Health

One year of DefaultVeg at the Uehiro Centre

Today (1 November) is ‘world vegan day’. This is a good moment to reflect on a decision that the Oxford Uehiro Centre for Practical Ethics took almost exactly a year ago. In October 2021, we chose to firmly commit to a DefaultVeg approach to help reduce meat and dairy consumption. Such reduction will help transform our current farming practices, which are extremely harmful to our planet, and all those who live on it. [National Food Strategy. Independent Review for the Government]

What does this DefaultVeg commitment entail? Over the past year, we have provided plant-based food and drinks by default for all meetings and events that we host, and for our staff and visitors at the Centre during normal workdays. The choice to opt for meat and/or dairy remains, but those who want this have to opt in. Given the high numbers of vegans among our admin team, staff and students, we had already adopted a DefaultVeg approach to some extent, but DefaultVeg has ensured that we do this more consistently and explicitly. As we expected, almost everyone opts for the default: plant-based options.

We hope that, by explicitly and firmly committing to a DefaultVeg approach, the Uehiro Centre also sets an example for other research centres, institutions, and workplaces in general. Going DefaultVeg is not difficult in a world with an increasing variety of plant-based food and drinks.

‘Why are we opting for DefaultVeg and not going vegan ‘all the way’?’, you may wonder.
We think that preserving freedom of choice is valuable. Food is deeply embedded in cultural and social values, and we realise that people do not always find it easy or desirable to entirely change their eating habits overnight. It is important to acknowledge this, and not rush people into different food choices, though, we hope that most people will opt for plant-based diets eventually. Forcing a food choice onto people may not always be the best way to convince people that they should eat less meat and dairy. It may make some people feel hostile towards, and hence resist, veganism. And this may result in a slower transition to a society in which most people are happy to eat (mostly) plant-based food.

Last year, the Oxford City Council approved a proposal to only offer plant-based options during council meetings. Conservative councillors objected and said whether one opts for a vegan lunch should remain a choice: “Veganism should not be forced down people’s throats. It should be a matter of choice and education.”  At the first lunch, two conservative councillors walked out in protest, and around 15 Conservative councillors enjoyed a self-funded lunch at a nearby pub and one of the councillors confirmed it ‘contained meat’.

I’m not saying that the Oxford City Council took the wrong decision by making the lunches vegan. But as the strong reaction shows, perhaps a more incremental approach towards a vegan society may work better in some contexts. Perhaps when not forced, people may find it easier to shift. And changing the default to vegan, helps to shift people towards the vegan options. As more people reduce their meat and dairy consumption, more plant-based food options will become available, which, in turn will make it easier, and thus more attractive, to become vegan. Both approaches (all vegan, and DefaultVeg) have benefits.

We find that, for the Centre, the DefaultVeg approach, has worked well (though it has taken some trial and error to find caterers and restaurants with enough good vegan options). It has been an exciting and positive journey, and we look forward to continuing it.

For those of you who are interested in adopting a DefaultVeg approach, feel free to get in touch (katrien.devolder@philosophy.ox.ac.uk) if you would like more information about how to get started.

Sex and Punishment: How Old Do You Have to Be?

By Maximilian Kiener

 

In March 2022, Philippines President Rodrigo Duterte signed a bill that increased the minimum age for sexual consent from 12 to 16 years. This bill marked a significant change to a previous law that dated back to 1930.[1] International Organisations have advocated for a changed in the Philippines for a long time and welcomed the new bill. ‘Having this law is a very good protective instrument for our children from sexual violence, whether or not it starts online or whether or not it also starts in a face-to-face encounter’, commented Margarita Ardivilla, a UNICEF child protection specialist.[2]

To the Western World, the Philippines’ new bill seems obvious and overdue. After all, most other countries already specify the age of 16 for consent to sex or health care. But we should not feel complacent too quickly. In fact, there might be more to do to protect children and adolescents. Although most countries now convergence on 16 as the age of consent, they still have a much lower age for criminal responsibility, that is they punish children much earlier than they allow them to consent.

 

Consider the following case from the UK. On Friday 12th February 1993 in Liverpool, UK, Robert Thompson and Jon Venables murdered the two-year-old James Bulger. At the time of their appalling crime, Thompson and Venables were only ten years old, an age at which they would not have been able to give legally valid consent to their own healthcare, or to sex. Yet, the authorities considered them criminally responsible and made them the youngest convicted murderers in 20th-century Britain.[3]

Although this is an extreme case, it illustrates a more general fact: the age at which children become criminally responsible is often considerably lower than the age at which they become able to give legally valid consent. Noroozi et al. found that in 80% of countries with clearly defined ages for consent and responsibility, the age of criminal responsibility is still about 2 to 8 years lower than the age of consent.[4]

This situation should make us think. Now that we agree that the age of consent should be around 16, and not 10 or 12, let’s think about the age of criminal responsibility too. Why should children or adolescents be criminally responsibility for their deeds when they could not possibly give consent to anything important in their lives?

 

Those who support a lower age for criminal responsibility often pursue one of two routes, neither of which is convincing.

First, they argue that consent requires greater mental capacity, or reasoning skills, than responsibility. When deciding whether to consent, one needs to be able to understand one’s own prudential interests, values, and the potentially intricate consequences of one’s decision, and doing so requires a great deal of intellectual and emotional maturity. On the other hand, understanding that one should not murder, steal, or break other fundamental norms, is pretty straightforward and everyone with a basic grasp of our social interactions should be able to master this.

But this line of reasoning is not convincing. Morality is not just about regurgitating slogans. It requires understanding, more fundamentally, what we owe each other as fellow moral beings. Moreover, sometimes, the situations regarding consent and responsibility could be very similar. Consider the fictitious case of the 15-year-old Mary who can be convicted of murder but cannot refuse her own life-saving treatment. In both cases, Mary needs to understand the concepts of death and fatal action, and it may therefore be inconsistent to hold Mary responsible for murder but then deny her ability to validly refuse treatment for herself. So, on purely capacity-based terms, a categorical divergence between the age of consent and the age of responsibility lacks warrant.

A second argument for a lower age of responsibility often refers to a policy of being ‘tough on crime’. Being tough on crime means sending a clear signal to children and adolescents that their wrongs will be prosecuted and punished.

Yet, this policy presupposes that children possess sufficient competence to understand the signal. Therefore, this approach cannot justify a lower age of responsibility independent of a psychological assessment of children’s competence. If children at 10 years old cannot sufficiently understand relevant moral and legal norms, there is simply no point in sending them ‘a clear signal’. Consider again the ten-year-old Thompson, one of the children who killed James Bulger, who is reported to have asked the police whether they took his victim James to the hospital ‘to get him alive again’.[5] Such a child is very unlikely to have understood the fatal nature of his acts, let alone their moral repugnance. Thus, being tough on children like him is very unlikely to deter children of similar competence.

 

Thus, the view that the age of responsibility should always be lower than the age of consent cannot be justified. We need a more fine-grained approach and should be particularly critical of wide age gaps, like those in the UK, where the age of criminal responsibility is 10 and the age of consent to much in life is 16.

For this reason, the news from the Philippines about the age of consent should be the start, not the end, of a conversation on how to best protect children and adolescents. It should prompt us to think about the age of criminal responsibility too and reform the law in ways that make it coherent across different domains.

 

[1] https://www.reuters.com/world/asia-pacific/philippine-leader-approves-bill-raising-sex-consent-age-12-16-2022-03-07/

[2] https://theaseanpost.com/geopolitics/2022/mar/09/philippines-raises-age-sexual-consent-16

[3] https://en.wikipedia.org/wiki/Murder_of_James_Bulger

[4] https://ebmh.bmj.com/content/21/3/82.abstract

[5] https://en.wikipedia.org/wiki/Murder_of_James_Bulger

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. Continue reading

Healthcare Ethics Has a Gap…

By Ben Davies

Last month, the UK’s Guardian newspaper reported on a healthcare crisis in the country. If you live in the UK, you may have already had an inkling of this crisis from personal experience. But if you don’t live here, and particularly if you are professionally involved in philosophical ethics, see if you can guess: what is the latest crisis to engulf the publicly funded National Health Service (NHS)?

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New Publication: ‘Overriding Adolescent Refusals of Treatment’

Written by Anthony Skelton, Lisa Forsberg, and Isra Black

Consider the following two cases:

Cynthia’s blood transfusion. Cynthia is 16 years of age. She is hit by a car on her way to school. She is rushed to hospital. She sustains serious, life-threatening injuries and loses a lot of blood. Her physicians conclude that she needs a blood transfusion in order to survive. Physicians ask for her consent to this course of treatment. Cynthia is intelligent and thoughtful. She considers, understands and appreciates her medical options. She is deemed to possess the capacity to decide on her medical treatment. She consents to the blood transfusion.

Nathan’s blood transfusion. Nathan is 16 years of age. He has Crohn’s disease. He is admitted to hospital with lower gastrointestinal bleeding. According to the physicians in charge of his care, the bleeding poses a significant threat to his health and to his life. His physicians conclude that a blood transfusion is his best medical option. Nathan is intelligent and thoughtful. He considers, understands and appreciates his medical options. He is deemed to possess the capacity to decide on his medical treatment. He refuses the blood transfusion.

Under English Law, Cynthia’s consent has the power to permit the blood transfusion offered by her physicians. Her consent is considered to be normatively (and legally) determinative. However, Nathan’s refusal is not normatively (or legally) determinative. Nathan’s refusal can be overridden by consent to the blood transfusion of either a parent or court. These parties share (with Nathan) the power to consent to his treatment and thereby make it lawful for his physicians to provide it.

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Exercise, Population Health and Paternalism

Written by Rebecca Brown

 

The NHS is emphatic in its confidence that exercise is highly beneficial for health. From their page on the “Benefits of exercise” come statements like:

“Step right up! It’s the miracle cure we’ve all been waiting for”

“This is no snake oil. Whatever your age, there’s strong scientific evidence that being physically active can help you lead a healthier and happier life”

“Given the overwhelming evidence, it seems obvious that we should all be physically active. It’s essential if you want to live a healthy and fulfilling life into old age”.

Setting aside any queries about the causal direction of the relationship between exercise and good health, or the precise effect size of the benefits exercise offers, it at least seems that the NHS is convinced that it is a remarkably potent health promotion tool. Continue reading

Three Observations about Justifying AI

Written by:  Anantharaman Muralidharan, G Owen Schaefer, Julian Savulescu
Cross-posted with the Journal of Medical Ethics blog

Consider the following kind of medical AI. It consists of 2 parts. The first part consists of a core deep machine learning algorithm. These blackbox algorithms may be more accurate than human judgment or interpretable algorithms, but are notoriously opaque in terms of telling us on what basis the decision was made. The second part consists of an algorithm that generates a post-hoc medical justification for the core algorithm. Algorithms like this are already available for visual classification. When the primary algorithm identifies a given bird as a Western Grebe, the secondary algorithm provides a justification for this decision: “because the bird has a long white neck, pointy yellow beak and red eyes”. The justification goes beyond just a description of the provided image or a definition of the bird in question, and is able to provide a justification that links the information provided in the image to the features that distinguish the bird. The justification is also sufficiently fine grained as to account for why the bird in the picture is not a similar bird like the Laysan Albatross. It is not hard to imagine that such an algorithm would soon be available for medical decisions if not already so. Let us call this type of AI “justifying AI” to distinguish it from algorithms which try, to some degree or other, to wear their inner workings on their sleeves.

Possibly, it might turn out that the medical justification given by the justifying AI sounds like pure nonsense. Rich Caruana et al present a  case whereby asthmatics were deemed less at risk of dying by pneumonia. As a result, it prescribed less aggressive treatments for asthmatics who contracted pneumonia. The key mistake the primary algorithm made was that it failed to account for the fact that asthmatics who contracted pneumonia had better outcomes only because they tended to receive more aggressive treatment in the first place. Even though the algorithm was more accurate on average, it was systematically mistaken about one subgroup. When incidents like these occur, one option here is to disregard the primary AI’s recommendation. The rationale here is that we could hope to do better than by relying on the blackbox alone by intervening in cases where the blackbox gives an implausible recommendation/prediction. The aim of having justifying AI is to make it easier to identify when the primary AI is misfiring. After all, we can expect trained physicians to recognise a good medical justification when they see one and likewise recognise bad justifications. The thought here is that the secondary algorithm generating a bad justification is good evidence that the primary AI has misfired.

The worry here is that our existing medical knowledge is notoriously incomplete in places. It is to be expected that there will be cases where the optimal decision vis a vis patient welfare does not have a plausible medical justification at least based on our current medical knowledge. For instance, Lithium is used as a mood stabilizer but the reason why this works is poorly understood. This means that ignoring the blackbox whenever a plausible justification in terms of our current medical knowledge is unavailable will tend to lead to less optimal decisions. Below are three observations that we might make about this type of justifying AI.

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Cognitive snobbery: The Unacceptable Bias in Favour of the Conscious

There are many corrosive forms of discrimination. But one of the most dangerous is the bias in favour of consciousness, and the consequent denigration of the unconscious.

We see it everywhere. It’s not surprising. For when we’re unreflective – which is most of the time – we tend to suppose that we are our conscious selves, and that the unconscious is a lower, cruder part of us; a seething atavistic sea full of monsters, from which we have mercifully crawled, making our way ultimately to the sunlit uplands of the neocortex, there to gaze gratefully and dismissively back at what we once were.  It’s a picture encoded in our self-congratulatory language: ‘Higher cognitive function’; ‘She’s not to be blamed: she wasn’t fully conscious of the consequences.’: ‘In the Enlightenment we struck off the shackles of superstition and freed our minds to roam.’ Continue reading

Shaming unvaccinated people has to stop. We’ve turned into an angry mob and it’s getting ugly

Written by Alberto Giubilini and Julian Savulescu. Cross-Posted from The Conversation 
Shutterstock

Julian Savulescu, University of Oxford and Alberto Giubilini, University of Oxford

Unvaccinated mother, 27, dies with coronavirus as her father calls for fines for people who refuse jab.

This is the kind of headline you may have seen over the past year, an example highlighting public shaming of unvaccinated people who die of COVID-19.

One news outlet compiled a list of “notable anti-vaxxers who have died from COVID-19”.

There’s shaming on social media, too. For instance, a whole Reddit channel is devoted to mocking people who die after refusing the vaccine.

COVID-19 vaccinations save lives and reduce the need for hospitalisation. This is all important public health information.

Telling relatable stories and using emotive language about vaccination sends a message: getting vaccinated is good.

But the problem with the examples above is their tone and the way unvaccinated people are singled out. There’s also a murkier reason behind this shaming.

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Paying for the Flu Vaccine

By Ben Davies

As I do every winter, I recently booked an appointment for a flu vaccine. I get it for free in the UK. If I didn’t have asthma, I’d still get vaccinated, but it would cost me between £9 and £14.99. That is both an ethical error on the part of the government, and may be a pragmatic one too.

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