Announcement: “Brave New Love” – peer commentaries due October 7
Dear Practical Ethics readers,
The paper, “Brave new love: the threat of high-tech ‘conversion’ therapy and the bio-oppression of sexual minorities” by Brian D. Earp, Anders Sandberg, and Julian Savulescu has been accepted for publication in the American Journal of Bioethics: Neuroscience. Proposals for open peer commentaries are due this Monday October 7th.
The article may be accessed here, or at the following link: http://editorial.bioethics.net. Be sure to select AJOB:Neuroscience from the drop-down menu of journals. Here is an abstract of the argument:
Abstract: Our understanding of the neurochemical bases of human love and attachment, as well as of the genetic, epigenetic, hormonal, and experiential factors that conspire to shape an individual’s sexual orientation, is increasing exponentially. This research raises the vexing possibility that we may one day be equipped to modify such variables directly, allowing for the creation of “high-tech” conversion therapies or other suspect interventions. In this paper, we discuss the ethics surrounding such a possibility, and call for the development of legal and procedural safeguards for protecting vulnerable children from the application of such technology. We also consider the more difficult case of voluntary, adult “conversion” and argue that in rare cases, such attempts might be permissible under strict conditions.
Open Peer Commentary articles are typically between 500-1500 words and contain no more than 10 references. A guide to writing an Open Peer Commentary is available under the Resources section “Instructions and Forms” at http://editorial.bioethics.net. AJOB:Neuroscience asks that by Monday, October 7, 2013 you submit a short summary of your proposed Open Peer Commentary (no more than 1-2 paragraphs). Please submit your proposal online via the AJOB:Neuroscience Editorial site, following the instructions provided there. They ask that you do not prepare a full commentary yet. Once they have evaluated your proposal, they will contact you via email to let you know whether or not they were able to include you on the final list of those to be asked to submit an Open Peer Commentary.
You will then have until Friday, October 25, 2013 to submit your full Open Peer Commentary.
Several days ago, a middle-aged man named Nam Young-ho was shot to death while crossing the Imjin River, which divides North and South Korea. Such stories are sadly not uncommon, but the particular facts make this case quite unusual: Nam was a South Korean trying to enter the North, and was shot by South Korean soldiers. This killing received relatively little attention in the news (perhaps in part because it occurred on the same day as a larger tragedy in the US), but it’s hard to view it as anything other than a terrible injustice. I’ve been racking my brains, and I can’t figure out a plausible justification. From news reports, it sounds like the South Korean military is standing by the soldiers’ actions and no prosecution is forthcoming. This makes the killing all the more disturbing – it was not the result of poor training or accident, but a deliberate and pernicious policy to use lethal force on anyone attempting to cross into the North. Continue reading
Stop killer robots now, UN asks: the UN special rapporteur on extrajudicial, summary or arbitrary executions Christof Heyns has delivered a report about Lethal Autonomous Robots arguing that there should be a moratorium on the development of autonomous killing machines, at least until we can figure out the ethical and legal issues. He notes that LARs raise far-reaching concerns about the protection of life during war and peace, including whether they can comply with humanitarian and human rights law, how to device legal accountability, and “because robots should not have the power of life and death over human beings.”
Many of these issues have been discussed on this blog and elsewhere, but it is a nice comprehensive review of a number of issues brought up by the new technology. And while the machines do not yet have fully autonomous capabilities the distance to them is chillingly short: dismissing the issue as science fiction is myopic, especially given the slowness of actually reaching legal agreements. However, does it make sense to say that robots should not have the power of life and death over human beings?
Cultural bias and the evaluation of medical evidence: An update on the AAP
Since my article on the American Academy of Pediatrics’ recent change in policy regarding infant male circumcision was posted back in August of 2012, some interesting developments have come about. Two major critiques of the AAP documents were published in leading international journals, one in the Journal of Medical Ethics, and a second in the AAP’s very own Pediatrics. In the second of these, 38 distinguished pediatricians, pediatric surgeons, urologists, medical ethicists, and heads of hospital boards and children’s health societies throughout Europe and Canada argued that there is: “Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision.”
The AAP took the time to respond to this possibility in a formal reply, also published in Pediatrics earlier this year. Rather than thoughtfully addressing the specific charge of cultural bias, however, the AAP elected to boomerang the criticism, implying that their critics were themselves biased, only against circumcision. To address this interesting allegation, I have updated my original blog post. Interested readers can click here to see my analysis.
Finally, please note that articles from the Journal of Medical Ethics special issue on circumcision are (at long last) beginning to appear online. The print issue will follow shortly. Also be sure to see this recent critique of the AAP in a thoughtful book by JME contributor and medical historian Dr. Robert Darby, entitled: “The Sorcerer’s Apprentice: Why Can’t the US Stop Circumcising Boys?”
By Brian Earp
This is a rough draft of a lecture delivered on October 1st, 2012, at the 12th Annual International Symposium on Law, Genital Autonomy, and Children’s Rights (Helsinki, Finland). It will appear in a substantially revised form—as a completed paper—at a later date. If you quote or use any part of this post, please include the following citation and notice:
Earp, B. D. (forthcoming, pre-publication draft). Assessing a religious practice from secular-ethical grounds: Competing metaphysics in the circumcision debate, and a note about respect. To appear in G. C. Denniston, F. M. Hodges, & M. F. Milos (Eds.), Proceedings of the 12th Annual International Symposium on Law, Genital Autonomy, and Children’s Rights, published by Springer. * Note, this is not the finished version of this document, and changes may be made before final publication.
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My name is Brian Earp; I am a Research Associate in the philosophy department at the University of Oxford, and I conduct research in practical ethics and medical ethics, among some other topics. As you saw from the program, my topic today is the ethics of infant male circumcision—specifically as it is performed for religious reasons.
UPDATED as of 27 May, 2013. See the bottom of the post.
The AAP report on circumcision: Bad science + bad ethics = bad medicine
For the first time in over a decade, the American Academy of Pediatrics (AAP) has revised its policy position on infant male circumcision. They now say that the probabilistic health benefits conferred by the procedure just slightly outweigh the known risks and harms. Not enough to come right out and positively recommend circumcision (as some media outlets are erroneously reporting), but just enough to suggest that whenever it is performed—for cultural or religious reasons, or sheer parental preference, as the case may be—it should be covered by government health insurance.
That turns out to be a very fine line to dance on. But fear not: the AAP policy committee comes equipped with tap shoes tightly-laced, and its self-appointed members have shown themselves to be hoofers of the nimblest kind. Their position statement is full of equivocations, hedging, and uncertainty; and the longer report upon which it is based is replete with non-sequiturs, self-contradiction, and blatant cherry-picking of essential evidence.
Tony Nicklinson is 58, and suffers from locked-in syndrome. His mind is as sharp as it ever was, but for the last seven years, as the result of a stroke, he has been entirely physically dependent on others, able to move only his eyes and eyelids. Just recently, his condition has worsened, and he is in constant pain and discomfort. As seems entirely reasonable, he wants to die. But of course he will need assistance to do so, and anyone who helps him will run the risk of prosecution for murder.
Nicklinson, along with another man in a similar position, recently applied to the High Court. Their lawyers had two main arguments. The first was that the ‘necessity’ defence for murder in the common law should be extended to cover cases such as Nicklinson’s, since forcing him to continue to live is not a reasonable option. They argued also that taking that option would violate his right under article 8 of the European Convention, contrary to s1 and 6 of the Human Rights Act 1998. That article provides that:
1. Everyone has the right to respect for his private and family life, his home and his correspondence.
2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.
Nicklinson’s lawyers argued that forcing him to continue to live violates his autonomy and dignity and is therefore a violation of Article 8.
The High Court decided (see paras. 75-87) to allow Nicklinson’s torment to continue, primarily because it believed that, as was claimed in the earlier cases of Bland and Inglis, it is for Parliament to decide whether to change the law on euthanasia: the issues are too complicated and opinions too varied for the court to be competent to make a decision; any change would be controversial and so a matter for Parliament; and it might also lead to bad consequences, such as pressure’s being put on the vulnerable to end their lives.
These seem to me somewhat weak arguments. The issues are in fact quite clear, and it is not the job of a court to seek to enforce any public opinion, even majority opinion (if it were, the death penalty would have to be reintroduced for child-killers). It is true that any change would be controversial, and certainly it is an issue that Parliament should discuss (and surely would have done, were Nicklinson’s request to have been granted). But the job of the court was to decide whether Nicklinson’s human rights are being violated and to let Parliament deal with the wider issues. Finally, the judgement says nothing about how the Justices assessed the consequences of acceding to Nicklinson’s request. Certainly, leaving things as they are will lead to some very bad consequences, for Nicklinson and others in his position. Nor do courts usually take what are almost certainly very small risks into account when deciding matters of law. It is not the role of a court to consider such consequentialist factors when making its decisions. That is a matter for those making the law, not those executing it, as H.L.A. Hart and John Rawls demonstrated clearly many years ago. Of course, were voluntary euthanasia to be made legal, there would be need for a proper procedure to ensure informed consent. And it would be be the role of Parliament to develop such a procedure, once the Court’s decision had been passed down.
Para. 19 of the judgement says:
The common law is declared by the courts, which have the power to develop it. Section 6(1) makes it unlawful for a public authority to act in a way which is incompatible with a Convention right.
Since it is so plausible that there is a serious violation of human rights in forcing a citizen to undergo serious pain and discomfort, perhaps for many years, on the basis of an unsubstantiated claim about minor risk to others which could anyway be dealt with by Parliament, it seems likewise plausible that the High Court has acted unlawfully in this case. What makes things even worse is that its decision provides yet another precedent on which further inhumane and unjust decisions may be based in the future.
VIDEO DEBATE LINKED TO BELOW – ARI KOHEN AND I DISCUSS THE ETHICS OF RELIGIOUSLY-MOTIVATED CIRCUMCISION
Ari Kohen doesn’t like my recent post about circumcision—the one in which I argue that it is unethical to remove healthy tissue from another person’s body without first getting his permission. I then go on to say that religious justifications cannot override this basic principle. Here’s that post again.
Ari is a professor of political theory and human rights at the University of Nebraska at Lincoln. In this blog post, he takes me to task for failing to take seriously the religious commitments of Jews in framing my arguments. And while he gets some things wrong about, for example, the relevance of “sexually-sensitive tissue” to my overall reasoning; and while he misses the point of my bringing up female genital cutting entirely (I’ve since edited my post to clear up any lingering ambiguity) – he is probably right that my approach to debating this issue is unlikely to win me any converts from within the ranks of the religious.
On the ethics of non-therapeutic circumcision of minors, with a pre-script on the law
By Brian D. Earp (Follow Brian on Twitter by clicking here.)
PRE-SCRIPT AS OF 25 SEPTEMBER 2012: The following blog post includes material from an informal article I wrote many years ago, in high school, for a college essay competition. I would like to think that my views have gained some nuance since that time, and indeed with increasing speed, as I have researched the topic in more detail over the past several months–specifically during the period of a little over a year since the blog post first appeared online. Since quite a few (truthfully: many thousands of) people have come across my writings in this area, and since I am now being asked to speak about circumcision ethics in more formal academic company, I feel it is necessary to bring up some of the ways in which my thinking has evolved over those many months.
The most significant evolution is away from my original emphasis on banning circumcision. I do maintain that it should be considered morally questionable to remove healthy tissue from another person’s genitals without asking that person’s permission; but I also recognize that bringing in the heavy hand of the law to stamp out morally questionable practices is not always the best idea. It is a long road indeed from getting one’s ethical principles in order, to determining which social and legal changes might most sensibly and effectively bring about the outcome one hopes for, with minimal collateral damage incurred along the way. Until enough hearts and minds are shifted on this issue, any strong-armed ban would be a mistake.
In the long term, however, I think the moral goal remains: that each male newborn should have the same legal protections enjoyed by his sisters, designed to preserve his sex organs in their healthy, natural form until such time as he is mentally competent to make a decision about altering them, surgically or otherwise.
The project for the meantime is to work on hearts and minds.
I am grateful to the many hundreds of individuals who have left thoughtful comments on my sequence of posts on the ethics of circumcision, and I look forward to developing my arguments in ever more sophisticated ways in the coming months and years as this important debate continues. I am especially grateful to those of my interlocutors who have disagreed with me on various points, but who have done so in a thoughtful and productive manner. May we all aim at mutual understanding, so that the best arguments may emerge from both sides, and so that the underlying points of genuine disagreement may be most clearly identified. — B.D.E.
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Routine neonatal circumcision in boys is unethical, unnecessary, and should be made illegal in the United States. Or so I argue in this post.
Yet lawmakers in California, it is now being reported, have introduced a bill with the opposite end in mind. They wish to ban legislation that could forbid circumcision-without-consent. Read that sentence again. What could be going on?