Honesty and Public Health Communication: Part 2
Written by Rebecca Brown
This post is based on two recently accepted articles: Brown and de Barra ‘A Taxonomy of Non-Honesty in Public Health Communication’, and de Barra and Brown ‘Public Health Communication Should be More Transparent’.
In a previous post, I discussed some of the requirements for public health institutions to count as ‘honest’. I now want to follow that up to discuss some of the ways in which public health communication seems to fall short of honesty. Continue reading
Abortion in Wonderland
By Charles Foster
Image: Heidi Crowter: Copyright Don’t Screen Us Out
Scene: A pub in central London
John: They did something worthwhile there today, for once, didn’t they? [He motions towards the Houses of Parliament]
Jane: What was that?
John: Didn’t you hear? They’ve passed a law saying that a woman can abort a child up to term if the child turns out to have red hair.
Jane: But I’ve got red hair!
John: So what? The law is about the fetus. It has nothing whatever to do with people who are actually born.
Jane: Eh?
That’s the gist of the Court of Appeal’s recent decision in the case of Aidan Lea-Wilson and Heidi Crowter (now married and known as Heidi Carter). Continue reading
Sex and Punishment: How Old Do You Have to Be?
By Maximilian Kiener
In March 2022, Philippines President Rodrigo Duterte signed a bill that increased the minimum age for sexual consent from 12 to 16 years. This bill marked a significant change to a previous law that dated back to 1930.[1] International Organisations have advocated for a changed in the Philippines for a long time and welcomed the new bill. ‘Having this law is a very good protective instrument for our children from sexual violence, whether or not it starts online or whether or not it also starts in a face-to-face encounter’, commented Margarita Ardivilla, a UNICEF child protection specialist.[2]
To the Western World, the Philippines’ new bill seems obvious and overdue. After all, most other countries already specify the age of 16 for consent to sex or health care. But we should not feel complacent too quickly. In fact, there might be more to do to protect children and adolescents. Although most countries now convergence on 16 as the age of consent, they still have a much lower age for criminal responsibility, that is they punish children much earlier than they allow them to consent.
Consider the following case from the UK. On Friday 12th February 1993 in Liverpool, UK, Robert Thompson and Jon Venables murdered the two-year-old James Bulger. At the time of their appalling crime, Thompson and Venables were only ten years old, an age at which they would not have been able to give legally valid consent to their own healthcare, or to sex. Yet, the authorities considered them criminally responsible and made them the youngest convicted murderers in 20th-century Britain.[3]
Although this is an extreme case, it illustrates a more general fact: the age at which children become criminally responsible is often considerably lower than the age at which they become able to give legally valid consent. Noroozi et al. found that in 80% of countries with clearly defined ages for consent and responsibility, the age of criminal responsibility is still about 2 to 8 years lower than the age of consent.[4]
This situation should make us think. Now that we agree that the age of consent should be around 16, and not 10 or 12, let’s think about the age of criminal responsibility too. Why should children or adolescents be criminally responsibility for their deeds when they could not possibly give consent to anything important in their lives?
Those who support a lower age for criminal responsibility often pursue one of two routes, neither of which is convincing.
First, they argue that consent requires greater mental capacity, or reasoning skills, than responsibility. When deciding whether to consent, one needs to be able to understand one’s own prudential interests, values, and the potentially intricate consequences of one’s decision, and doing so requires a great deal of intellectual and emotional maturity. On the other hand, understanding that one should not murder, steal, or break other fundamental norms, is pretty straightforward and everyone with a basic grasp of our social interactions should be able to master this.
But this line of reasoning is not convincing. Morality is not just about regurgitating slogans. It requires understanding, more fundamentally, what we owe each other as fellow moral beings. Moreover, sometimes, the situations regarding consent and responsibility could be very similar. Consider the fictitious case of the 15-year-old Mary who can be convicted of murder but cannot refuse her own life-saving treatment. In both cases, Mary needs to understand the concepts of death and fatal action, and it may therefore be inconsistent to hold Mary responsible for murder but then deny her ability to validly refuse treatment for herself. So, on purely capacity-based terms, a categorical divergence between the age of consent and the age of responsibility lacks warrant.
A second argument for a lower age of responsibility often refers to a policy of being ‘tough on crime’. Being tough on crime means sending a clear signal to children and adolescents that their wrongs will be prosecuted and punished.
Yet, this policy presupposes that children possess sufficient competence to understand the signal. Therefore, this approach cannot justify a lower age of responsibility independent of a psychological assessment of children’s competence. If children at 10 years old cannot sufficiently understand relevant moral and legal norms, there is simply no point in sending them ‘a clear signal’. Consider again the ten-year-old Thompson, one of the children who killed James Bulger, who is reported to have asked the police whether they took his victim James to the hospital ‘to get him alive again’.[5] Such a child is very unlikely to have understood the fatal nature of his acts, let alone their moral repugnance. Thus, being tough on children like him is very unlikely to deter children of similar competence.
Thus, the view that the age of responsibility should always be lower than the age of consent cannot be justified. We need a more fine-grained approach and should be particularly critical of wide age gaps, like those in the UK, where the age of criminal responsibility is 10 and the age of consent to much in life is 16.
For this reason, the news from the Philippines about the age of consent should be the start, not the end, of a conversation on how to best protect children and adolescents. It should prompt us to think about the age of criminal responsibility too and reform the law in ways that make it coherent across different domains.
[1] https://www.reuters.com/world/asia-pacific/philippine-leader-approves-bill-raising-sex-consent-age-12-16-2022-03-07/
[2] https://theaseanpost.com/geopolitics/2022/mar/09/philippines-raises-age-sexual-consent-16
[3] https://en.wikipedia.org/wiki/Murder_of_James_Bulger
The Homeric Power of Advance Directives
By Charles Foster
[Image: Ulysses and the Sirens: John William Waterhouse, 1891: National Gallery of Victoria, Melbourne]
We shouldn’t underestimate Homer’s hold on us. Whether or not we’ve ever read him, he created many of our ruling memes.
I don’t think it’s fanciful (though it might be ambitious) to suggest that he, and the whole heroic ethos, are partly responsible for our uncritical adoption of a model of autonomy which doesn’t do justice to the sort of creatures we really are. That’s a big claim. I can’t justify it here. But one manifestation of that adoption is our exaggerated respect for advance directives – declarations made when one is capacitous about how one would like to be treated if incapacitous, and which are binding if incapacity supervenes if (in English law) the declaration is ‘valid and applicable.’ 1.
I suspect that some of this respect comes from the earliest and most colourful advance directive story ever: Odysseus and the Sirens. Continue reading
Healthcare Ethics Has a Gap…
By Ben Davies
Last month, the UK’s Guardian newspaper reported on a healthcare crisis in the country. If you live in the UK, you may have already had an inkling of this crisis from personal experience. But if you don’t live here, and particularly if you are professionally involved in philosophical ethics, see if you can guess: what is the latest crisis to engulf the publicly funded National Health Service (NHS)?
Returning To Personhood: On The Ethical Significance Of Paradoxical Lucidity In Late-Stage Dementia
By David M Lyreskog
About Dementia
Dementia is a class of medical conditions which typically impair our cognitive abilities and significantly alter our emotional and personal lives. The absolute majority of dementia cases – approximately 70% – are caused by Alzheimer’s disease. Other causes include cardiovascular conditions, Lewy body disease, and Parkinson’s disease. In the UK alone, it is estimated that over 1 million people are currently living with dementia, and that care costs amount to approximately £38 billion a year. Globally, it is estimated that over 55 million people live with dementia in some form, with an expected 10 million increase per year, and the cost of care exceeds £1 trillion. As such, dementia is widely regarded as one of the main medical challenges of our time, along with cancer, and infectious diseases. As a response to this, large amounts of money have been put towards finding solutions over decades. The UK government alone spends over £75 million per year on the search for improved diagnostics, effective treatments, and cures. Yet, dementia remains a terrible enigma, and continues to elude our grasp.
Video Interview: Is Vaccine Nationalism Justified?
High income countries have been criticised for hoarding covid-19 vaccines: they have been accused of ‘vaccine nationalism’. But what exactly is vaccine nationalism? Is it really wrong to prioritise one’s own citizens, and, if so, why? How can we do better when the next pandemic strikes? In this Thinking Out Loud interview, philosopher Dr Jonathan Pugh (Oxford) discusses these questions with Dr Katrien Devolder (philosopher, and producer of the Thinking Out Loud interview series).
Exercise, Population Health and Paternalism
Written by Rebecca Brown
The NHS is emphatic in its confidence that exercise is highly beneficial for health. From their page on the “Benefits of exercise” come statements like:
“Step right up! It’s the miracle cure we’ve all been waiting for”
“This is no snake oil. Whatever your age, there’s strong scientific evidence that being physically active can help you lead a healthier and happier life”
“Given the overwhelming evidence, it seems obvious that we should all be physically active. It’s essential if you want to live a healthy and fulfilling life into old age”.
Setting aside any queries about the causal direction of the relationship between exercise and good health, or the precise effect size of the benefits exercise offers, it at least seems that the NHS is convinced that it is a remarkably potent health promotion tool. Continue reading
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