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Disability, Chronic Conditions and Rehabilitation

To kill or to violate?

By Charles Foster

A highly intelligent 32 year old woman has profound anorexia. She has had it for years. It is complicated by alcohol and opiate dependency, and by personality disorder. Her BMI is 11.3. A healthy BMI is around 20. Less than 17.7 is in the anorexic range. Less than 14 indicates dangerous weight loss. Over the last 4 years her BMI has been well below 14. She describes her life as ‘pure torment’. All the things she wanted to do have been frustrated by her illness. She feels unable to give anything to the world, or to take anything out. For years she has had intense treatment for her anorexia and related conditions. On about 10 occasions she has been sectioned under the Mental Health Act. One of those periods lasted almost 4 months. Twice she has executed advance decisions refusing life-saving or life-prolonging treatment.
There are only two options: death or the violation of her autonomy . If she is not admitted against her will to hospital, detained there for not less than a year, and forcibly fed under physical or chemical restraint, she will die. She understands this perfectly well. She doesn’t actively seek death, but doesn’t want to be force fed. As well as the anorexic’s usual horror of calories, the forcible medical administration of nutrition reminds her horribly of the sexual abuse she suffered as a child.Read More »To kill or to violate?

Bad seed is a robbery of the worst kind: prolific sperm donation and screening

New York Times writes about “In Choosing a Sperm Donor, a Roll of the Genetic Dice”: recipients of sperm donation have found out the hard way that there is a risk of genetic disease affecting their children. In at least one case a donor with a clean bill of health and who had, according to the laboratory, been tested for genetic conditions. Unfortunately he turned out to be a carrier for cystic fibrosis like the mother, and the child suffered. Other cases of transmission of genetic conditions to multiple children from a single donor have appeared, suggesting a need to do something. Is there an ethical need for ensuring genetic testing in the case of sperm donation – or is the problem that some donors father many children?

Read More »Bad seed is a robbery of the worst kind: prolific sperm donation and screening

Moormann

Arbitrary Execution: Why the Law Needs Help from Neuroscience, Psychology and Philosophy

On February 29th, 2012, Robert Henry Moormann was executed in Arizona for murder. Back in 1984, he was in prison for kidnapping and molesting an eight year old girl, when the state gave him three days of compassionate leave. His elderly adoptive mother took a long bus trip to go and meet him. After an argument in a motel room where she was staying, he beat, stabbed and suffocated her, then dismembered her body. He asked a number of local businesses if he could dispose of “spoiled meat and animal guts” in their refuse containers, before disposing of most of her remains in bins and sewers around town. He also asked a prisoner officer to dispose of a box of what he described as “dog bones”. This behaviour raised suspicion. Moormann claimed not to remember the details of the crime, and at the original trial, Moormann’s lawyers mounted a defence of insanity. The jury rejected it. Since 1985, he had been living on death row while his appeals process was gradually exhausted.

In light of the gruesomeness of his crime, it is easy to think that if anyone ever deserved the death penalty, Moormann did. But the contention of Moormann’s defence lawyers that he was intellectually disabled casts a new light on the case.

Read More »Arbitrary Execution: Why the Law Needs Help from Neuroscience, Psychology and Philosophy

Nothing to lose? Killing is disabling

In a provocative article forthcoming in the Journal of Medical Ethics (one of a new series of feature articles in the journal) philosophers Walter Sinnott Armstrong and Franklin Miller ask ‘what makes killing wrong?’ Their simple and intuitively appealing answer is that killing is wrong because it strips an individual of all of their abilities – acting, moving, communicating, thinking and feeling.

So what, you might ask? If this is right, say Sinnott-Armstrong and Miller, it means that it would be just as bad to commit an act that caused someone to be in a permanent vegetative state, as it would to kill them.Read More »Nothing to lose? Killing is disabling

My son’s dyslexic, and I’m glad

By Charles Foster

My son is dyslexic, and I’m glad.
Most people think that I am deranged or callous. But I have two related reasons, both of which seem to me to be good.
The first is that his dyslexia is an inextricable part of him. I can’t say: ‘This is the pathological bit, which I resent’, as one might say of a tumour. Take away his dyslexia, and he wouldn’t be the same person, but able to read and write. He wouldn’t be him. That would be far too high a price for me to pay. And for him to pay? Well, there you run into Parfit’s non-identity problem.

Read More »My son’s dyslexic, and I’m glad

The Savage in Us All

Many since the nineteenth century, including Ghandi and Churchill, have said that a society should be judged by how it treats its weakest members. They must be right – although of course it’s not the only relevant measure. The Panorama programme which uncovered the systematic abuse of highly vulnerable people by staff at the Winterbourne… Read More »The Savage in Us All

Suicide for sale in Oregon: a “valuable service”?

Oregon is currently the scene of a controversy about the sale of so-called “suicide kits” or “helium hoods” (see here and here). These kits are sold by mail by a two-person company called The Gladd Group; one of its owners is reported to be a 91-year-old San Diego County woman who has been selling the kits for four years. The device is now receiving increased media attention following the suicide, with the help of the helium hood kit, of 29-year old Nick Klonoski, who had health-related issues that had brought him into depression, but was not terminally ill. His tragic death has now sparked a movement to outlaw the sale of those kits in Oregon. However, the woman selling the kits protests that she is providing a valuable service, and is quoted as saying that “[i]t is not my intention to hurt anybody, but to offer people comfort when they die”. Is the sale of those suicide kits a legitimate form of business, or should it be banned?

Read More »Suicide for sale in Oregon: a “valuable service”?

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?