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‘Trust Me, I’m a Doctor’: On the Unnecessity of Some Necessary Post-Mortems

‘Trust Me, I’m a Doctor’: On the Unnecessity of Some Necessary Post-Mortems

Having a post-mortem (henceforth PM) carried out on a recently deceased loved one can be hugely distressing for those left behind. The procedure involves a detailed examination of the body after death, and requires what some would deem to be a violation of the deceased’s bodily integrity. For obvious reasons, the subject of the PM him or herself is not harmed by the procedure (unless, perhaps, they had previously expressed a wish not to undergo a PM). Rather, it seems that the harm that PMs do, if any, is most readily understood as being inflicted upon those of the friends and relatives of the deceased who are distressed by the idea of a pathologist examining their loved one, mere days after they have been confronted with the loss of that person. Here, I shall consider the ethics of certain legally required post mortems.Read More »‘Trust Me, I’m a Doctor’: On the Unnecessity of Some Necessary Post-Mortems

Announcement: “Brave New Love” in AJOB:Neuroscience – peer commentaries due October 7

Announcement: “Brave New Love” – peer commentaries due October 7 Dear Practical Ethics readers, The paper, “Brave new love: the threat of high-tech ‘conversion’ therapy and the bio-oppression of sexual minorities” by Brian D. Earp, Anders Sandberg, and Julian Savulescu has been accepted for publication in the American Journal of Bioethics: Neuroscience. Proposals for open peer commentaries are… Read More »Announcement: “Brave New Love” in AJOB:Neuroscience – peer commentaries due October 7

There are no significant facts about human beings

By Charles Foster

A few days ago, at dinner, I sat next to a well-known literary biographer. As you’d expect, we fell to talking about the biographer’s obligations, and as you’d also expect, she said that the biographer should be neither advocate nor prosecutor – indeed should strive to keep herself out of the book as much as possible, aiming for objectivity. I heard myself saying that, worthy though this aspiration may be, it was so obviously doomed to failure that it probably wasn’t worth trying. When I reviewed that conversation later, I squirmed. On re-reviewing it I think that the response was right. And here’s why.

There are no significant facts about individual human beings. Or, to wrap it up in philosophese, a human has no qualities which partake of factness sufficiently to make it sensible to treat those qualities in the same way that one would treat, say, the weight of a brick or the length of a stick. Yes, I have physical and chronological dimensions, but in themselves they don’t indicate anything very significant about me. If you told me your date of birth, I could say how long, according to the conventional metrics, you had been alive on the planet: but so what? Your cells age at a different rate from anyone elses, and neither of us knows with which juggernaut the mischievous universe has planned to flatten you, or when. ‘You are as young as you feel’, you will say, and who but you knows how you feel? No one at all thinks that significance lies in the mere accumulation of years, or the mere number of inches from the ground to the top of your head. Where does it lie, then? In the events that fill the years? They, or their corollaries, are the interesting parts of biographies. But what are the events? Yes, a few people have lives marked significantly by their association with undoubted facts: leave the undoubted fact of the double helix out of a biography of Crick or Watson and there would be a serious gap; but even Crick and Watson were infinitely more than their Eureka moment and its prologue and epilogue.Read More »There are no significant facts about human beings

A not-so-great escape: suicide in prison

Christian Brown is a newly qualified junior doctor with an interest in psychiatry and ethics. 

Early last month, Ariel Castro, convicted kidnapper, rapist, and murderer, used a bed sheet and a window-ledge to commit suicide in his prison cell. He was just four weeks into a life sentence. Recently on this blog, Rebecca Roache wrote a post about the possibility of enhancing prison sentences – today, I’d like to consider the right-to-die of inmates, and the role of medical professionals in their suicidal behaviour.

Inside the walls of our high security prisons, small numbers of prisoners face life-long sentences, deprived of all but the minimum of human contact, and confined for most of the day to their cells. Some people argue that it can be rational to commit suicide – for the purposes of this post, I’ll refer to suicidal acts which are voluntary, informed, and the individual shown to have mental capacity, as ‘rational suicide’. If one accepts this, it is hard to imagine a more subjectively powerful circumstance in which to kill oneself than at the outset of a life sentence. Indeed, suicide rates among prisoners are around six times higher than those of the general male population. Of course, a proportion of these cases will not meet the criteria for ‘rational suicide’, but let’s consider those that do.Read More »A not-so-great escape: suicide in prison

How to get positive surveillance – a few ideas

I recently published an article on the possible upsides of mass surveillance (somewhat in the vein of David Brin’s “transparent society”). To nobody’s great astonishment, it has attracted criticism! Some of them accuse me of not knowing the negative aspects of surveillance. But that was not the article’s point; there is already a lot written on the negative aspects (Bruce Schneier and Cory Doctorow, for instance, have covered this extremely well). Others make the point that though these benefits may be conceivable in principle, I haven’t shown how they could be obtained in practice.

Again, that wasn’t the point of the article. But it’s a fair criticism – what can we do today to make a better surveillance outcomes more likely? Since I didn’t have space to go through that in my article, here are a few suggestions:Read More »How to get positive surveillance – a few ideas

US Congress shutsdown CDC, also other unimportant agencies

So the US government is likely being shutdown, which will suspend the work of many government agencies, including the Center for Disease Control (CDC). But, fair citizens, I reassure you – in its wisdom, the US Congress has decided that the military’s salaries will be excluded from the shutdown. With all due respect to military personnel, this… Read More »US Congress shutsdown CDC, also other unimportant agencies

Stress Influences Our Moral Behaviour

All of us are stressed, every now and then. Acute stress can have a profound impact on the human body and mind: both physical and psychological stressors affect the autonomic nervous system and the hypothalamic–pituitary–adrenal axis, leading to changes in cardiovascular and neuroendocrine measures. Stress also is shown to affect cognitive functions like memory and attention. Just recently, however, research discovered that acute stress also can influence our moral behaviour.

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Is compassion a necessary component of healthcare?

Last week, the Daily Mail reported on Dr Anna Smajdor’s paper in which she argues that compassion ‘is not a necessary component’ of healthcare. This claim contrasts interestingly with Jeremy Hunt’s recent proposal that all student nurses should have to prove that they are capable of caring by spending a year on wards carrying out basic tasks. This proposal, along with the suggestion that pay be linked to levels of kindness would, according to Hunt, go some way to improving the standard of NHS care.  The motivating idea behind Hunt’s proposals is that lack of compassion amongst NHS staff is partly responsible for poor care and, in some cases, for cultivating a ‘culture of cruelty’.

So is compassion a necessary component of healthcare? Is an adequate standard of care necessarily unattainable when compassion amongst staff is absent? In considering these questions I do not intend to embark on a detailed critique of Dr Smajdor’s paper. Instead, I will begin from her main ideas and use them to motivate a general discussion of the role of compassion in healthcare. According to the report, Dr Smajdor argues for two main claims: 1) that compassion is not a necessary component of healthcare – that acceptable standards can be attained without it – and 2) that compassion can actually be dangerous for healthcare workers, possibly resulting in impaired standards of care. Read More »Is compassion a necessary component of healthcare?

Ethical Enhancement

Scientists in America have found a way to reduce crime amongst some high risk groups by 30-40%. It involves a simulation of crime scenes where the victim is a hologram representing the potential criminal in question, followed by discussion with a trained therapist. The experience causes the subject to feel greater empathy and reduces violent crime. We should introduce this therapy now, as a matter of priority.

There is no such therapy, sadly. But there is something which promises the same effects in some groups. Ritalin. A Swedish study found that taking ADHD medication significantly reduced the criminality rate amongst those with ADHD: by 32% in men, and 41% in women. ADHD has itself been associated with an increase in criminality.

Some people will argue that this is a therapy for ADHD, not an enhancement. But ADHD is not a disease like cancer – it is likely a variant of normal functioning involving lower levels of impulse control and attention.

Ritalin, Adderall, Modafenil are all taken by thousands of professionals and students to enhance performance, in a similar way to caffeine. The film Limitless was loosely based on modafenil (in fact, Modafenil doesn’t appear to have such a dangerous side effect profile as is portrayed in the film, though there are as yet no long term studies of normal people). Ongoing research into Alzheimers disease and other impairments will lead to other drugs which enhance normal cognition.

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A death on the border

Several days ago, a middle-aged man named Nam Young-ho was shot to death while crossing the Imjin River, which divides North and South Korea.  Such stories are sadly not uncommon, but the particular facts make this case quite unusual: Nam was a South Korean trying to enter the North, and was shot by South Korean soldiers.  This killing received relatively little attention in the news (perhaps in part because it occurred on the same day as a larger tragedy in the US), but it’s hard to view it as anything other than a terrible injustice.  I’ve been racking my brains, and I can’t figure out a plausible justification.  From news reports, it sounds like the South Korean military is standing by the soldiers’ actions and no prosecution is forthcoming.  This makes the killing all the more disturbing – it was not the result of poor training or accident, but a deliberate and pernicious policy to use lethal force on anyone attempting to cross into the North.Read More »A death on the border