“The Best Interests of the Family”: Parents v Baby?
There is much that is good to be said about Dominic Wilkinson’s new book Death or Disability? The ‘Carmentis Machine’ and decision-making for critically ill children.
My favourite part of the book is how Dominic confronts head on the issue of the best interests of the family in relation to care, and withdrawal of medical treatment, in newborns.
This is one of the most neglected areas of bioethics.
On the one hand, there is a rhetoric that goes we are all social beings, we are socially connected, not atomistic individuals, the community matters, etc etc The usual communitarian mantra.
Then there is the alleged overriding legal and medical ethical principle of the best interests of the patient, which is the newborn infant in the case of neonatal medicine. The sole basis of the provision of medical treatment is meant to be to promote the best interests of the patient, and medicine should never be used to harm the patient, etc etc. The usual medical ethics and law mantra.
And then there is real life. The interests of the parents, siblings, other relatives, friends, society etc can all diverge from the interests of the patient, even a newborn infant. How are these to be weighed? The hard edged reality is that the interests of families and especially parents do play a role in clinical decision making, and even in cases to withdraw life-prolonging medical treatment. (For example, in one survey 90% of American intensivists believed that family interests should be included in decisions for incompetent patients. )
In ‘Death or Disability?’, Dominic reaches several striking conclusions. We should certainly give some weight to the interests of the family for decisions about children. This is most likely to sway our decisions in relatively borderline cases, where the net benefit or harm to the child is small. But he also argues that the amount of weight will vary depending on the age of the child, and on the availability of resources. We should give greater weight to the wishes of parents for newborn infants than for an older child. And we should give greater weight again in societies with few resources, where the burden of caregiving is going to fall heavily on families, and where health resources are seriously limited.
It is time for an honest, open and rational approach to these kinds of dilemmas. Dominic does just that.
The Best Practical Ethics Books of the Year…
By the editors of the Practical Ethics blog.
What is the best practical ethics book you read this year, and what is so good about it (in 1-3 sentences)?
We asked this question to our colleagues at the Oxford Uehiro Centre for Practical Ethics. To our surprise, not a single title received multiple votes. This perhaps indicates that so many good books in the field appeared in the last couple of years, or perhaps a different explanation is due. Either way, below is the list of the recent titles we found excellent:
The Ends of Harm: The Moral Foundations of Criminal Law by Victor Tadros
‘In this book, Tadros provides a highly engaging non-consequentialist account of the permissible harming of others. It is an important and illuminating work containing a number of original insights’. – David Birks
The Ethics of Transplants: Why Careless Thought Costs Lives by Janet Radcliffe Richards
‘I give this out to people as a paradigm example of how to do good practical philosophy, especially in medical ethics. Janet dismembers bad arguments, like a pathologist dissecting a corpse riddled with metastatic cancer, and reveals the diagnosis, chapter after chapter. It is a fine example in the now neglected method of giving sound arguments, and exposing invalid ones. It is unabashedly pre-postmodernist and, as such, is intelligible and useful to any thoughtful person, specialist or non-specialist.– Julian Savulescu
Moralizing Technology: Understanding and Designing the Morality of Things by Peter-Paul Verbeek
‘A thought-provoking account of human-technology relation that calls for a new understanding of and method for ethics in our technological age. This book will surely give you some food for thought. Perhaps, it will even change the way you understand the technologies around you’. – Pak-Hang Wong
Philosophy and the Environment ed. by Anthony O’Hear
‘Philosophy and the Environment contains several excellent papers, including an outstanding piece by David Wiggins, which is both ethical and practical’. – Roger Crisp
The Prison Officer by Alison Liebling, David Price, and Guy Shefer
‘Most of us never face extreme violence, aggression, corruption and despair, let alone need to make good, daily decisions about how to manage it effectively and with moral decency. Prison officers do. This book explores the psychology of prison officers and their relationships with prisoners, revealing what it is to do this demanding job well and carve morality out of the chaos often found within prisons’. – Hannah Pickard
The Righteous Mind: Why Good People Are Divided by Politics and Religion by Jonathan Haidt
‘The Righteous Mind synthesises Haidt’s influential work on different aspects of moral psychology, to create a unified vision of the field, and it is having significant influence accross a variety of academic disciplines’. – Stephen Clark
Skepticism and Freedom: A Modern Case for Classical Liberalism by Richard A. Epstein
‘An interesting consequentialist defence of classical liberalism, limited government and free markets by an eminent academic lawyer. Philosophers may think some of the philosophical arguments go by rather quickly, but this is to miss the peculiar virtue of the book. His knowlege of the way law has worked in practice and the commonalities of law across culture and history fills out the defence with the kind of important and illuminating facts that philosophers rarely know’. – Nicholas Shackel
‘The Spirit of Compromise skilfully combines normative reasoning with empirical analysis to provide concrete suggestions to correct some of the most serious deficiencies in contemporary democratic politics. It brilliantly shows how the “policy implications” of normative theory can be more than a polite gesture towards funding bodies’. – Kei Hiruta
Thinking, Fast and Slow by Daniel Kahneman
‘A nice summary of the evidence he’s compiled during the course of his brilliant career into the scary levels of human irrationality’. – David Edmonds
Why Some Things Should Not Be for Sale: The Moral Limits of Markets by Debra Satz
‘It draws on philosophy, economics, and anthropology to present a sophisticated and nuanced appraisal of the moral consequences of markets in human organs, sex and other actual or potential commodities. In doing so, it moves the debate about markets beyond the standard trite claims about efficiency, equality, or human dignity’. – Simon Rippon
‘1493 is a beautifully written and deeply insightful exploration of how hard it is (and has always been) to anticipate the human consequences of globalization’. – Regina Rini
Is your favourite recent title listed above, or do you have other suggestions? Please reply below to share with us the practical ethics book you found most interesting this year!
Fifty shades: should BDSM become part of general sexual education?
“BDSM [Bondage, Discipline, Sadism, Masochism] might be mainstream now, but it has a new PR problem. I blame Christian Grey.” writes ‘sexual submissive’ Sophie Morgan in an article in the Guardian.
I started reading E.L. James’ Fifty Shades of Grey but didn’t get very far. It’s very badly written (guess that’s no longer a secret) and, well, I found it incredibly boring (Pride and Prejudice is more exciting, I think). In any case, the book is just a starting point for something I began thinking about after a recent conversation with a friend who is part of the ‘BDSM community’.
The legal status of BDSM varies from country to country. In the UK, it is illegal if it results in any injury which is more than “transient or trifling”. Possessing extreme pornography is a criminal offence, which, for obvious reasons, may be problematic for those who are into SM. Moreover, those who engage in any kind of BDSM are not legally protected against discrimination on the basis of their sexual preferences (for example, they can be, and have been, fired for that reason).
I haven’t studied the issue in depth, but it seems to me that BDSM should be legal, the main reason being that it concerns a consensual sexual act by adults that doesn’t cause harm to third parties. (There’s an interesting paper by Nafsika Athanassoulis arguing why SM can be considered a consensual sexual act). But I was thinking about a further question. Should we put more effort into breaking the BDSM taboo? For example, in countries where BDSM is legal, should it be part of general sexual education?
Nine to five philosophers
Owen Barfield was lunching in C.S. Lewis’s rooms. Lewis, who was then a philosophy tutor, referred to philosophy as ‘a subject’. ‘”It wasn’t a subject to Plato”, said Barfield, “It was a way.”’1
It would be dangerous for a modern professional philosopher to say that her philosophy was her ‘way’. I can well imagine the responses. ‘She’s lost objectivity’. ‘She’s a preacher, not an academic.’ ‘Most of us were disabused in our first week as undergraduates of the childish notion that philosophy was about the meaning of life. She obviously missed that lecture. She was probably at a prayer meeting instead.’
For the scoffers, philosophy is a job. It’s something they do from nine to five. Then, when they leave the faculty, they walk out into the world of angst and bereavement and sick children, and begin, without reference to the day job, to try to puzzle out the meaning of the world and of their own place in it. The job, often, is about exactitude – about ensuring that every step in an examined argument is unimpeachably rigorous. But stop and ask them whether, as a result of the rigour, the argument can now be relied upon to change conduct, and they’ll stop, scratch their heads, and look at you as if you’re simple.
I’m not really accusing them of hypocrisy – of failing to judge themselves by their own standards. For an allegation like that to stick you’d have to show that they knew that the world of the day job was the same as the world outside. The problem is that they don’t perceive the two worlds as having any connection at all. The diagnosis is non-integratedness. It would be unkind to translate it as lack of integrity.
Recently I was reading Charlie Camosy’s book Too expensive to treat? Finitude, Tragedy and the Neonatal ICU2. It’s rather a good book, but its contents aren’t the point for the moment.
Charlie and I don’t always see eye to eye. He’s a Catholic, for a start, with far too much respect for old dead men for my comfort. But the tone of the book struck me. Here was someone doing philosophy because the answers mattered. He’d unfashionably remembered that ‘philosophy’ means the love of wisdom. He approached the issues reverentially but insistently, determined not to let them go until he knew that they had something useful to say to an artificially ventilated child.
No, this doesn’t mean that the book is a Catholic polemic; or that he’s mainly interested in crafting an argument that accords with the ruling Encyclicals; or that he’s trying to ensure his back will be covered when he next slinks into a confessional; or that it’s a set of inevitable inferences from a set of a priori assumptions; or that it’s humourless, earnest, preachy or fanatical. Let alone correct. It’s just a book by all of someone, with the intention of deriving principles that apply to whole, real, humans, rather than to an abstracted portion of a human, or a pastiche of a human. It’s written to appeal to reason, conscience, intuition and hospital accountants, rather than to the Chairmen of grant-giving authorities and tenure committees. It’s the work of someone with a conjoined personal and professional life. That should be unremarkable. It’s actually very unusual.
That it is so unusual is a big problem both for philosophy and philosophers.
[Conflict of interest: Charlie Camosy is a friend. Come to think of it, that's hardly a conflict of interest. He wouldn't stop being a friend if I hadn't written this, won't be more of a friend because I have, and I won't be getting a cut of any book sales this blog might generate.]
References
1. C. S. Lewis, Surprised by Joy, Geoffrey Bles, 1955
2. Eerdmans, 2010
Ad usum Delphini: should we Bowdlerize children’s books?
The Ture Sventon books are a series of Swedish children’s detective stories written by Åke Holmberg 1948-1973. They are locally well-known and appreciated, but henceforth Ture Sventon i Paris (1953) will likely not be republished. The reason is that the publisher Rabén & Sjögren wanted to remove the word “neger” in the book, and the Swedish Writers’ Union (who owns the copyright to the books) refused this change, since it would change the character of the book. They acknowledged that it was a word with a racist resonance but also a part of cultural history, and hence it could not be removed or replaced with “colored” or “black”. They suggested adding an explanatory introduction instead. The publisher choose not to reissue the book.
In English-speaking countries another recent controversy is about the new edition of Huckleberry Finn that replaces use of the word “nigger” with “slave” and “injun” to “Indian”. Again, literature experts complains that this fundamentally changes the novel (which after all is an anti-racist book) and might have deeply upset the author, yet others think that this will allow it to be read more in schools or public. Are we seeing examples of well-intentioned acts of “cultural vandalism and obscurantism that constricts rather than expands the life of the mind”, or just attempts to reduce impediments for the public to read the works?
Are some temperaments “better” than others?
by Alexandre Erler
Jerome Kagan’s latest book, The Temperamental Thread, is – as usual with Kagan – a fascinating read. It draws on the three decades of research done by Kagan on the topic of human temperament. In a famous series of studies, Kagan examined the way infants reacted to unfamiliar or unexpected events. He found that about 20 per cent of these infants were unusually responsive to such events, exhibiting vigorous motor activity and frequent crying. He calls these infants “high reactives”, and found after following their evolution during their subsequent years that they were biased to become timid, subdued toddlers and shy adolescents who become uneasy when they cannot predict or control the future. About 20 per cent of these high reactives proved unable to cope with their temperament and were subsequently diagnosed with social anxiety disorder, depression, or both. By contrast, another other group of infants showed a high threshold of excitability to the same events. Kagan calls them “low reactives”. They tended to become outgoing, relatively fearless children and relaxed adolescents who like risk and challenge [3]. In the wake of Kagan’s earlier work The Long Shadow of Temperament, The Temperamental Thread paints a rich and detailed picture of the differences between these two psychological types.
Science and Morality
Roger Crisp writes…
In his new book The Moral Landscape, Sam Harris claims that science 'reveals' values to us. Kwame Anthony Appiah is one of the many who have pointed out that Harris makes the common mistake of seeking to derive an 'ought' from a series of mere 'is' statements, a mistake pointed out by David Hume centuries ago.
But the relationship between natural science and normative ethics does raise interesting questions. Let's assume that Harris is correct in thinking that the right action is that which maximizes overall well-being, and assume also that well-being consists in the greatest balance of pleasure over pain. Pleasantness and painfulness are properties that scientists — psychologists in particular, but others too — can talk about, and if we assume that these properties can be measured in some way or other, then we find that the property that makes actions right is a property that can be studied by natural science.
But what is the relation between rightness and the property of maximizing well-being? In recent years, several naturalistically inclined philosophers have been inclined towards identifying them. So, just as heat turns out to be the same as molecular kinetic energy, so rightness turns out to be the same as maximizing well-being.
In a book which should be published in the new year, Derek Parfit argues that moral properties and 'natural' properties (the ones studied by science) are far too different to be identified. The claim of the naturalists about rightness in the previous paragraph is, he thinks, rather like the claim that heat is a cabbage.
But there is another option — a broader form of naturalism, to which Parfit is less hostile. This might allow that moral properties and natural properties are indeed different, but insist that moral properties are 'anchored' (to use Robert Audi's term) in natural properties in the same sort of way that mental properties are anchored in physical properties — by supervening on them.
If we continue with our assumption (made just to simplify the argument) that rightness in this world supervenes on the maximization of well-being, it is hard not to think that rightness in all possible worlds will supervene on such maximization. That gives us a necessity claim linking moral and natural properties which those on both sides of the metaphysical debate between naturalism and non-naturalism can agree on. Indeed it may be that there's enough common ground here for that debate to be put to one side, so that we can engage in another genuine philosophical question — how it is that we can understand these necessities. We — those who've understood Hume, anyway — know that it's not through application of the scientific method as that is usually understood. But how, then, do we do it?
On Knowing (or Not)
Judy is an intelligent, articulate woman with a great sense of humor. She is also completely paralyzed on her left side. Trouble is, she doesn’t know she is. On the contrary, she knows that she isn’t.
What’s going on? Self-deception? Denial? Puzzling examples like this are scattered throughout a recent series in the NY Times, which explores what it means to know, not know, know what you don’t know and not know what you know. Follow? Me neither.
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