Shared from WordPress

I don’t wear poppies, and this image perfectly encapsulates why – http://wp.me/p1pLiJ-MW

Update concerning first Print Journal

We have received a great amount of pressure to move our journal to a strict digital format (due to the cost of print). Myself, along with most of the contributors,  feel that this is a mistake. We will apologize for the delay but maintain that once the print copy is available (when we finalize arrangements with our finances), we will mail them out to the respective institutions. This also means, if you had missed the opportunity to request a copy, you may do so now.

 

We thank everyone for their patience.

 

 

At What Point Does Respecting Autonomy Become Self-Defeating?

From O’Neill’s conception of Reproductive Autonomy to Autonomy Proper

One of my more favorite authors on issues concerning autonomy is Onara O’Neill. As an academic she does a very good job at discussing the contextual developments of certain forms of autonomy. The more notable discussions can be found in chapter three of Autonomy and Trust in Bioethics; “Autonomy and Twentieth-Century Reproduction”. It begins with an analysis of how some conceptualizations of Reproductive Autonomy developed (became manifest) through a mainly patriarchal society. As O’Neill discusses, it was an appeal to privacy laws that permitted citizens to practice whatever form of contraception they desired because it occurred in the private sphere. And through the developments of Roe v. Wade it was deemed a practice (using contraceptives) that did not result in direct harm of another individual. The positive results of this development was the ability for couples and women to make informed decisions concerning their reproductive choices. It should be noted, as O’Neill makes explicit, that as contraceptives did become available it was still up to the discretion of physicians and so it was not always the case that getting your hands on such forms of contraceptives was as liberal as one would have preferred.

What must be maintained when discussing patient autonomy is the importance of including context in ones analysis. The historical and philosophical take on reproductive autonomy that O’Neill provides is absolutely crucial to constructing models that might address imbalances of power between the relevant players. The worry is that if we do not fully represent the interests of the patient because there is too much power on the side of one of the players, then we run the risk of an oppressive situation. This “oppression” needs to be addressed because it sheds a very vibrant light on one of the worst situations a patient can experience. This is what we should aim to prevent. It is also the basis for many problems in clinical scenarios because it is not a balance that is easily struck.

What can be said of the benefits of respecting patient autonomy?

I do not want to get into the debates surrounding the best model or explication of “respecting patient autonomy” here. What I hope to appeal to is an intuitive description of what most would agree is the benefit of respecting patient autonomy. It will look something like this:

1. When engaging in a reflection of patient autonomy it is important to note the setting and the players: i. Hospital, Physicians Office, Counseling clinics, Mental Health Clinics, Homes (in emergency scenarios) etc.. ii. The patient and the medical health professional.
2. Each competent patient has the capacity to make decisions given the willingness of the health care professional to engage in informed discussions with the patient. (Note: There are cases where a physician may deem someone as incompetent and I do not wish to address those scenarios here. I understand that they are important and ought to be discussed but do not feel an article of this length can do a sufficient job.)
3. There are presuppositions that both the patient and the physician hold concerning what the aim of medical care is. For the patient it would represent a state of affairs where the quality of life of the patient is somewhat improved. For the physician this would represent what ‘treatments‘ are the most relevant considering the circumstance by which the patient finds herself/himself.
4. Trust is another central component that some might say is either necessary or sufficient in order for a respect for autonomy to take place. I will not say whether this is valid or not but will simply state that “trust” is very important in order to facilitate some goal that both the patient and physician must be a part of.

All of these taken together can be constructed by the following logical model:

(D & P)->; (Q & T)

i. Given a scenario where a patient is in need of the services of a physician, it follows that the there must be some agreement about the patients quality of life against the available treatment of the physician.

This is a rough conceptualization of what the aim of respecting autonomy ought to be about. So let us consider what reflections we can arrive at concerning its application.

Does “Q” take precedence over “T”?

The first question that should be asked is whether the patients conception of an ‘improvement of their quality of life’ takes precedence over the physicians ‘available treatments’?

If we say that there are circumstances where “Q” DOES take precedence over “T”, the likely consequence is at least one of two possibilities. First we have a scenario where the patient simply refuses the proposed treatments offered by the physician. For example, if a physician is encouraging a patient to transition to Palliative Care because the physician deems “Curative” measures useless, the patient ought to have the freedom to refuse. Even if this means that their only reason for refusing such a transition is because they value life over death. This first scenario is one where the patient chooses what they feel is the best treatment out of a list of available treatments. The second scenario is a situation where the patient simply does not abide by any of the medical counsel of their physician. This can be exemplified by a scenario where a patient may choose homeopathic remedies over medical ones. Say, for example, in situations where a patient is prescribed Clonazepam and refuses on the grounds that they feel that St. Johns Wart can be just as good at handling anxiety.

To be continued (first draft)..
*please note that this is a working draft, part of which, that has already been published
Please feel free to share your opinions by emailing feedback@ethicalonion.com

A response to “Bioethics and the Dark Knight Massacre” (Bioedge): A Communal Ethics

A short reflection was offered on Bioedge concerning whether or not bioethics should shed a light on matters concerned with life, death and suffering. It is not exactly clear what the author of this article thinks the role of bioethics ought to have in the consideration of the Colorado massacre, other than what is made explicit in the following question:

Most bioethicists focus on how to avoid suffering rather than on how to find meaning in it. But shouldn’t bioethics be able to direct us toward some existential relief? What do you think?

To begin, as was alluded to in the article, this issue seems to be a multifaceted one. It will have “markers” in several domains of inquiry. What I would like to focus on, is the contextual impact on ethical considerations. There is a backdrop defining the setting of James Holmes inevitably steering him in a particular direction. This backdrop is going to have some impact on what he felt was justified and what he felt was not justified. So we are left in deep contemplation of what his “backdrop” might have looked like.

To be clear, by ‘backdrop’ I am referring to contemplative matter. This is the kind of structure our minds embody over a period of growth and encounters. It is defined by dispositions, mental states, emotions, reactions and possibly more unidentified compositions of character. It will have, arguably, two components that lend themselves to a ‘bank’ of behavior; the first are the biological components and the second are the components of the external world that feed into the structure of the mind. This is different than taking a reductivist stance on the mind because what we are saying is that the exchange of external data with ‘whatever it can be said that the mind is’ leads to a particular consciousness that is constantly formulating itself. (We will say, intuitively, that there will be structured components of the mind and formulative components of the mind. This does not mean we make the mistake of reducing the former to the biological state of the mind and the latter to some mystical state the mind, to be clear). To better ground this theoretical status of the mind, we will say that the facets which contribute to the shape of the mind will be comprised of ‘what is learned throughout ones Ph.D.’, ‘what ones dispositions are, given certain stimuli’, ‘what ones memory bank is comprised of’, ‘what ones moral beliefs might be’ and so on and so forth.

There have been a few suggestions, in the linked posting, concerning what the believed impetus of Holmes actions might have been. The first is suicide. The suggestion is that there is some link between the intention to end ones own life and the ultimate, and unfortunate, murder of those in the theatre. The other suggestion concerned the deterministic nature of the study of neuroscience. The idea here is that if what we do, say, and how we act are a consequent of inevitable actions against the backdrop of the facade of free will, then what does it matter what we do- it was going to happen whether we wanted it to or not. A scary consideration, no doubt, but one suggested nonetheless.

The other responses focused on the context of where the killings took place. These responses trailed into discussions about particular film genres and rights to bare arms. The former, it was claimed, fed on the inspirations of the perpetrator. The latter, it was proposed, is what equipped Holmes to carry out this terrible action. Whether or not each of these factors, either exclusively or mutually, had some impact on the final result, is pure conjecture at this point.

Where does that leave us? Where does this leave bioethical considerations?

Going back to the quote from the article, the author is looking for some “existential relief” via a bioethical consideration inclusive of some meta-ethic, it is presumed. I take it, what is being referred to here, is some manner -philosophically speaking- of reconciling what had happened. Through this reconciliation there is, perhaps, a way to come to terms with what happened: perhaps by discovering why it was that Holmes did what he did. This will entail more than just some statement that Holmes did what he did because he lived in a country where his constitution gave him the right to bare arms. This latter kind of response does not really fill in the gaps as to why Holmes acted in the way he did. Perhaps all we can really say is that whatever our theory of Holmes will be comprised of is some explanation as to why he did not, in the moment of the act, recognize the value of “the other in life” over “the other in death”.

Examining all the facets may help us to come to terms with how we feel about what happened. It will most probably fall short of why Holmes acted in the way he did, because whether we like it or not, the mind is a complicated thing. So I suggest that, instead of looking to justifications that are based on conjecture, we look to what can be done via a particular communal ethics.

With a communal type of ethics we may not be providing some bioethical theory. We may only be providing some kind of moral theory that speaks to the right for each individual to have our informed attention. That is to say, we need to be more open to listen to one another with a certain level of measured temperance. This kind of ethics will, oddly enough, recognize our state as a collective species. If it is the case that we share some kind of qualia of experience, then we owe it to ourselves, our families and our communities to extend a listening ear; one that is unprejudiced and ready to accept other vantage points and perspectives.

Good questions concerning such a communal ethics

1. Where does this obligation to extend our concern to others come from?
2. What type of ethics are we speaking of?
3. Can Harry G. Frankfurt’s analysis on Love offer something productive here?
4. How pervasive would such a system be?
5. Is this arising out of deontology, consequentialism, compassion, etc…?
6. Will this proposed ethics require other domains as well, such as ‘collective consciousness’ philosophies?
7. …what else do you think ought to join this list and what considerations do you have about what has been said? The notion of a communal ethics is left entirely open, save the goal to begin to be more open to others in our communities.

*please note that this is a working draft, part of which, that has already been published

Contemplations of Law and Morality: Is it Right or Just Right?

What is the relationship between law and morality?

I do not believe there is a simple answer to this question because of the complicated problem of trying to find out just exactly where morality is manifest. Knowing the loci of morality helps to identify the way in which it moulds our legal enterprise. In a very rudimentary sense we can say that there is a kind of moral conscience that exists with each and every one of us. This, it has been said, is often exemplified as a kind of intuition about right and wrong. It is manifest, in some instances, as a uneasy feeling when we participate in acts that just do not feel right. For others, the localized morality is well thought out. For these people there is a kind of contemplative buzz working in the background as they find themselves face to face with moral questions. In some cases, what is right, is not at all what feels right. Rather, it is a kind of ruled and principled system not unlike a deontological morality. For others, the moral enterprise has already been worked out by God, and as such, there is no need to contemplate beyond what has already been established as right and wrong. One such example is ‘the non-consumption of alcohol’, as established by scripture. There are others who have a hedonistic view of morality that is acted upon on the basis of pain or pleasure; whatever is right ought to encourage pleasure. Conversely whatever is wrong is what encourages pain. Whether, in a hedonistic morality, the intention is directed at the other or the self is unclear.

The loci of the law, as compared to morality, is not as complicated a concern. There are, in most legal systems within North America, a collection of laws that determine what is legal and what is not legal. There is also a process, a legal process, that allows what was once not a law to become a law. This process of jurisprudence is not an entirely liberal process, in the sense that any rule can become a law. There is a written constitution that determines what the boundaries are for certain laws to arise. There are also written components of the constitution that are left open such that new laws may have the potential to become manifest on the condition that such a law is what is ‘determined or pre-established is belonging to the people’. One such example is what has been referred to as the ‘Kevorkian 9th’; basically establishing that ‘the rights of the constitution do not supersede those rights that each citizen is born with’. In the context of the Kevorkian case an interpretation of this amendment can lead to the potential right for an individual to die. The important thing to remember here is that Dr. Kevorkian had some idea of what is right and wrong that, at the time of his hearing, was not permitted legal. Therefore although one can use the 9th Amendment to make a case for an individuals right to die as a possible basis for establishing law, this does not necessitate that it should.

The Kevorkian case is a good place to think seriously about how:

1. morality supersedes the law
2. law can arise out of a shared morality
3. the constitution is a tool for making a shared moral right into a law

1.) Morality Supersedes the Law

The opening paragraph of this article should shed some light on why it is that morality supersedes the law. The classic example of this is what was practiced in Nazi Germany. We do not want to say that what was practiced by the SS was in any sense moral. This would be a clear misunderstanding of what exactly morality entails, in a universal sense. The idea is that morality represents a systematic rule of rightness and wrongness. We understand that differential treatment of an individuals, with racial purification purposes, is clearly wrong. There are many theories as to why this is so and I do not intend to examine them because I believe, for the most part, educated persons understand why the laws governing Nazi Germany represents a clear example of a governed system ruled by fascism rather than morality.

Another less controversial example are the traffic laws in North America as compared with some European countries. In Canada it is part of the convention of the law that a driver drives on the right side of the road. If they are caught driving on the left side of the road, they can get charged -say for reckless driving or whatever context demands. Alternatively, in certain European countries, it is wrong to drive on the right side of the road. The citizens are expected drive on the left side of the road. Now if we were to say that “it is wrong to drive on the right side of the road”, clearly we are speaking of a legal “wrong” and not a moral wrong – unless your moral system is inclusive of a obligation to follow the laws of the placed which you reside. For the most part, we can say, that the “wrong” here implied is of a legal wrong.

This might get a bit confusing but it is also important to remember that although morality supersedes the law, there is a sense that the law supersedes morality in a pragmatic way. So we can say that those members (SS Officers and Polish prisoners) who participated in the eradication of the prisoners were clearly wrong in a moral sense. However, following the fall of Nazi Germany, there were many perpetrators who were not charged. Part of the reason for this was because of their adherence to their law. Although it was determined that their law was not acceptable it still nevertheless resulted in the citizens obligation to follow the law or they would be punished with the very real possibility of a death sentence.

To be continued (editing and feedback) ….

*please note that this is a working draft, part of which, that has already been published

What first to consider when evaluating ethical arguments…

I firmly believe that ethical arguments are progressive in a certain sense. The word “progressive” is ambiguous because it presupposes a context-based understanding of it. I will clarify what I mean by that designation. We want to say that we have moved forward in a progressive sense because, amongst other things, we:

• have a more open approach than before (we are not as exclusive when considering pressing concerns);
• we are not quick to pretend that there are generic resolutions;
• we are evaluating each dilemma/problem/argument within a group setting;
• we have a global perspective and therefore have more viewpoints to consider.

All of these facets of progress point to a more collective grasp of ethical concerns, which in my mind demands that we need to be careful that we do not move too quickly. There are arguably many ways to treat each concern carefully, but I intend to first focus on the clarification of conceptual understandings of ethical problems. I should also mention that there is a tendency to conflate the conceptual with the doctrinal in the context of bioethics because of the applied nature of this field. The conceptual/doctrinal distinction is exhaustively examine by Quine in the first few pages of his Epistemology Naturalized. However the doctrinal will be deferred for another analysis because it leads to a digression from this short introduction.

The conceptual underpinnings of a bioethical/ethical analysis should be carefully scrutinized so that we can be clear about a few things. First it will allow us to identify the scope of the project under analysis. When, for example, we allude to the recent “locked-in-syndrome” case, the ethical concern -at least as how I came to understand it- was already clearly publicized. The patient (anon-intended) was seeking assistance with his decision to end his life. Because of his condition, he could not carry out this wish on his own. This required, what we refer to as, assisted suicide. The replies to this recent development have been less than clear, in terms of the conceptual domain. Some have suggested that the issue concerns “rights” and based upon our ‘global constitutions’ this patient should be permitted to decide not to eat; to not be force-fed. This response is, in my mind, a clear misunderstanding of the relationship between “rights” and “ethical considerations”. Others have suggested that on the basis of self-determinism (autonomy), the patient should have the freedom to decide for them self how they want to live or die .  Others still, are pushing the conflation of active and passive euthanasia in order to argue that, just as physicians are permitted to increase sedatives under the false pretense of alleviating pain, so should this patient be allowed to end his life on similar terms.

All of these positions speak to a particular understanding of rights, self-determinism and euthanasia, and if we do not clarify our conceptions we run the risk of misconstruing the ethical lens. We need to be more careful when we make public statements about certain ethical concerns because we run the risk of setting a wrong precedent. We also run the risk of creating a value-statement that could eventually permeate itself into society, alienating certain people who do not share the ethical viewpoints. If, for example, this individual has judged for themselves (and they are seemingly competent to do so)  that they would like to end their life, this should not entail a situation where we become too quick to push for legal, ethical, moral and academic alterations  to conceptions that have not been properly construed.

I have included a link to a discussion between Chomsky and Buckley concerning Buckley’s misuse of “disinterested”. Chomsky provides a clear example of the conceptual mistake Buckley makes in trying reconcile “disinterested causes for war” in particular circumstances and the paradoxical result of “dis-interested” referring to the unintended referent.