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Renaming a Disorder

Renaming a Disorder

What’s in a name? Quite a lot, considering the huge commotion over proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM). Almost a thousand pages long, this psychiatric bible is
used all over the world to classify and diagnose mental patients – it’s
the definitive authority on that nebulous concept known as “normal”.
The implications of any revisions are tremendous, and the American Psychiatric Association, publisher of the manual, has attracted support as well as harsh criticism.
Could these revisions actually cause more harm than good? I’m not sure,
but I want to explore the implications of just one of the proposed
revisions – that concerning EDNOS, or “Eating Disorders Not Otherwise Specified.”

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The worth of a life and a life worth living

There has been a lot of discussion about health care rationing in the North American media over the last year, much of it hysterical and barely coherent. A number of respected ethicists have tried to make the case for rationing, including Peter Singer in the New York Times last year, and recently John Freeman.

This week Newsweek Science Editor Sharon Begley asked ‘What is a Life Worth?’ drawing on a recent study presented at the American Society for Maternal-Fetal Medicine meeting. Begley noted

“This is the kind of news that unleashes hysteria about "death panels" and "health-care rationing," but here goes: an analysis of genetic screening for an incurable, untreatable disease called spinal muscular atrophy shows that it would cost $4.7 million to catch and avert one case, compared with $260,000 to provide lifetime care for a child born with it. So here's the question: do we say, "Damn the cost; it is worth any price to spare a single child the misery of being unable to crawl, walk, swallow, or move his head and neck"—or do we, as a society, put on the green eyeshades and say, "No, sorry, we can't afford routine screening"?”

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Court compels woman to go to bed

Jacob M Appel writes in the Huffington Post  that Samantha Burton was 25 weeks pregnant when she ruptured her membranes and started contractions. There was a risk of infection and premature birth, risking her health and the life of her unborn child. It could also risk the health of her future child who may survive but be disabled.                                                                                                             
Burton was ordered rest in hospital for the remainder of her pregnancy. She wanted to go home but wasn't allowed to leave.

The hospital successfully went to court forcing Burton to comply. 

Three days later she had an emergency cesarean, but the baby was stillborn.

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The Racist Shopper

By: David Edmonds

The Equality Bill is currently making its way through the two unequal chambers of the British parliament.  It’s radical and wide-ranging and the debate about it has been heated, but the most interesting contribution has come from the upper chamber, the House of Lords.  In a thoughtful speech, Bhikhu Parekh, a political theorist, advanced an argument in support of positive action.  He said that in some circumstances one’s sex could in itself be a qualification for a post.

Take a hospital whose obstetrics and gynaecology department is all-male. Many women would like to be seen by a female gynaecologist, but there is none. A vacancy occurs. We have two candidates, a male and a female, with equal medical or academic qualifications and equal professional experience. The woman doctor could be appointed, either as a form of positive action, or by simply saying that the needs of the organisation require that her gender is an important part of the qualification itself. In other words, what is called positive action here is not simply an add-on in a situation where there is equality of qualification or experience, rather it is built into the structure of the assessment criteria themselves, so that she is appointed because she has an additional qualification, by virtue of her gender, which others do not have.
 

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Easing the passing: Death booths, misrepresentations and the ‘Ugh factor’

Death is in the air. To stop us being engulfed by the ‘silver
tsunami’,  Martin Amis urges the
construction of euthanasia booths, and encourages the elderly to go to them for
a martini, a medal and a pharmaceutical nudge into the void. Terry Pratchett
talks cosily about ‘shaking death by the hand’ as he sits on his lawn, Tallis
on his IPod, drinking some modern Socratic hemlock washed down with vintage
brandy. He and his backers in the euthanasia industry shrewdly propose death
tribunals who, having heard evidence about individual cases, would sign or
withhold a death warrant. Such tribunals, they say, would obviate the risk that
vulnerable people might opt unacceptably for euthanasia. The opinion polls
consistently indicate considerable public support for a change in the law
against assisted suicide. The opponents of assisted dying are caricatured as
reactionary bigots, probably fuelled by otiose, antediluvian religious
prejudice: people who care more about some dogma of the sanctity of life than
about pain, fear, despair and autonomy. The crusade for assisted dying is a
campaign by the modern and enlightened against the mediaeval  and  benighted.

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Brain imaging and PVS: How excited should we be?

How exciting is the new research on the consciousness of patients diagnosed as in a persistent vegetative state (discussed here)? From a scientific point of view, this is an important piece of research. The ability to respond to yes/no questions is surely a reliable indicator of consciousness; once we have identified patients who can pass this test, we can begin to conduct other tests, to see whether the results correlate. We can begin to see whether the evidence of electrical activity in the brain in response to words or to physical discomfort reflect consciousness or are merely indicators of unconscious activity.  The new research also might have great diagnostic value. But we must be careful not to overinterpret the results.

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Is the brain half full – or half empty?

There have been dramatic headlines in the media ('Coma Man. I think…I’m alive') following the publication yesterday of a new study using brain scans to detect consciousness in profoundly brain damaged patients. For the first time scientists and doctors have demonstrated that some patients diagnosed with persistent vegetative state may be able to communicate using functional magnetic resonance imaging (fMRI).

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Persons of the Sea?

You’ve stumbled upon a group of beings. For all you can tell, these beings are self-aware, intelligent, have emotions, solve complex problems, and call each other by name. They have thoughts and feelings and probably experience life in a way that is very similar to your own. Are they persons? And do you have moral obligations towards them?

Thomas White, Fellow at the Oxford Centre for Animal Ethics, has made news claiming that we have found such a group of beings. In fact, we’ve been living alongside them for a while now. They’re dolphins, and they’re people too. At an upcoming AAAS conference in San Diego, White will be arguing that dolphins deserve the status of “nonhuman persons”. The research in marine science now overwhelmingly shows that dolphins have a highly sophisticated type of consciousness and inner world – and their cognitive capacity is second only to humans (yes, they beat chimps). With such high intellectual and emotional abilities, White claims they are entitled to special moral status and protections. The implications for current practices involving dolphins (in the context of fishing, entertainment, research and the military) are serious, since they would be considered chillingly unethical if they involved human persons.

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Mind the Gap?

Much attention has been paid over the last week or so to An Anatomy of Economic Inequality in the UK, a government-sponsored study which has taken over ten years to produce: http://www.guardian.co.uk/society/2010/jan/27/unequal-britain-report

The study contains a huge amount of data, much of it on the gaps between richer and poorer groups. It turns out, for example, that the richest 10% own about one hundred times as the poorest 10%. Many appear to think that such inequality is obviously, in itself, a bad thing — something any government, especially one with its roots in socialism, ought to be doing something about. But in fact this is far from obvious. Imagine that each person in the poorest group were earning £100,000 p.a., and each in the richest group £10,000,000. Such a result would be described as an economic and political miracle. Or imagine that the government sought to deal with the real gaps between rich and poor merely by 'levelling down' the income of the rich to that of the poor. Given the absence of any trickling down, and the effects on incentives, the outcome of such a policy might well be to make everyone, both existing rich and existing poor, even poorer than they are now. The fact that the gap would have disappeared seems irrelevant in a situation when all have been made worse off.

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Professor George’s Unnatural Reasoning

Some of us know Professor Robert George as the ultraconservative Catholic bioethicist from Princeton. It could hardly be said that his writings have dominated discussion in contemporary ethics. It is thus slightly surprising to find out, in recent profile in the New York Times, that Professor George is a thinker of immense influence—the mastermind of the conservative side of the culture wars in the US, having the ear of rightwing political leaders and religious authorities, even of TV commentators. What is Robert George’s exciting new idea? There is nothing terribly surprising about his views. He is of course vehemently opposed to abortion, stem cell research, homosexuality, and same-sex marriage. What is supposed to be exciting is that he claims to demonstrate the truth of these familiar conservative views using natural reason alone. Finally conservatives can conclusively prove that liberals are dead wrong, and they don’t even need to mention tradition and religion. Well, Professor George’s arguments might have awed George W. Bush, but on inspection they turn out less than impressive.

 

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