Rationing/ Resource Allocation

Should exceptional people receive exceptional medical treatment?

There are approximately 150,000 human deaths each day around the world. Most of those deaths pass without much notice, yet in the last ten days one death has received enormous, perhaps unprecedented, attention. The death and funeral of Nelson Mandela have been accompanied by countless pages of newsprint and hours of radio and television coverage. Much has been made of what was, by any account, an extraordinary life. There has been less attention, though, on Mandela’s last months and days. One uncomfortable question has not been asked. Was it ethical for this exceptional individual to receive treatment that would be denied to almost everyone else? Continue reading

Oxford Martin School Seminar: Robert Rogers and Paul Van Lange on Social Dilemmas

In a joint event on November 15th, Prof Robert Rogers and Prof Paul van Lange presented their scientific work related to social dilemmas.

Social dilemmas are situations in which private interests conflict with collective interests. This means that people facing a social dilemma have to decide whether to prioritise either their own short-term interests or the long-term interests of a group. Many real-life situations are social dilemmas. For example, as individuals we would (economically) benefit from using public motorways without paying taxes to maintain them, but if all acted according to their self-interest, no motorways would be built and the whole society would be worse off. In the academic literature, the three types of social dilemmas that are discussed most prominently are the Prisoner’s Dilemma, the Public Goods Dilemma, and the Tragedy of the Commons. All three types have been modelled as experimental games, and research from different fields like psychology, neuroscience, and behavioural economics uses these games to tackle the question of under which conditions people are willing to cooperate with one another in social dilemmas, instead of maximising their self-interest. The ultimate goal of such research is to be able to give recommendations about how to solve social dilemmas in society.

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Keeping pace?

If you receive an implanted pacemaker for your heart, does it become your property? When it is no longer any use to you (because you have died), do you have to give it back?

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Winchester Lectures: Kamm and Permissibility

In her first Winchester Lecture, ‘Who Turned the Trolley?’, presented in Oxford on 21 October, Frances Kamm discussed some of the recent views of Judith Thomson on so-called trolley casesContinue reading

Pay politicians much more

The Independent Parliamentary Standards Authority (Ipsa) just proposed a rise of MPs’ annual salary to £74,000, from the current £66,396.

This is a stupid idea. The MPs should be paid a lot more. In the private sector, and even in most NGOs, it’s well understood that if you want to attract high quality workers, you need to pay them higher salaries.

The UK government budget in 2012 was £682 billion. The UK civil service employs 6 million people. There are 650 MPs in total. So a crude estimate is that, on average, each MP controls a budget of over a billion pounds and directs nearly ten thousand people (of which a significant portion are heavily armed). They also vote on regulations that affect the whole country. Only in public service would it seem sensible to pay people with that kind of responsibility, that kind of salary.

Some might feel that increasing MPs salary may reduce their commitment to public service, or cut them off from the concerns of the people they serve. But £66,396 a year already cuts them off from most people, and I haven’t seen any evidence that their current lower salary is causing an irresistible stampede of public minded individuals to swarm parliament.

Pushethics: How to get a lung for your child

By Julian Savulescu & Brian D. Earp

[updated version]

Sarah Murnaghan is a 10-year-old from Pennsylvania. Suffering from cystic fibrosis, she was likely to die without a lung transplant. Her situation was deteriorating. But because of a rule that says that children under the age of 12 have the lowest priority for adult donor lungs, Sarah would have to wait for another child’s lungs to become available, a much rarer occurrence.

Sarah’s parents sprang into action. They got the attention of members of congress and the media. They shared Sarah’s story on social networking sites, showing pictures of their daughter in the hospital bed. They said that the “Under 12” rule was discriminatory against children, and got a federal judge to agree. So, with the help of a court order temporarily preventing the enforcement of the Under 12 rule, Sarah got a second chance at life. An adult lung match became available, and Sarah is now recovering from transplant surgery.

It’s a story with a happy ending—depending upon how you tell it. Certainly the news is good for Sarah. Yet as Sarah’s mother acknowledged in a post on Facebook, “We … know our good news is another family’s tragedy.”

But who are those families? What are their stories? What are the names of those who will die—or who have already died—without a lung transplant of their own?

What this case illustrates is something we might call “pushethics” – a way of pushing one’s own story, or that of one’s family member, into the moral spotlight. Since ordinary human beings—from news anchors to congressmen to federal judges—are more likely to feel empathy for known individuals with compelling narratives of suffering, they can become motivated to bend the rules in favor of those specific individuals whose stories best capture their attention.

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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)

www.catholicmoraltheology.com

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

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