 2016. 
Michael Cook

Michael Cook

This week in BioEdge

by Michael Cook | Dec 20, 2015
Canada could soon have the world's most liberal euthanasia laws

by Michael Cook | Dec 19, 2015
There has been a moral failure to confront serious epidemics

by Michael Cook | Dec 19, 2015
Tabasco restricts surrogacy to Mexican nationals

by Michael Cook | Dec 19, 2015
ASRM issues official statement

by Michael Cook | Dec 19, 2015
From talking Barbie to CRISPR

by David S. Oderberg | Dec 15, 2015
A highly critical look at contemporary bioethical discourse by a UK philosopher.

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