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Decision Making

Expertise and Autonomy in Medical Decision Making

Written by Rebecca Brown.

This is the fourth in a series of blogposts by the members of the Expanding Autonomy project, funded by the Arts and Humanities Research Council.

This blog is based on a paper forthcoming in Episteme. The full text is available here.

Imagine you are sick with severe headaches, dizziness and a nasty cough. You go to see a doctor. She tells you you have a disease called maladitis and it is treatable with a drug called anti-mal. If you take anti-mal every day for a week the symptoms of maladitis should resolve completely. If you don’t treat the maladitis, you will continue to experience your symptoms for a number of weeks, though it should resolve eventually. In a small number of cases, maladitis can become chronic. She also tells you about some side-effects of anti-mal: it can cause nausea, fatigue and an itchy rash. But since these are generally mild and temporary, your doctor suggests that they are worth risking in order to treat your maladitis. You have no medical training and have never heard of maladitis or anti-mal before. What should you do?

One option is that you a) form the belief that you have maladitis and b) take the anti-mal to treat it. Your doctor, after all, has relevant training and expertise in this area, and she believes that you have maladitis and should take anti-mal.Read More »Expertise and Autonomy in Medical Decision Making

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?

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

In Praise of Unthinking National Religion

By Charles Foster

Image: Easter on Santorini: Georgios Michos, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons: Link to image here.

I spent Orthodox Easter in Greece. Then, and for the week afterwards, the neon displays over the main roads announced ‘Christ is Risen’, and the shopkeepers wished me a ‘Good Resurrection’.

This piety isn’t reserved for Easter. Almost everyone wears a cross around their neck. Drivers, without interrupting the high volume argument with their passengers, cross themselves when they pass a church.

‘Superstition, not true religion’, sneers the ardent Protestant – for whom, drawing on a Puritan tradition, diligent examination of conscience and the deliberate orientation of the will towards God are the only completely acceptable mental states. The professional philosopher typically agrees: what is philosophy, these days, other than the disciplined examination of propositions and reasons – and of course disciplined examination demands strenuous, conscious attention.

But I’m not so sure. Religion is part of the web and weave of these Greeks: a way primarily of being, and only secondarily of doing, and often not at all of thinking, in the sense that philosophers typically mean by ‘thinking’. It’s a reflex – or at the root of a reflex –  which has ethical consequences. If one sees the right result (rather than the means to that result) as the most important thing about ethics, a reflex which produces the right result fast, invariably and unconsciously might be preferable to a process of highly cognitive deliberation which could be derailed before it produces the ethically appropriate end. And if what matters is general moral character, who is more praiseworthy: someone who is constitutionally altruistic (for instance), or someone who decides on a case by case basis whether or not to be altruistic?Read More »In Praise of Unthinking National Religion

Honesty and Public Health Communication: Part 2

Written by Rebecca Brown

This post is based on two recently accepted articles: Brown and de Barra ‘A Taxonomy of Non-Honesty in Public Health Communication’, and de Barra and Brown ‘Public Health Communication Should be More Transparent’.

In a previous post, I discussed some of the requirements for public health institutions to count as ‘honest’. I now want to follow that up to discuss some of the ways in which public health communication seems to fall short of honesty.Read More »Honesty and Public Health Communication: Part 2

Abortion in Wonderland

By Charles Foster

 

 

Image: Heidi Crowter: Copyright Don’t Screen Us Out

Scene: A pub in central London

John: They did something worthwhile there today, for once, didn’t they? [He motions towards the Houses of Parliament]

Jane: What was that?

John: Didn’t you hear? They’ve passed a law saying that a woman can abort a child up to term if the child turns out to have red hair.

Jane: But I’ve got red hair!

John: So what? The law is about the fetus. It has nothing whatever to do with people who are actually born.

Jane: Eh?

That’s the gist of the Court of Appeal’s recent decision in the case of Aidan Lea-Wilson and Heidi Crowter (now married and known as Heidi Carter). Read More »Abortion in Wonderland

Fracking and the Precautionary Principle

By Charles Foster

Image> Leolynn11, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

The UK Government has lifted the prohibition on fracking.

The risks associated with fracking have been much discussed. There is widespread agreement that earthquakes cannot be excluded.

The precautionary principle springs immediately to mind. There are many iterations of this principle. The gist of the principle, and the gist of the objections to it, are helpfully summarised as follows:

In the regulation of environmental, health and safety risks, “precautionary principles” state, in their most stringent form, that new technologies and policies should be rejected unless and until they can be shown to be safe. Such principles come in many shapes and sizes, and with varying degrees of strength, but the common theme is to place the burden of uncertainty on proponents of potentially unsafe technologies and policies. Critics of precautionary principles urge that the status quo itself carries risks, either on the very same margins that concern the advocates of such principles or else on different margins; more generally, the costs of such principles may outweigh the benefits. 

Whichever version of the principle one adopts, it seems that the UK Government’s decision falls foul of it. Even if one accepts (controversially) that the increased flow of gas from fracking will not in itself cause harm (by way of climate disruption), it seems impossible to say that any identifiable benefit from the additional gas (which could only be by way of reduced fuel prices) clearly outweighs the potential non-excludable risk from earthquakes (even if that risk is very small).

If that’s right, can the law do anything about it?Read More »Fracking and the Precautionary Principle

The Homeric Power of Advance Directives

By Charles Foster

[Image: Ulysses and the Sirens: John William Waterhouse, 1891: National Gallery of Victoria, Melbourne]

We shouldn’t underestimate Homer’s hold on us. Whether or not we’ve ever read him, he created many of our ruling memes.

I don’t think it’s fanciful (though it might be ambitious) to suggest that he, and the whole heroic ethos, are partly responsible for our uncritical adoption of a model of autonomy which doesn’t do justice to the sort of creatures we really are. That’s a big claim. I can’t justify it here. But one manifestation of that adoption is our exaggerated respect for advance directives – declarations made when one is capacitous about how one would like to be treated if incapacitous, and which are binding if incapacity supervenes if (in English law) the declaration is ‘valid and applicable.’ 1.

I suspect that some of this respect comes from the earliest and most colourful advance directive story ever: Odysseus and the Sirens.Read More »The Homeric Power of Advance Directives

Peter Railton’s Uehiro Lectures 2022

Written by Maximilian Kiener

Professor Peter Railton, from the University of Michigan, delivered the 2022 Uehiro Lectures in Practical Ethics. In a series of three consecutive presentations entitled ‘Ethics and Artificial Intelligence’ Railton focused on what has become one the major areas in contemporary philosophy: the challenge of how to understand, interact with, and regulate AI.

Railton’s primary concern is not the ‘superintelligence’ that could vastly outperform humans and, as some have suggested, threaten human existence as a whole. Rather, Railton focuses on what we are already confronted with today, namely partially intelligent systems that increasingly execute a variety of tasks, from powering autonomous cars to assisting medical diagnostics, algorithmic decision-making, and more.Read More »Peter Railton’s Uehiro Lectures 2022

Hang Onto Your Soul

By Charles Foster

Image: https://the-conscious-mind.com

I can’t avoid Steven Pinker at the moment. He seems to be on every page I read. I hear him all the time, insisting that I’m cosmically insignificant; that my delusional thoughts, my loves, my aspirations, and the B Minor Mass’s effect on me are merely chemical events. I used to have stuck up above my desk (on the principle that you should know your enemy), his declaration (as stridently irrational as the sermon of a Kentucky Young Earth Creationist): ‘A major breakthrough of the Scientific Revolution – perhaps its greatest breakthrough – was to refute the intuition that the Universe is saturated with purpose.’ 1

He tells me that everything is getting better. Has been getting better since the first eruption of humans into the world.2 That there’s demonstrable progress (towards what, one might ask, if the universe has no purpose? – but I’ll leave that for the moment). That there’s less violence; there are fewer mutilated bodies per capita. He celebrates his enlightenment by mocking my atavism: he notes that the Enlightenment came after the Upper Palaeolithic, and (for the law of progress admits no exceptions) concludes that that means that our Enlightenment age is better than what went before.Read More »Hang Onto Your Soul