A Judge’s Breakfast
Legal Realism has been caricaturised as a school that believes that judicial decisions are made according to what the judge has had for breakfast. Research conducted in Israel suggests that this may not be so far from the truth.
Decision Making
Banks: Liberty or Regulation
Gordon Brown has just said that he made a big mistake about financial regulation. His remarks are in line with many politicians on the financial crisis: regulation failed therefore we need more regulation. But do we?
Frideswide Square is a notorious traffic junction in Oxford, and it’s a nightmare. It has about 20 sets of traffic lights and small problems here lead to long tailbacks in many directions, tripling journey times for many otherwise short trips. So you can imagine how awful it was when the traffic lights all broke down recently.
Except it wasn’t.Read More »Banks: Liberty or Regulation
Autonomy: amorphous or just impossible?
By Charles Foster
I have just finished writing a book about dignity in bioethics. Much of it was a defence against the allegation that dignity is hopelessly amorphous; feel-good philosophical window-dressing; the name we give to whatever principle gives us the answer to a bioethical conundrum that we think is right.
This allegation usually comes from the thoroughgoing autonomists – people who think that autonomy is the only principle we need. There aren’t many of them in academic ethics, but there are lots of them in the ranks of the professional guideline drafters, (look, for instance, at the GMC’s guidelines on consenting patients) and so they have an unhealthy influence on the zeitgeist.
The allegation is ironic. The idea of autonomy is hardly less amorphous. To give it any sort of backbone you have to adopt an icy, unattractive, Millian, absolutist version of autonomy. I suspect that the widespread adoption of this account is a consequence not of a reasoned conviction that this version is correct, but of a need, rooted in cognitive dissonance, to maintain faith with the fundamentalist notions that there is a single principle in bioethics, and that that principle must keep us safe from the well-documented evils of paternalism. Autonomy-worship is primarily a reaction against paternalism. Reaction is not a good way to philosophise.Read More »Autonomy: amorphous or just impossible?
The patient vanishes
by Dominic Wilkinson
If a patient’s family refuse to allow withdrawal of breathing machines should doctors provide long-term support in an intensive care unit for a patient who is clinically brain dead? Should doctors provide heart-lung bypass (ECMO) for a child with anencephaly? Should doctors perform a tracheostomy and provide a long-term breathing machine for a patient in a documented persistent vegetative state?Read More »The patient vanishes
Ethical Lessons From Locked-In Syndrome: What Is a Living Hell?
A recent important study by Stephen Laureys and colleagueson what it is like to be to experience severe brain damage has been widely reported. (eg, http://abcnews.go.com/Health/Wellness/locked-patients-life/story?id=12984627). Laureys and colleagues surveyed the views of people with “locked-in” syndrome. This syndrome, which typically occurs after certain kinds of stroke, results in the person unable to move his arms or legs and unable to speak. In some cases, they can move their eyes and communicate through eye movements but in other cases, the eyes are paralysed. They are awake and aware.
Many people would think this is a living hell, imprisoned in one’s own body, with limited if any means of communication. But Laureys et al found differently when they actually asked patients who were in this condition. According to the ABC,
“More than half of patients coping with a form of nearly complete paralysis called locked-in syndrome indicated — through eye blinks in some cases — that they were getting some satisfaction in life, though 8 percent had often thought of suicide.
“Among 65 patients who had developed the syndrome a median of eight years previously, only 18 characterized their lives as “somewhat on the bad side” or worse… Seventeen patients indicated that they felt as well, or almost as well, as in their happiest times before becoming locked-in. Another 21 gave their overall quality of life lesser but still positive marks.”
So what can we learn from this study?Read More »Ethical Lessons From Locked-In Syndrome: What Is a Living Hell?
Can forced sterilization ever be ethical?
A British court still needs to decide whether to authorize the sterilization, at her mother’s own request, of a mentally disabled woman (see e.g. here and here). Reading only the headlines and initial paragraphs of the news entries devoted to the case, one might become worried that we are seeing here a resurgence of an abhorrent practice that gained much favour in the first half of the 20th-Century, in countries like Germany or the United States: i.e. the compulsory sterilization of the mentally retarded for eugenic purposes. However, it is important to look at the particulars of this case in order not to be misled. The 21-year old woman, referred to as P, is pregnant with her second child, and her mother (“Mrs. P”) says that they “can’t carry on supporting more and more children”. She also said that after the birth of her second child her daughter would have “a complete family” (a girl and a boy). But her mother is worried that she will soon fall pregnant again, in which case the child will have to be given away for adoption – something that her daughter, she says, is unable to understand, yet an outcome that would cause her much distress were it to happen.
Reacting to the case, bioethicist George Annas, from Boston University, commented that “this is eugenics if they are doing this because she’s mentally disabled. This decision needs to be made based on the person’s best interests, not the best interests of society or her caregivers.”
On Forgiveness
by Charles L. Griswold
(This piece was originally published in “The Stone” series of the New York Times (on-line), on Dec. 26, 2010, and is also available here along with responses by readers. Thanks to Roger Crisp for inviting me to post it here, and to the NYT for permission. Copyright held by the NYT.)
We are in a season traditionally devoted to good will among people and to the renewal of hope in the face of hard times. As we seek to realize these lofty ideals, one of our greatest challenges is overcoming bitterness and divisiveness. We all struggle with the wrongs others have done to us as well as those we have done to others, and we recoil at the vast extent of injury humankind seems determined to inflict on itself. How to keep hope alive? Without a constructive answer to toxic anger, addictive cycles of revenge, and immobilizing guilt, we seem doomed to despair about chances for renewal. One answer to this despair lies in forgiveness.
Cloudy with a Chance of Dementia
Is Discounted Therapy Fair?
by David Shipley
A friend of mine is a therapist. She faced the following dilemma.
My friend specialises in enhancing fertility and was approached by a prospective patient who wished to become pregnant but could not afford to pay the standard fee of £45 per treatment as she was on benefits. The woman was aged 40 and had no children. What should my friend the therapist have done?
Is it ethical to force-feed prisoners on a hunger strike?
by Alexandre Erler
The question, which generated debate a few years ago in the context of the US detention camp at Guantanamo Bay, is now arising again in Switzerland, where imprisoned cannabis farmer Bernard Rappaz has been on hunger strike for about three months now, in protest against a prison sentence he considers excessive. Rappaz was sentenced to five years and eight months behind bars for trading in cannabis and various other offenses. The Federal Court, Switzerland’s highest instance, has ruled that Rappaz should be force-fed if necessary, but doctors in charge of him have refused to obey those orders. A criminal law Professor has argued that according to the Swiss Penal Code, these doctors should be prosecuted, as their refusal amounts to civil disobedience. How should we regard such a legal implication? Is it ethically acceptable, perhaps even required, to force feed someone like Bernard Rappaz?
Read More »Is it ethical to force-feed prisoners on a hunger strike?