Global Positioning Systems and Dementia: An Ethical Analysis
Sussex police have announced a scheme to fit people suffering from dementia with GPS tracking systems. These small devices will allow police to locate the wearer, and also allow the wearer to reach a 24 hour helpline by pressing a small button on the device. It has been claimed that these devices will save police time and resources, as well as reducing both the potential risk to dementia patients who go missing, and the anxiety that relatives of the missing person will feel when their loved one goes missing.
However, some parties have decried the introduction of this scheme as barbaric and inhumane. For example, Neil Duncan-Jordan, the national officer of the National Pensioners’ Convention, claimed that the scheme serves to stigmatise sufferers of dementia by equating them with people who have committed a criminal act. Continue reading
The Rationalist Prejudice
Professional ethicists seem to love controversy. I myself have been too boring in this regard, but many of my colleagues have provoked heated debate. This often spills out of the safety of academia unto society at large, as many of the past entries in the Practical Ethics blog testify to. And professional ethicists rarely regret sparking off controversy, for this in many of their view amounts to inviting more people to think and that cannot be a bad thing. Behind this is an implicit, and rationalist assumption that subjecting generally accepted – and thus hitherto uncontroversial – norms and practices under critical scrutiny is always a good thing to do. They believe that public debate over an ethical problem is likely to generate a wide range of ideas which may eventually lead to a solution; and that to make people think harder and talk openly about ethical issues has intrinsic value. It is part of the ethicist’s job, then, to be controversial. Indeed, it is what practical ethics is really about in some people’s opinion.
Is the rationalist assumption sound, though?
Certainly, there is something to be said for it. After all, many of what may reasonably be described as the achievements of human moral progress could not have happened unless somebody took the task, and often the burden, of challenging and critically scrutinising traditionally held beliefs. Slavery and gender inequality used to be taken for granted; interracial marriage used to be considered morally repulsive and was illegal in some parts of the world. Those and other past prejudices are fortunately gone. Of course, rational scrutiny by itself has never been and will never be enough to bring about significant moral and political change. It must be complemented by campaigning, pamphleteering, bargaining, compromise, agitation, mobilisation and sometimes even violence. But rational scrutiny is vitally important because good reason must be shown to promote a cause. Otherwise, indoctrination will replace persuasion, might will make right.
However, pace my over-rationalist colleagues, this does not mean that rational scrutiny is always a good thing to do. For one thing, there are many questions that do not deserve serious consideration. For example, ethicists do not need to ponder – at least for now – whether literally going back in time by time machine is a solution to historical injustice. In addition, there are some ethical issues that have been settled and settled for good. We do not need to seriously consider whether slavery should be restored, or whether a certain category of people may be massacred because they are of a ‘wrong’ kind. A society where a public debate occurs over those issues is worse than a society where it does not. If so, provoking controversy on settled issues can amount to doing damage to the society we live in. Of course, what issues have been settled and what have not is highly contestable; one should indeed raise a voice of dissent if one has good reason to do so, even if the voice is likely to upset the fabric of society. Yet one should not forget that trying to put what seems like a long-settled ethical issue back on the agenda often comes with a significant price to pay as well as potential benefits to gain.
That said, the most important objection to the rationalist assumption seems to me to lie elsewhere; it is about opportunity cost. Neither professional ethicists nor the public can afford to discuss everything with equal seriousness. Rational scrutiny costs. While we consider X, we cannot consider Y. This week’s op-ed has to focus on this issue, not others. If so, we must judge which issues matter more, which less. In our world where resources are limited, we cannot afford to critically examine everything. This is especially true in academia, where zero-sum competition for resources inevitably occurs between different branches of an institution. If a grant is given to ethics, it was not given to other potentially useful subjects such as pharmacology and social policy. Utility is not everything, but it requires due consideration.
If what I’ve said is right, then the rationalist assumption turns out to be a prejudice – and a potentially harmful one. By endorsing the rationalist prejudice, one may be taking our attention away from what really matters and doing damage to our society.
Unfortunately, professional ethicists in this age of growing academic competition and ‘impact factor’ measurement are in a way structurally incentivised to badly judge what matters. We are pressured to show that we are doing something – that our papers are cited, our ideas discussed, our output ‘making a difference’. This is a legitimate and even admirable goal to pursue, but it can work perversely today because one lazy way of numerically increasing the ‘impact’ of research is to scandalise. Defend a ridiculous ethical position you do not even believe in, and you may be a ‘high impact’ ethicist! In the long run, then, we need a better way of assessing the significance of research in ethics to reduce the incentives to scandalise and to vulgarise the discipline. A word of caution is in order in the meantime: we should resist the rationalist prejudice or we will do disservice to what we care about.
Peter Singer and Christian Ethics: Beyond Polarization
For those of us doing Catholic moral theology, we most often hear and read the name “Peter Singer” invoked by our colleagues in a dismissive way. Indeed, if one can somehow show that another’s argument is heading in a Singer-like direction, then for many of us one essentially has reduced it to the absurd. Furthermore, and very unfortunately, Singer remains consistently dismissed as a ‘popularizer’ who can’t be taken seriously as an academic given how widely his work is read.
But when I actually look carefully and systematically at his work I see not only how consistent and even rigorous it often is, but also how much it common it has with Christian Ethics. Consider, for instance, the topic of abortion. Though Peter Singer is pro-choice for abortion and infanticide, and the Catholic position condemns the intentional killing the fetus and early embryo as intrinsically evil, the actual disagreement between the two on this very complex topic turns out to be very narrow. Both believe that public policy cannot retreat into a privacy-centered moral neutrality with regard to (1) the moral status of the fetus and (2) whether one can kill or refuse to sustain a fetus. Both also agree, assuming for the sake of argument that a fetus is a person, that no unintended negative effects of making abortion illegal would justify allowing for the legal killing of fetuses. Both reject the American Supreme Court abortion decision Roe v. Wade. Both agree (again, assuming a fetus is a person) that not only would it be morally wrong to kill a fetus, but that one has a moral duty to support a fetus for nine months with one’s body. Both reject the idea that viability is a morally significant dividing line. Both also see a strong logical connection between one’s view of abortion and one’s view of infanticide. In fact, it is my contention that the wide divergence in their ultimate conclusions comes from a very complex argument involving the distinction that Aristotle and Thomas made between “active” and “passive” potential. On every issue but that one, Peter Singer looks a lot like John Paul II on abortion.
Singer also criticizes Christianity for being speciesist, but he (along with, to be fair, many Christians) is largely unaware of how complex the tradition is on this topic. For instance, the traditional definition of a person is “an individual substance of a rational nature”—with no mention of biological species as morally significant. Indeed, the Christian tradition makes explicit room for non-human persons (angels and aliens are good examples) and even (in the past) for the concept of human non-persons (human beings who are “slaves by nature”, for instance). Furthermore, the Catechism of the Catholic Church insists that it is seriously morally wrong to needlessly cause non-human animals pain and suffering, and even PETA has used the words of Pope Benedict (now known as “the Green Pope” for his heroic ecological work) criticizing factory farming in their advertisements. This should not be a surprise to anyone who reads Genesis and learns that not only are non-human animals created “good” without any reference to human beings, but that God intended other animals to be our companions, not our food.
The most overwhelming case of all for overlap involves how each understands our duties to the poor. Singer broke on the academic scene with his 1972 article on Famine, Affluence and Morality, and continues to hammer away at the problem of poverty through his continued work (especially his recent book: The Life You Can Save) and personal giving. Modern-day Roman Catholic movements to aid the impoverished (led by the American Bishops via their poverty arm called Catholic Relief Services) are not only absolutely massive in scale and trend-setting among their peer organizations, but their roots go back to the very beginnings of Christianity. Indeed, though Jesus himself rarely speaks of Hell, when he does so it is almost always connected to a failure of one’s duties to the poor, and the early Christian Church largely served as the social welfare system of the ancient world. Singer himself built on precisely this point when, in the second edition of Practical Ethics, he suggested we give 10% of our resources to those in absolute poverty in part because this was the tithing percentage required by the social welfare mechanism of the age: the Catholic Church. In a shocking indictment of most of us, I suspect, both approaches insist that a selfish failure meet one’s duty to aid the global poor is seriously immoral behavior—akin to something like indirect homicide.
Those who are familiar with ethical theory are probably the most skeptical of conversation between Peter Singer and Christian Ethics—especially because Singer is utilitarian and the Church is a big fan of exceptionless moral norms. But even here the possibilities for overlap are striking and important. The Catholic Church has a teleological ethic which, yes, is ultimately directed toward union with God, but is proximately directed at the flourishing of the “universal common good.” Even exceptionless moral norms are teleological in nature given that they are at the service of this kind of flourishing. Furthermore, Singer is exploring a new kind of objectivity in his moral theory—even to the point where it is no longer clear that he will remain a preference utilitarian. Indeed, in his latest edition of Practical Ethics he admits that preference utilitarianism is at variance with his moral intuitions about replacement theory (especially of persons), the good of distant future persons, and whether the existence of persons at all is a morally good thing. Especially as Singer moves to include more objectivity into his theory and go beyond preference utilitarianism, he becomes an even better conversation partner for Christian Ethics.
Much more needs to be said to back up these ideas and arguments, of course, and I try to do just that in my new book Peter Singer and Christian Ethics: Beyond Polarization—just released this weekend in the United States by Cambridge University Press. (Available in both paperback and Kindle versions.) I’m certainly interested in any feedback about the book, so feel free to send me a note (either here or via e-mail: camosy@fordham.edu), or join the discussion on the book’s Facebook page. The book will also serve as the basis of an exchange/debate between Julian Savulescu and myself next Autumn, so if you are in or around Oxford October 17th-19th, come by and see us.
Charlie Camosy
Fordham University (webpage is here)
The cost of living and the cost of dying
X, a patient with reliably diagnosed PVS, lies in a hospital bed for years, fed via a nasogastric tube. He has not, and by definition never will have, any capacity for pain, pleasure or any sort of sensation. Devoted family members come each day to sit by his bedside, but he has no idea that they are devoted, or that they exist.
It is expensive to keep him alive. He occupies a bed and consumes a good deal of nursing time.
The NHS Trust responsible for his care has a limited budget. It decides that the money spent on maintaining his merely biological life would be better spent on dialysis machines. It can, and does, justify its decision in purely utilitarian terms. It writes in the minutes of the relevant committee meeting: ‘For the money we spend keeping X alive, we can save the lives of 10 kidney patients, each of whom will have a good quality of life for many years. The QALY arithmetic makes X’s continued existence nonsensical.’ Continue reading
Fellow-Citizens, Foreigners, and Statistical Lives
Like many in the UK, I was gripped last week by the reports from Wales about the search for four trapped miners, and saddened to hear of their deaths. Readers outside the UK perhaps heard nothing, or very little, about this story, thought it dominated the news here. One important reason for that, of course, is that most of us care much more about fellow-citizens than foreigners, and about identifiable people than merely ‘statistical lives’.
That we care is a mere fact. But since the days of David Hume many philosophers have claimed that we can take moral sentiments of this kind as the foundation for our ethics, and indeed that such sentiments can be the only such foundation. So our attitudes might justify our spending much more on saving the lives of identifiable fellow citizens rather than those of foreigners or unidentified people in the future.
Imagine some group of beings like us, except that these beings cared much more about people born on Tuesdays than those born on other days. (Their so caring is a brute fact, and does not rest on, say, any religious or superstitious assumptions about Tuesdays.) Even sentimentalists about ethics will probably wish to claim that there is something dubious about this differential attitude. But that raises the question whether we should say the same about a preference for identifiable fellow-citizens.
The property of being an identifiable fellow-citizen is not clearly morally irrelevant in the way that being born on Tuesday is. Indeed, it seems similar in important ways to the property of being one’s child, and most of us think that this is a property of great moral relevance when we are deciding how to spend our scarce resources. But there is of course one big dissimilarity: in most cases, a parent has deep personal relations with a child, and these could be taken to ground a parent’s giving greater weight to the interests of her child over those of others. The fact that such a relationship is lacking in the case of identifiable fellow-citizens suggests that the property of being an identifiable fellow-citizen may well be morally as irrelevant as that of being born on a Tuesday.
Should we, then, try to avoid our bias towards identifiable fellow-citizens? In the utilitarian tradition, some radical thinkers have occasionally argued that we should seek complete impartiality, not giving priority even to the interests of our own children over the interests of others. It has plausibly been said in response that, though from the utilitarian point of view the priority we do give is almost certainly far too great, trying to be completely impartial – given our psychology, evolutionary history, and so on – would be quite likely to be self-defeating.
I think a similar argument can be mounted in defence of the special concern we have for identifiable fellow-citizens. So is everything all right as it is? Far from it. What we must do is build upon that care and concern and, as Peter Singer puts it, ‘extend the circle’ to include foreigners and statistical lives. We do not have to choose (other than in bizarre philosophical examples) between saving people from mines and spending more on helping foreigners or saving statistical lives. We can, and should, do all of these things.
Autonomy: amorphous or just impossible?
By Charles Foster
I have just finished writing a book about dignity in bioethics. Much of it was a defence against the allegation that dignity is hopelessly amorphous; feel-good philosophical window-dressing; the name we give to whatever principle gives us the answer to a bioethical conundrum that we think is right.
This allegation usually comes from the thoroughgoing autonomists – people who think that autonomy is the only principle we need. There aren’t many of them in academic ethics, but there are lots of them in the ranks of the professional guideline drafters, (look, for instance, at the GMC’s guidelines on consenting patients) and so they have an unhealthy influence on the zeitgeist.
The allegation is ironic. The idea of autonomy is hardly less amorphous. To give it any sort of backbone you have to adopt an icy, unattractive, Millian, absolutist version of autonomy. I suspect that the widespread adoption of this account is a consequence not of a reasoned conviction that this version is correct, but of a need, rooted in cognitive dissonance, to maintain faith with the fundamentalist notions that there is a single principle in bioethics, and that that principle must keep us safe from the well-documented evils of paternalism. Autonomy-worship is primarily a reaction against paternalism. Reaction is not a good way to philosophise. Continue reading
The patient vanishes
by Dominic Wilkinson
If a patient’s family refuse to allow withdrawal of breathing machines should doctors provide long-term support in an intensive care unit for a patient who is clinically brain dead? Should doctors provide heart-lung bypass (ECMO) for a child with anencephaly? Should doctors perform a tracheostomy and provide a long-term breathing machine for a patient in a documented persistent vegetative state? Continue reading
On rebuilding Noah’s Ark and drinking old Burgundy
By Charles Foster
In North Kentucky, forty miles from its Creation Museum (where you can see Eve riding on a triceratops and videos in which weeping girls blame their moral degeneracy on their failure to believe in the verbal inerrancy of Scripture), ‘Answers in Genesis’ is building a full-size replica of Noah’s Ark. It’s an expensive business. The total bill will be $24.5 million, of which $845,910 has been raised to date. ‘Partner with us in this amazing outreach by sponsoring a peg, plank or beam…’, pleads the website. A peg will cost you $100, a plank $1000, and a beam $5000. But if you buy a beam, you’ll also get a model of the Ark personally signed by Ken Ham, the President of ‘Answers in Genesis’. Continue reading
Is it the thought that counts?
There was a jolly fire in the fireplace. The snow was falling outside the windows, to the delight of children and despair of transport planners. Aristotle sipped on the mulled wine, watching while Kant meticulously wrapped another jar of homemade mustard.
“Dear Immanuel, are you going to give all your friends mustard?”
“Everybody except Georg. He likes to mix it with ketchup; he says it makes a great synthesis. I don’t care much for that idea and I would hate to see it spread. He will get a writing style guide instead.”
“I guess for you it is the thought that counts, when it comes to Christmas presents.”
Is Discounted Therapy Fair?
by David Shipley
A friend of mine is a therapist. She faced the following dilemma.
My friend specialises in enhancing fertility and was approached by a prospective patient who wished to become pregnant but could not afford to pay the standard fee of £45 per treatment as she was on benefits. The woman was aged 40 and had no children. What should my friend the therapist have done?
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