Alberto Giubilini

Medical assistance in dying: what are we talking about?

Alberto Giubilini

Oxford Uehiro Centre for Practical Ethics

 

Medical assistance in dying  – or “MAiD”,  to use the somehow infelicitous acronym – is likely to be a central topic in bioethics this year. That might not be true of bioethics as an academic field, where MAiD has been widely discussed over the past 40 years. But it is likely true of bioethics as a wider societal and political area of discussion. There are two reasons to think this.  First, the topic has attracted a lot of attention the last year, especially with “slippery slope” concerns around Canada’s policies. Second, MAiD has recently been in the news in the UK, where national elections will take place in 2024.  It is not hard to imagine it will feature in the heated political polarization that always accompanies election campaigns.

Little can be done to prevent that kind of polarization. However, some clarity about the different issues at stake might help to steer clear of unnecessary quarrels and focus on the relevant points of disagreement. Without claiming to be exhaustive, here I want to try to take some step in that direction. Continue reading

Cross-post: Fairness and Freedom in Public Health Policy – On the need for a Humanities-based approach to public health policy

by Alberto Giubilini

Originally posted on the Oxford Medical Humanities website

 

This conference explored two distinct but related issues in public health. One is the extent to which individual freedom could be restricted in the pursuit of public health goals. The other is whose freedom could be restricted. That is, freedom and fairness in public health policy.

The tension between freedom and public goods pervades our lives. Public goods such as functioning healthcare systems or environmental resources depend on actions we collectively take. Collective actions raise issues about whether and how each of us ought to contribute to them by giving up some of our own personal interests. Pandemic policies simply made that tension more salient. However, our living together is a constant negotiation of the boundaries between us as individuals and us as members of communities, often (but not necessarily) through the mediation of Governmental restrictions.

Public goods cost freedom or, if you prefer, freedoms can erode public goods. Continue reading

The Language of Freedom in Public Health: the Case of the Smoking Ban

Alberto Giubilini

 

Enough manipulation of the definition of man, and freedom can be made to mean whatever the manipulator wishes

(Isaiah Berlin, Two Concepts of Liberty, 1958)

 

The UK Prime Minister has announced his plan to ban the sale of tobacco products to young generations in England. Smoking will be phased out by progressively increasing the legal age for buying tobacco every year. Assuming the plan is effective and does not simply open the door to a black market, young generations in England will be prevented from starting to smoke. According to the Prime Minister, “this measure will be the single biggest intervention in public health in a generation.”

It is hardly necessary to provide figures about the risks of smoking. Lighting up that first cigarette is one of the most unhealthy choices one could ever make. In fact, it is a decision many regret later in life. The question is: to what extent is a government justified in preventing competent individuals from making unhealthy decisions for themselves?

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It is not about AI, it is about humans

Written by Alberto Giubilini

We might be forgiven for asking so frequently these days whether we should trust artificial intelligence. Too much has been written about the promises and perils of ChatGPT to escape the question. Upon reading both enthusiastic and concerned accounts of it, there seems to be very little the software cannot do. It can provide or fabricate a huge amount of information in the blink on an eye, reinterpret it and organize it into essays that seem written by humans, produce different forms of art (from figurative art to music, poetry, and so on) virtually indistinguishable from human-made art, and so much more.

It seems fair to ask how we can trust AI not to fabricate evidence, plagiarize, defame, serve anti-democratic political ends, violate privacy, and so on.

One possible answer is that we cannot. This could be true in two senses.

In a first sense, we cannot trust AI because it is not reliable. It gets things wrong too often, there is no way to figure out if it is wrong without doing ourselves the kind of research that the software was supposed to do for us, and it could be used in unethical ways. On this view, the right attitude towards AI is one of cautious distrust. What it does might well be impressive, but not reliable epistemically or ethically.

In a second sense, we cannot trust AI for the same reason why we cannot distrust it, either. Quite simply, trust (and distrust) is not the kind of attitude we can have towards tools. Unlike humans, tools are just means to our ends. They can be more or less reliable, but not more or less trustworthy. In order to trust, we need to have certain dispositions – or ‘reactive attitudes’, to use some philosophical jargon – that can only be appropriately directed at humans. According to Richard Holton’s account of ‘trust’, for instance, trust requires the readiness to feel betrayed by the individual you trust[1]. Or perhaps we can talk, less emphatically, of readiness to feel let down.

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Dobbs v Jackson Women’s Health Organization and doctors’ conscientious commitment to provide abortion

Alberto Giubilini, University of Oxford 

Udo Schuklenk, Queen’s University

Francesca Minerva, University of Milan 

Julian Savulescu, National University of Singapore and University of Oxford

(reposted from the Journal of Medical Ethics Blog )

The reversal of the 1973 Roe v Wade ruling by the US Supreme Court in the 2022 Dobbs v. Jackson Women’s Health Organization removed the Constitutional protection of women’s right to access abortion services in the US. This decision has resulted in renewed interest in the morality of conscientious commitment by health care professionals to provide abortion care.

Typically, ethical debates on conscience in health care revolve around the morality of doctors refusing to provide professional services on idiosyncratic personal conscience claims. Here the issue is different in that conscientious doctors, motivated by a commitment to professional values, might want to provide services that are arguably in their patients’ best interest, but that are illegal.

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The Football World Cup in Qatar

 

By Alberto Giubilini

 

The forthcoming World Cup in Qatar is perhaps the most controversial in football history.  Qatari social, religious, and legal norms clash with values that many people from other parts of the world hold dear.  For example, things like extramarital sex, same-sex behaviour, and importation of religious books are illegal in Qatar. A Qatari ambassador for the World Cup said that homosexuality is a ‘damage of the mind’ and a ‘spiritual harm’. He added that people going to Qatar will have to accept their rules.

This flies in the face of the fact that many players, commentators, and other stakeholders who will go to Qatar have been openly condemning Qatari social, religious, and legal norms in many ways. For example, Australian footballers have released a video condemning human rights violations in Qatar, including the treatment of migrant workers. German defender Leon Goretzcka said that by displaying messages against Qatari norms players want to “set an example for the values we want to stand for”. Is this hypocritical?

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Abortion, Democracy, and Erring on the Side of Freedom

by Alberto Giubilini

(crosspost: this article appeared with a different title in iaiNews)

The leaked draft opinion by Supreme Court Justice’ Samuel Alito foreshadows the overturn of the 1973 Roe vs Wade ruling. Roe vs Wade grounded women’s (limited) right to abortion in the US in the 14th Amendment of the US Constitution and its implied right to privacy. Acknowledging the pervasive disagreement over the morality of abortion, the Supreme Court has now decided to “return the power to weigh those arguments to the people and their elected representatives”.

In this way, the Supreme Court is in fact democratizing the legal availability abortion. Which raises the ethical question about whether the legal availability of abortion should be a matter of democratic procedure, as opposed to a constitutional matter around fundamental rights. I side with the latter view. I do not think a decision over women’s right to abortion should be a matter of democratic procedure such as a State election or a referendum. And I am going to provide reasons for why I think people on either side of the abortion debate can share my view, assuming they accept some fundamental tenets of liberal democracy.

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What is a party?

By Alberto Giubilini

 

There seems to be some confusion these days around what exactly a party is. The Sue Gray report updates on the alleged (i.e. actual) parties at No.10 during lockdowns cast doubts on our certainties.

For what is a party? Intriguing question, for those into philosophy. You start by thinking you know the answer and you end up confused. For example, it is obvious that not all after work drinks at the pub are parties. But what if you have a beer with your comrades in the office? Or a birthday cake appears during after work drinks? All of a sudden we feel less certain. Maybe the drinks have turned into a party at some point.

This is a rather pleasurable exercise, as long as it doesn’t affect everyday communications. It doesn’t really matter.

Except that, all of a sudden, it does. It’s partygate time.

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Omicron Travel Restrictions Are Not Ethically Justified

Written by: Alberto Giubilini, Julian Savulescu

*A version of this blogpost appears as an article in the Spectator*

 

Governments are at it again. It has become an involuntary reflex. A few days after South Africa sequenced and identified the new Omicron variant, England placed some South African countries back in the ‘red list’. Quarantine has been imposed on all incoming passengers until they show evidence of a negative test. Some European countries banned incoming flights from that region. Switzerland introduced quarantine for passengers arriving from the UK, but also banned all the unvaccinated passengers from the UK from entering the country. The domino effect we have seen so many times during this pandemic has kicked in again.

Is closing borders ethical? We don’t think so. At the beginning of the pandemic, border closures were, arguably, too little too late. Angela Merkel sealed off Germany’s borders in March 2020 less than a week after having declared that, in the name of solidarity, EU countries should not isolate themselves from one another, as the situation was out of control and extremely uncertain. The UK was also criticized for closing borders and locking down too late. In fact, countries that closed borders relatively early, such as Australia and New Zealand, fared better in terms of keeping the virus at bay.

However, we are at a very different stage of the pandemic now.  The disease is endemic, vaccination has been introduced, and we have treatments available. Why do we think the same measures that might have been appropriate in March 2020 are the best response in this very different context?

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