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The cost of living and the cost of dying

The cost of living and the cost of dying

X, a patient with reliably diagnosed PVS, lies in a hospital bed for years, fed via a nasogastric tube. He has not, and by definition never will have, any capacity for pain, pleasure or any sort of sensation. Devoted family members come each day to sit by his bedside, but he has no idea that they are devoted, or that they exist.
It is expensive to keep him alive. He occupies a bed and consumes a good deal of nursing time.
The NHS Trust responsible for his care has a limited budget. It decides that the money spent on maintaining his merely biological life would be better spent on dialysis machines. It can, and does, justify its decision in purely utilitarian terms. It writes in the minutes of the relevant committee meeting: ‘For the money we spend keeping X alive, we can save the lives of 10 kidney patients, each of whom will have a good quality of life for many years. The QALY arithmetic makes X’s continued existence nonsensical.’Read More »The cost of living and the cost of dying

Cabs, censorship and cutting tools

The smith was working hard on making a new tool. A passer-by looked at his work and remarked that it looked sharp and dangerous. The smith nodded: it needed to be very sharp to do its work. The visitor wondered why there was no cross-guard to prevent the user’s hand to slide onto the blade, and why the design made it easy to accidentally grip the blade instead of the grip. The smith explained that the tool was intended for people who said they knew how to use it well. “But what if they were overconfident, sold it to somebody else, or had a bad day? Surely some safety measures would be useful?” “No”, said the smith, “my customers did not ask for them. I could make them with a slight effort, but why bother?”

Would we say the smith was doing his job in an ethical manner?

Here are two other pieces of news: Oxford City Council has decided to make it mandatory for taxicabs in Oxford to have CCTV cameras and microphones recording conversations of the passengers. As expected, many people are outraged. The stated reason is to improve public safety, although the data supporting this decision doesn’t seem to be available. The surveillance footage will supposedly not be made available other than as evidence for crimes, and not stored for more than 28 days. Meanwhile in the US, there are hearings about the Stop Online Piracy Act (SOPA) and the PROTECT IP Act, laws intended to make it easier to block copyright infringement and counterfeiting. Besides concerns that critics and industries most affected by the laws are not getting access to the hearings, a serious set of concerns is that they would make it easy to censor websites and block business on fairly loose grounds, with few safeguards against false accusations (something that occurs regularly), little oversight, few remedies for the website, plus the fact that a domestic US law would apply internationally due to the peculiarities of the Internet and US legal definitions.

Read More »Cabs, censorship and cutting tools

Celebrity Culture

Every Saturday evening, and often on other evenings too, my daughters sit goggling at the TV talent show X Factor. Am I witnessing the long tentacles of the dreaded ‘celebrity culture’ we are said to inhabit reaching into my living room? I think not. I confess I find the show tedious, but as part of… Read More »Celebrity Culture

What is feasible?

Climate change raises questions of global distributive justice and I am interested in what kinds of actions might be considered as fair responses.  Recently, I have observed that some accounts of climate justice have been dismissed for being “infeasible”.  I have started to wonder what this means.   In ordinary language, “feasible” might mean “possible” or “likely”, even “easy” or “inexpensive”  – with infeasible meaning the opposite.   What kind of criticism is it to say that an account of climate justice, for example, the distribution of equal per capita shares of greenhouse gas emissions is “infeasible”?  It might be presented as an empirical claim: that such a proposal will not be acted upon, or, at least, is unlikely to be acted upon.  This does not mean that the account is lacking on normative grounds.  People are not always that good at being good.     Read More »What is feasible?

World funds: implement free mitigations

The future is uncertain and far. That means, not only do we not know what will happen, but we don’t reason about it as if it were real: stories about the far future are morality tales, warnings or aspirations, not plausible theories about something that is going to actually happen.

Some of the best reasoning about the future assumes a specific model, and then goes on to explore the ramifications and consequences of that assumption. Assuming that property rights will be strictly respected in the future can lead to worrying consequences if artificial intelligence (AI) or uploads (AIs modelled on real human brains) are possible. These scenarios lead to stupidly huge economic growth combined with simultaneous obsolescence of humans as workers – unbelievable wealth for (some of) the investing class and penury for the rest.

This may sound implausible, but the interesting thing about it is that there are free mitigation strategies that could be implemented right now. Read More »World funds: implement free mitigations

Discovering Consciousness in the “Permanently Unconscious”: What Should We Do?

Comment on “Bedside detection of awareness in the vegetative state: a cohort study” by Damian Cruse, Srivas Chennu, Camille Chatelle, Tristan A Bekinschtein, Davinia Fernández-Espejo, John D Pickard, Steven Laureys, Adrian M Owen. Published in The Lancet, online Nov 10.

 Cruse and colleagues founds evidence of some kind of consciousness in 3 out of 16 patients diagnosed as being permanently unconscious. They used an EEG machine, capable of being deployed at the bedside. Is this good news?

This important scientific study raises more ethical questions than it answers. People who are deeply unconscious don’t suffer. But are these patients suffering? How bad is their life? Do they want to continue in that state? If they could express a desire, should it be respected?

The imporMan in Prisontant ethical question is not: are they conscious? It is: in what way are they conscious? Ethically, we need answers to that. Life prolonging treatment has been and legally can be withdrawn from patients who are permanently unconsciousness. We need guidelines for when life-prolonging treatment should be withdrawn in these minimally conscious states. Paradoxically, it could be worse for some than being permanently unconscious. And in countries like the Netherlands, we need guidelines on whether and when active euthanasia should be performed. For some of these patients, consciousness could be the experience of a living hell.

Read More »Discovering Consciousness in the “Permanently Unconscious”: What Should We Do?

Holier and happier than thou?

Are ethical people happier? Many philosophers have claimed this, from Plato and Aristotle onwards. A new study claims it is empirically true, or more exactly that ethical people are more satisfied with life.

The 2009 study looked at cross-country data from the World Values Survey from the US, Canada, Mexico and Brazil. It looked at  people who agreed with the view that it is never justifiable to engage in ethically questionable behaviours like avoiding fares on public transports, cheating on taxes or taking bribes (35%) compared the rest. Controlling for things like gender, income, age, health, being married etc. the study found being ‘ethical’ by this standard increased the likeliehood of being very satisfied with life fairly significantly. The effect size is like a modest increase in income. A good reason to try to become a better person, or (as the paper suggests) for governments that are trying to increase subjective well being to do it by improving moral conduct… or is it?

Read More »Holier and happier than thou?

Wellcome Lecture in Neuroethics: Moral enhancement? Evidence and challenges, Dr Molly Crockett, University of Zürich

Abstract: Can pills change our morals? Neuroscientists are now discovering how hormones and brain chemicals shape social behaviour, opening potential avenues for pharmacological manipulation of ethical values. In this talk, I will present an overview of recent studies showing how altering brain chemistry can change moral judgment and behaviour. These findings raise new questions about the… Read More »Wellcome Lecture in Neuroethics: Moral enhancement? Evidence and challenges, Dr Molly Crockett, University of Zürich

The moral case for elective caesarean section

Should a father dive into a flowing stream to aid his daughter, struggling to keep her head above water? Should a mother donate a kidney to her child with renal failure? Is it ethical for a parent to work two or three jobs so that they can pay private health insurance or school fees for their children? In all of these situations most of us would think that it is commendable for a parent to take these actions. We applaud and approve of a parent who decides to take on some personal risk, who sacrifices his or her own wellbeing and health in order to prevent a risk of serious harm to their child. It is one of the duties of a parent to do whatever they reasonably can to avoid risks  and secure benefits to their children. How morally important it is for parents to make these sacrifices depends on the balance between the risks to the child and those to the parent. But it is appropriate for a parent to give greater weight to the risks to their child than to themselves. Indeed we might well be critical of a parent who failed to do so.

What then, of a mother who decides to undergo abdominal surgery in order to reduce the risk of her child suffering brain injury, or being admitted to intensive care? Shouldn’t we also applaud this decision?Read More »The moral case for elective caesarean section

Killing With Drones, Proportionality, and Trolley Problems

Reports of killing by drones are increasing. Initially they were exceptional, now they are commonplace. Every few weeks there is a report of another killing, invariably by the US, in some far off country. With the rapid pace of technological development, the investment being made into more and more autonomous systems, and little sign of this trend being checked, it can only continue. The ethicality and legality of such practices outside international armed conflict is extremely dubious. In the context of international armed conflict the practice is checked only by the concept of ‘proportionality’, a concept that is problematic generally, and is almost entirely unable to discharge the heavy burden that is imposed on it by the practice of drone killing.Read More »Killing With Drones, Proportionality, and Trolley Problems