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2012

Psychopaths should not be punished

Lincoln Frias – member of the International Neuroethics Society, Post-Doctoral Fellow at the Federal University of Minas Gerais (CAPES, NEPC-UFMG), Brazil. 

Please focus: now, imagine a cute little child with her curious big eyes, her surprising funny remarks, and out of blue kindness. But now imagine her being kicked in the head to death, blood all over the place, despite her helplessness and her painful screams. If you really imagined this scenario, you probably experienced a revulsive feeling in your guts, tension in the jaw and maybe even a bitter taste in your mouth. Now, change the perspective: now it is you who is kicking her, causing her teeth to break, and all the blood coming out of her little body while she cries with a squeaky voice. This new vision probably brought even more aversive feelings, something similar to disgust, and it is possible that you are frowning right now, maybe even considering stop reading. To make things worse, imagine that your mother saw you doing that. This elicits a powerful feeling composed by anxiety, horror and intrusive thoughts of guilt and inadequacy, leaving you in a submissive state of mind.Read More »Psychopaths should not be punished

The Liverpool Care Pathway in the News: Even by the Mail’s Standards, this is Low

(Cross-posted from the Journal of Medical Ethics blog)

The Liverpool Care Pathway provides a rubric for managing the care terminally ill as they approach death.  A helpful pamphlet explaining what it is and what it does is available here.  Ideally, I’d quote the lot; but for the sake of efficiency, I’ll make do with an edited quotation:

What is the Liverpool Care Pathway (LCP)?

The LCP is a pathway/ document that outlines this best care, irrespective of your relative/ friend’s diagnosis or whether they are dying at home, in hospital, in a hospice or a care home.

Medication/ treatment

Medication will be reviewed and any medication that is not helpful at this time may be stopped and new medication may be prescribed so that if a symptom should occur there would be no delay in responding.

It may not be possible to give medication by mouth at this time, so medication may be given by injection or sometimes if needed, by a continuous infusion by a small pump called a Syringe Driver, which will be tailored to individual needs.

It may not be appropriate to continue some tests at this time; these may include blood tests or blood pressure and temperature monitoring.

The staff should talk to you about maintaining your relative’s/ friend’s comfort; this should include discussion regarding position in bed, use of a special mattress and regular mouth care. You may want to be involved in elements of care at this time.

Diminished need for food and drink

Initially, as weakness develops, the effort of eating and drinking may simply have become too much and at this time help with feeding might be appreciated.

Your relative/friend will be supported to take food and fluids by mouth for as long as possible.

When someone stops eating and drinking it can be hard to accept, even when we know they are dying. It may be a physical sign that they are not going to get better. Your relative/friend may neither want or need food and/or drink and decisions about the use of artificial fluids (a drip) will be made in the best interests of your relative/friends for this moment in time. This decision will be explained to you and reviewed regularly.

This can be paraphrased further: medically futile treatment may be withdrawn; the main criterion for administering drugs will be symptom alleviation rather than life extension; some testing may be discontinued; it’s possible that there’ll come a point when artificial nutrition and hydration are no longer in the patient’s best interest, and they might be withdrawn if and when that point is reached.

None of this is particularly cheery; but death rarely is. Read More »The Liverpool Care Pathway in the News: Even by the Mail’s Standards, this is Low

Tony Coady on Religion in the Political Sphere: Part 2, Deliberative Restraint

In his second Leverhulme Lecture on November 22nd, Professor Tony Coady focused on the issues underlying the common assertion that we ought to exclude religious arguments from deliberations in the political sphere of liberal democratic societies. Coady traces this idea to arguments by Audi and Rawls on ‘secular reasons’ and ‘public reasons’ respectively, which suggest that the sorts of reasons and arguments made in public policy decision-making ought to be secular or neutral, in the sense of being accessible to all reasonable citizens, on the basis of mutual respect.

However, Coady raises a number of questions that demonstrate the problematic nature of this concept of ‘deliberative restraint.’ Perhaps most fundamentally, how can we in practice distinguish between religious reasons and non-religious reasons? Must an argument cite God in order to be considered a ‘religious argument’ or merely appear to be influenced by religious concepts? The later would probably exclude arguments from the natural law tradition or those based on human dignity, which in fact look quite similar to non-religious arguments. Furthermore, how can we know whether an individual accepts a given reason because it comes from a religious source or because it appeals to him independently? Finally, why do we think that mutual respect requires the articulation of only non-religious reasons in the public sphere? It seems religious individuals can demonstrate mutual respect for fellow citizens in many other ways, through respect for procedural and constitutional practices for instance, without excluding religious arguments.Read More »Tony Coady on Religion in the Political Sphere: Part 2, Deliberative Restraint

The best ethical ideas of the year?

Foreign Policy magazine recently released its annual list of the top 100 global thinkers of the year.  The members included a wide range of activists, scientists, politicians, academics and businesspeople, but what most interested me was a sidebar feature.  The feature consists of a half-dozen questions that were posed to each person on the list, including what was the best idea they heard this year.  This made me wonder, more specifically, what are the best ethical ideas of recent years?  There is often scepticism about the possibility of real moral progress, but are there some standout ideas that point to real forward movement in the moral realm?  Read More »The best ethical ideas of the year?

Don’t tax the fat!

by Rebecca Roache

Dr Philip Lee, Conservative MP for Bracknell and a practising GP, today suggested that people whose lifestyle choices lead to medical problems should have to contribute towards their healthcare costs. He apparently highlighted type 2 diabetes – which can be brought on by an unhealthy diet, being overweight, and lack of exercise, although some people are genetically disposed to it – and is quoted in the Huffington Post as saying, ‘If you want to have doughnuts for breakfast, lunch and dinner, fine, but there’s a cost’.

At first glance, the idea that those who lead unhealthy lifestyles should bear the burden of their own resulting health problems seems fair. But there are serious problems with this idea. Let us consider two of them.Read More »Don’t tax the fat!

Tony Coady on Religion in the Political Sphere: Part 1

In the last twenty years, there has been great interest in the dangers religion presents to liberal democracies, in particular as a result of terrorist attacks, and the political success of the religious right in the United States. Religion is difficult to define and its appropriate role in the public domain is frequently disputed. Violence is frequently attributed to religious absolutism however, in the first of the annual 2012 Leverhulme Lecture Series entitled ‘Religion and Politics’, Professor Tony Coady discusses why this sweeping claim can ultimately be rejected. The first lecture occurred on November 15 (you can listen to the podcast here), with two further lectures on November 22 and 29.

Read More »Tony Coady on Religion in the Political Sphere: Part 1

Treating ADHD may reduce criminality

Pharmaceutical treatment of attention deficit-hyperactivity disorder (ADHD) is associated with reduced criminality according to a study published yesterday in the New England Journal of Medicine. The study of over 25,000 Swedish adults with the disorder found that men undergoing pharmaceutical treatments had a 51% chance of committing at least one crime in a 4-year period compared to 63% for those not in treatment. The risk of criminality for women with ADHD was 25% for those taking medication, and 31% for those not in treatment. It’s possible, of course, that the reduction in criminality associated with treatment was due not to the treatment itself, but to other factors, such as desire to improve behaviour, which could have both motivated treatment and reduced criminality. However, even when the investigators adjusted for likely confounders, they found that treatment was associated with significantly reduced criminal offending. Thus, their findings are at least suggestive of a causal relationship between medication and reduced crime.

It will be interesting to see how such a relationship, if it can be further supported, will be viewed by the general public and medical profession. Will it be seen as strengthening or weakening the case for ADHD treatment?

Read More »Treating ADHD may reduce criminality

Armstrong the Good Giraffe and the Moral Value of Effort

Let me introduce you to Armstrong the Good Giraffe. Appearing in the news last week due to his goodness (and probably his giraffeness), Armstrong is a man in a costume who goes around voluntarily doing good deeds. Throwing himself into helpful tasks – such as providing free water and bananas to runners, picking up litter from beaches, and cleaning cages at cats and dogs homes – Armstrong clocks up an impressive number of non-trivial good deeds. Most impressively of all, he reportedly enjoys it.

He comments that doing these good deeds makes him feel ‘happy’ and ‘cheery’ and that this is why he does them. At first glance, this may make us think he is particularly remarkable: he not only goes about investing more time and energy into being helpful than most would reasonably expect of a person, but he also relishes it. But, I want to ask, are people like Armstrong really at the top of the moral ranks? Is there not something about effort – about having to try – that we value?Read More »Armstrong the Good Giraffe and the Moral Value of Effort