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Decision Making

Lethal Ethics: When Philosophical Distinctions Kill

by Julian Savulescu

Teresa Lewis died on the 24th of September after being a lethal injection at the Greensville Correctional Centre in Virginia. The 41-year-old was convicted of plotting to kill her husband, Julian Lewis, and her stepson, Charles Lewis. She persuaded two men to carry out the murders in return for sex and money. The two men received life sentences. The execution went ahead in spite of protests from lawyers, celebrities and others who argued that she should have been given clemency because of her low IQ. Under US law, anyone with an IQ of 70 avoids the death penalty. Lewis was judged to have an IQ of 72.

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Palmistry for the genome: genetic fundamentalism fights on

by Charles Foster
A recent paper in Social, Cognitive and Affective Neuroscience has the self-explanatory title Investigating the genetic basis of altruism: the role of the COMT Val158Met polymorphism. 1. The German authors aren’t as cautious in their claims as they should have been. They should have noted, nervously, the reception given to the infamous ‘God gene’ hypothesis,2 and entitled the paper something along the lines of ‘Some not very statistically significant correlations (from which we can’t begin to infer a causative relationship) between the COMT Val 158 Met polymorphism and some behaviour that might be markers of, amongst other things, being nice, whatever that means, ignoring other non-correlations with other more plausible markers of being nice.’

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Living in Plato’s Cave

Roger Crisp writes …

Plato’s allegory of the Cave (Republic 514a-517a) is perhaps the most famous image in the history of philosophy. Socrates describes a group of people living underground, bound so that they can see only in front of them. Behind them burns a fire, and in front of the fire there is a path with a barrier. Other people carry objects that project above the barrier, casting shadows on the wall in front of the prisoners. Naturally, the prisoners believe the truth to be nothing other than the shadows. ‘Strange prisoners’, says Socrates’s companion, Glaucon. ‘They’re like us’, Socrates answers.

This passage resonated with me during the recent mid-term elections here in the US. Liberal commentators were already expecting the worst after the landmark Supreme Court ruling in January, Citizens United v. Federal Election Commission, that the government cannot limit corporate funding of independent political broadcasts. That ruling was described by President Obama as ‘a major victory for big oil, Wall Street banks, health insurance companies, and the other powerful interests that marshal their power every day in Washington to drown out the voices of everyday Americans’. During the most recent elections, for example, Goldman Sachs (which you may remember received $10 billion in George Bush’s ‘Troubled Asset Relief Program’) gave the Republican party $1.2 million.

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Is professional integrity a futile argument?

by Dominic Wilkinson

In an earlier post this week I argued that there are only two substantive reasons for doctors not to provide treatment that they judge futile – either on the basis of a judgement that treatment would harm the patient (a form of paternalism), or on the basis that providing treatment would harm others (on the basis of distributive justice). I rejected the idea that professional integrity provided an additional reason to withhold or withdraw treatment.

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Break my bones, but don’t let me die! Should doctors provide ‘futile’ CPR?

by Dominic Wilkinson

Two recent cases in a Toronto hospital illustrate a dilemma that hospital doctors face all too frequently. What should they do if patients or their representatives insist on treatment that the doctor believes would be futile? Should they just go along with the patient despite their misgivings? Alternatively, should they unilaterally withhold treatment if they feel it would be inappropriate to provide it?

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Anti Addict Mummy Money

A US group that pays drug addicts to undergo sterilisation visits the UK this week, having recently paid its first British client for undergoing a vasectomy. “Project Prevention” claims that its goal is to make addicts and alcoholics use long-term birth control until they can care for the children they conceive. Founder Barbara Harris has said: “We don’t allow dogs to breed. We spay them. We neuter them. We try to keep them from having unwanted puppies, and yet these women are literally having litters of children.”

The visit has provoked strong responses. Some have compared the group to eugenicists, while supporters point to the cost to the children and society of conception by addicted parents. Dominic Wilkinson has controversially suggested on this blog that a version of the programme could be offered on the National Health Service.

This ethical debate is on the level that Mackie (1977) identifies as first order. However, the issue also highlights second order moral issues about the nature of morality. What are we doing when we express a moral view and how do we know that our views are reliable? One approach to answering these sorts of questions is to understand human morality as an adaptation that contributed to our ancestors’ evolutionary fitness. Without addressing the strengths and weaknesses of such an approach here, if correct, it has the potential to illuminate second, and by implication first, order questions.

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Should we force parents to vaccinate their children? No: let’s just scare them instead

by Rebecca Roache

The BBC recently reported that some homeopaths are offering their patients homeopathic remedies designed to replace the MMR vaccine.  Given that the efficacy of homeopathic remedies is notoriously unproven, this points to the worrying conclusion that some parents who have chosen a homeopathic alternative to the MMR vaccine believe that their children are immune to measles, mumps, and rubella, when in fact they are unprotected against these diseases.

This development marks another blow for the ongoing campaign to ensure that children receive the recommended vaccinations.  Sir Sandy Macara, ex-chairman of the British Medical Association, has claimed that the UK has lower immunisation rates than some developing countries in which people have poor access to healthcare.  The percentage of the UK population currently vaccinated against MMR falls well below the level needed to achieve ‘herd immunity’ – where the number of immune individuals in the population prevents the spread of disease, thereby protecting those who are not immune – and recent outbreaks of measles in Wales has led the Welsh Assembly to consider making the MMR vaccine compulsory.  Such a move would be highly controversial, but is this a price worth paying to protect public health?

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Is the UK’s HPV vaccination programme unethical and/or unlawful?

A colleague recently emailed me. Her daughter, just turned
12, had come back from school bearing an information leaflet about HPV vaccination
with the Glaxo Cervarix vaccine, and a consent form for the parent to sign.

The consent form nodded inelegantly to Gillick, asserting that ‘[t]he decision to consent or refuse is
legally [the girl’s], as long as she understands the issues in giving consent.’
There was no indication given, in the consent form or the accompanying
literature, as to whether and if so how that understanding would be tested. The
reality is that it won’t be tested at all.

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