Civilisation: 1 - Jamaica: 0 - Beenie Man concerts cancelled

Latest result in the ongoing match between Jamaica and civilisation. We won, Jamaica lost. Here from a circular Peter Tatchell just posted:

Beenie Man concerts axed in Australia & NZ

Big Day Out organisers faced storm of protest

Tour cancellation sends warning to all murder music singers

Beenie Man incited the murder of lesbians and gays

London, UK - 16 November 2009

All of Beenie Man's Australian and New Zealand concert dates have been cancelled. This follows protests by gay rights groups, including the Australian Coalition for Equality. It also follows representations to the tour organisers by Peter Tatchell of OutRage!, acting on behalf of the international Stop Murder Music campaign.

"These concert cancellations will hit Beenie Man hard in the pocket. He has lost tens of thousands of dollars. The success of this campaign sends a warning message to all murder music artists: inciting homophobic violence will cost you money. You will lose out big time," said Mr Tatchell.

Beenie Man had been scheduled to perform in January 2010 at Big Day Out concerts in the Australian cities of Sydney, Melbourne, Adelaide and Perth and in the New Zealand city of Auckland.

The organisers have now confirmed that he will not be in the concert line-up:
http://www.bigdayout.com/news/pressreleases.php?PressReleaseId=52

For more information about the concert cancellations in Australia, contact Big Day Out organiser, Susan Forrester, in Melbourne: 00 613 9820 4677 and susan@bigdayout.com

Ms Forrester contacted Peter Tatchell of the gay rights group OutRage! seeking his advice on whether to go ahead with the Beenie Man booking.

Mr Tatchell replied to her, urging Big Day Out to cancel Beenie Man's concerts. He wrote to Ms Forrester as follows:

"Beenie Man is clearly unrepentant. He has never apologised for urging the killing of gay people. In fact, he put out a statement and hit song called 'I no apologise'. You would not consider hosting Beenie Man if he was a white racist singer who had called for the murder of black people. You would dump him. There should be no double standards when it comes to singers who incite homophobic violence," wrote Mr Tatchell.

"Beenie Man is one of Jamaica's leading reggae stars. He has had hit tunes which incite the murder of lesbians and gay men. It is a tragedy that he has not used his undoubted musical talent to promote the true reggae message of justice, harmony, peace and love.

"Although Beenie Man made an agreement to cease his murder music, he has since reneged and denounced the agreement. He went on to release a song: 'I no apologise,'" confirmed Mr Tatchell.

In his hit tune Damn, Beenie Man sings: "I'm dreaming of a new Jamaica, come to execute all the queers."

Another of his popular recordings, Bad Man Chi Chi Man (Bad Man Queer Man), instructs listeners to kill gay DJs and boasts that people would gladly go to jail for killing a queer:

"If yuh nuh chi chi (queer) man wave yuh right hand and (NO!!!) / If yuh nuh lesbian wave yuh right hand and (NO!!!) / Some bwoy will go a jail fi kill man tun bad man chi chi man!!! / Tell mi, sumfest it should a be a showdown / Yuh seem to run off a stage like a clown (Kill Dem DJ!!!)".

Chi Chi Man is a very offensive Jamaican patois homophobic slang insult, equivalent to the insulting words queer, poof and faggot.

Promises, promises, promises - when will Rupert Murdoch DO as opposed to promise

Rupert Murdoch, proprietor of right-wing propaganda outlets such as the SUN and New York Post newspapers, and not to forget Fox 'News' promised the world that he would remove content from these and his other media from google. I think that's excellent news.

There is always the risk that accidentally I click a link found on google news and suddenly find myself on a New International site, thereby being inadvertently subjected to News Corp propaganda as opposed to actual news. If Rupert was to remove this challenge in order to charge (laughter) for access to his agitprop, he would do the world a BIG favour. Please Rupert, go for it...

Pfizer is at it again

I am reproducing a news wire from AP that I came across today. Watch out for the publication of the analysis in the New England Journal of Medicine. As ever Pfizer is the culprit. No wonder they are busy sponsoring ever more bioethics positions... unsurprisingly there are also happy takers among universities. I sometimes wonder whether there is any kind of cash that they would not take! Interesting that Pfizer's spin doctors would describe the peer reviewed publication in the leading medical journal as unable to pass the threshold of 'credible scientific research'. Clearly the reviewers and lawyers the journal employed to determine the value of the report thought differently.

First, here are the findings from the abstract of the report: 'We examined reporting practices for trials of gabapentin funded by Pfizer and Warner-Lambert's subsidiary, Parke-Davis (hereafter referred to as Pfizer and Parke-Davis) for off-label indications (prophylaxis against migraine and treatment of bipolar disorders, neuropathic pain, and nociceptive pain), comparing internal company documents with published reports. Results We identified 20 clinical trials for which internal documents were available from Pfizer and Parke-Davis; of these trials, 12 were reported in publications. For 8 of the 12 reported trials, the primary outcome defined in the published report differed from that described in the protocol. Sources of disagreement included the introduction of a new primary outcome (in the case of 6 trials), failure to distinguish between primary and secondary outcomes (2 trials), relegation of primary outcomes to secondary outcomes (2 trials), and failure to report one or more protocol-defined primary outcomes (5 trials). Trials that presented findings that were not significant (P0.05) for the protocol-defined primary outcome in the internal documents either were not reported in full or were reported with a changed primary outcome. The primary outcome was changed in the case of 5 of 8 published trials for which statistically significant differences favoring gabapentin were reported. Of the 21 primary outcomes described in the protocols of the published trials, 6 were not reported at all and 4 were reported as secondary outcomes. Of 28 primary outcomes described in the published reports, 12 were newly introduced.'

Here the AP summary as well as the usual talking head one-liners toward the end, exasperation and all...

'Analysis of a dozen published studies testing possible new uses for a Pfizer Inc. epilepsy drug found that reporting of the results was often misleading, indicating the medicine worked better than internal company documents showed.

According to the report, when a company-funded study's primary finding wasn't favorable, that result was usually buried and something else positive was highlighted, without disclosing the switch.

The documents used in the review were obtained by lawyers suing Pfizer for refunds on prescriptions paid for by insurers and consumers. The lawyers, who are seeking class action status for the cases, claim Pfizer concealed evidence the epilepsy drug Neurontin didn't work for those unapproved uses, including nerve pain, migraines and bipolar disorder.

One of the report's authors is an expert witness for the plaintiffs; another has received fees from the lawyers.

Pfizer disputes the report's conclusions, saying the company never "attempted to mislead the medical community about the effectiveness" of the drug for certain uses.

"We believe the review suffers from significant bias, insufficient data, poor methodology, and cannot pass the threshold of credible scientific research," Pfizer said in a statement.

The report, by researchers at the University of California at San Francisco and the Johns Hopkins Bloomberg School of Public Health, comes two months after Pfizer was fined a record $2.3 billion — including an unprecedented $1.2 billion criminal fine — for illegally marketing other blockbuster drugs.

The report appears in Thursday's New England Journal of Medicine.

Dr. Sidney Wolfe, head of health research at consumer group Public Citizen, called it the first comprehensive look "at studies in which a company and people working for it so maliciously manipulated the data to make a drug look more effective than it actually was."

"In every instance, the published article made the drug look better than it would have," said Wolfe, a member of the Food and Drug Administration's drug safety advisory committee. "This results in harm."

Neurontin was approved by the FDA a decade ago for treating seizures and later for pain caused by shingles — but not for other conditions. Its potential side effects include suicidal tendencies and depression.

While doctors can prescribe drugs for unapproved, or off-label uses, drug companies are legally barred from promoting their products for such uses. Drugmakers often test drugs for additional conditions and publicize the results. But they don't always seek approval for those new uses, particularly if the new findings aren't convincing.

Experts believe most Neurontin sales were for off-label uses — the ones in the reviewed studies. Sales peaked at $2.7 billion in 2004, when Pfizer paid $430 million in government fines to settle allegations it improperly marketed the epilepsy drug for unapproved uses. By last year, Neurontin sales fell to $387 million due to cheaper generic versions sold as gabapentin.

For the new review, the researchers examined 20 patient studies funded by New York-based Pfizer and its Parke-Davis unit on use of Neurontin for preventing migraines or treating nerve pain or bipolar disorder. The studies were published in medical journals or presented at conferences, mostly over the last decade.

In eight of the 12 published studies, the main outcome listed in internal documents differs from the one later given in the published report. In half the cases, a new primary outcome was substituted and in others, the original main outcome was instead reported as a secondary measure or wasn't disclosed at all.

The authors cited some limitations to their review, including not knowing who made the changes.

"We cannot be certain that selective reporting was a decision made by employees of Pfizer and Parke-Davis, since the authors of the published reports included nonemployees," the researchers wrote.

Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics, called the report "one of the most ethically disturbing papers I've read in some time" and "an indication that people have been playing fast and loose with studies," particularly industry ones.

Caplan said the FDA should have the power to audit industry drug studies. Wolfe said there should be bigger fines and jail terms for manipulating study data, plus tougher rules for studies being published in journals.

Medical journals in recent years have required that studies be listed on a federal Web site, http://www.clinicaltrials.gov, to be eligible for publication. That move was made partly to make it harder for industry to hide studies on products that don't pan out and only publish those with good results. The study descriptions also list their primary and secondary outcomes.

Pfizer said it now has 1,245 company-sponsored studies listed on the Web site.

Copyright © 2009 The Associated Press. All rights reserved.

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something light for the weekend

courtesy of the huffington post

Stand up, stand up, against Jesus

Civility has its uses, but we should not be afraid of satire and mockery as weapons against religious power

• Russell Blackford and Udo Schuklenk
• guardian.co.uk, Friday 6 November 2009 10.30 GMT

The question: Is there an atheist schism?

Religious teachings promise us much — eternal life, spiritual salvation, moral direction, and a deeper understanding of reality. It all sounds good, but these teachings are also onerous in their demands. If they can't deliver on what they promise, it would be well to clear that up. Put bluntly, are the teachings of any religion actually true or not? Do they have any rational support? It's hard to see what questions could be more important. Surely the claims of religion — of all religions — merit scrutiny from every angle, whether historical, philosophical, scientific, or any other.

Contrary to many expectations in the 1970s, or even the 1990s, religion has not faded away, even in the Western democracies, and we still see intense activism from religious lobbies. Even now, one religion or another opposes abortion rights, most contraceptive technologies, and therapeutic cloning research. Various churches and sects condemn many harmless, pleasurable sexual activities that adults can reasonably enjoy. As a result, these are frowned upon, if not prohibited outright, in many parts of the world, indeed people lose their lives because of them. Most religious organisations reject dying patients' requests to end their lives as they see fit. Even in relatively secular countries, such as the UK, Canada, and Australia, governments pander blatantly to Christian moral concerns as the protection of religiously motivated refusals to provide medical professional services demonstrates.

In a different world, the merits, or otherwise, of religious teachings might be discussed more dispassionately. In that world, some of us who criticise religion itself might be content to argue that the church (and the mosque, and all the other religious architecture that sprouts across the landscape) should be kept separate from the state. Unfortunately, however, we don't live in that world.

When religion claims authority in the political sphere, it is unsurprising — and totally justifiable — that atheists and skeptics question the source of this authority. If religious organisations or their leaders claim to speak on behalf of a god, it is fair to ask whether the god concerned really makes the claims that are communicated on its behalf. Does this god even exist? Where is the evidence? And even if this being does exist, why, exactly, should its wishes be translated into law?

In many situations, it is better to be civil, as Paul Kurtz has pointed out, but satire and mockery have traditionally had a legitimate place whenever absurd ideas are joined to power and privilege. Enlightenment thinkers such as Voltaire often used mockery to show the absurdity of ideological stances — including religious ones — that were considered sacrosanct. Mockery is one way of saying that a view does not deserve to be taken seriously. Religious views are fair game if one can also show, on a more serious level, why the view in question does indeed not deserve serious respect.

Perhaps some rationalist or humanist organisations, such as Kurtz's venerable Center for Inquiry, do have good reason to maintain a scholarly and dignified brand image. But there is also room for the younger, brasher atheists whom Kurtz inaccurately brands as "fundamentalists", and, in any event, there is a world of difference between appropriate civility and keeping quiet.
In the US, unfortunately, some atheists appear to have concluded that even civil and thoughtful criticism of supposedly "moderate" religion (i.e., almost anything that does not dispute evolutionary theory) should be discouraged.

These "accommodationist" atheists tend to be focused on science advocacy, particularly the teaching of evolution in public schools. In seeking public support for their positions, they think it prudent to take the various American demographics as they are. Since they want to sell evolutionary science to very large numbers of pious Americans, the last thing they want is to see it linked with atheism.

Once you think in that way, from a kind of marketing perspective, it can take over your approach to what you think you ought to say. Sincerity goes out the window, and everything must be "framed" to please the audience. We doubt that this strategy can work.

Religion cannot be eradicated — that is not a realistic goal — but the many problems with religious dogma can and should be highlighted. As atheists, we should state clearly that no religion has any rational warrant, and that many churches and sects promote cruelty, ignorance, and civil rights abuses.

There are harmful consequences to real people in the real world if the views of churches and sects are enshrined in law or given undue social deference - the acceptance even in liberal secular societies of conscientious objection as a legitimate reason for health care professionals and even civil servants to refuse to provide professional services to certain citizens is a case in point. For these reasons it is important that we should speak out and publicly contest the special authority that is accorded, all too often, to pontiffs, imams, priests, and presbyters. Religious leaders are not our moral leaders, much as they clamour to be, and however much the politicians flatter them. These spiritual emperors have no clothes, and we shouldn't flinch from saying so.

Bizarre commentary by Jamaican literature prof on violent lyrics

I'm sure many of you have heard about how homophobic Jamaica is, all the way up to the murder of gays and lesbians. Part of the responsibility for this, it has been suggested by some, are antigay violent lyrics by local artists calling in their songs for the murder of gays and lesbians. Here's the take of a local academic arguing that gays and lesbians who call for such artists' concerts to be canceled and boycotted are 'pathological'. Check out her take on the issue first, and then read my commentary below. Turns out to be the case that she attended the latest CD launch of the artist who called in past lyrics for the murder of gay people. I sent the below reply to the newspaper that published her OpEd; realistically you won't see my riposte there, though. Jamaican public debate is sufficiently incestuous to prevent that from happening. -

To whom it may concern:

Professor Cooper's editorial, well-intentioned and unusually considerate (by Jamaican standards) doesn't add up. She complains essentially that a Jamaican singer whose repertoire included a song calling for the killing of gay people is still subjected to boycott campaigns by gays and lesbians in other countries. She calls such campaigns 'perverse'. Cooper considers the offending song's lyrics 'infamous', however anyone not wanting the singer to perform in their neighbourhood is acting under a 'particularly perverse pathology'. Really, is my attempt at keeping such artists out of my country sick, Professor Cooper? So, our Jamaican artist sings infamous songs, while those who would be at the receiving end of his murderous art are sick (aka pathological). Nice touch professor, truly a well-balanced statement. You should be safe in homophobic Jamaica (whatever that means these days).

What reasons has Professor Cooper on offer for her take on the issue?

Well, for starters, she points out that our artist hero hasn't sung the song in question for awhile and launched recently a CD hoping it would be bought by amongst others gays, lesbians, and - guess what - even slim people. Let me just say that to the best of my knowledge, he has not yet apologized and retracted the song in question. That a more market savvy performer tries to increase market share is understandable, but surely shouldn't be seen as evidence for a changed mind set.

Comes the professor's next reason: the US based ACLU is defending the artist's 'right' to perform. The ACLU, of course, also defends the KKK's right to propagate its racist views in public. It's the result of a particularly silly bit of US Constitution that puts virtually no limits on speech acts, unlike any other country in the world. You could not make such statements anywhere in Europe (neither the Jamaican artist's 'lyrics' nor the KKKs racist rabble-rousing). The result is that such societies are more cohesive and peaceful than the USA.

And another lost-case type argument from our literary professor. She claims, citing an unsubstantiated statement from an ACLU activist, that there is no causal evidence that hate speech calling for violence against minority groups leads to such violence. There is an obvious reason for this: actions usually have multiple causes, some conscious, others unconscious. We do know that propaganda works; why it shouldn't work in a pathologically homophobic place such as Jamaica remains a mystery to me. Gay people have experienced time and again spikes in anti-gay violence following high-profile homophobic statements by artists or politicians and the like. Equally, many minority ethnic people in Britain were deeply incensed when the BBC permitted recently the BNP leader Nick Griffin to speak on a program. They pointed out that the mainstreaming of racism will undoubtedly lead to an increase in racist violence. I wonder whether Professor Cooper fully appreciates the implications of her feeble attempt at denying the link between homophobic statements calling for violence against gays and lesbians and the occurrence of such violence.

Her last unsubstantiated claim is that fans potentially engaging in homophobic violence would not do so after dancing to artists' tunes encouraging them to kills gays and lesbians. Is she seriously suggesting that there might be people out there who were considering killing gays and lesbians and then these folks get prevented from doing this because they attend a concert with an artists calling on them to go through with their tentative plans? What can I say, this surely is a breathtaking empirical claim without any basis in fact.

So, there you go, now you know why us folks outside your island go out of our way to have your violence and art kept where it belongs, namely on your island - as your problem, not ours. Let Buju apologize for this song and we will welcome him with open arms.

Royal Society of Canada End-of-Life Decision-Making Panel

RSC: The Academies of Arts, Humanities and Sciences of Canada (the Royal Society of Canada) will announce “End-of-Life Decision Making”, an expert panel commissioned at its own initiative. The press release follows.

RSC/SRC Expert Panel on End-of-Life Decision Making

October 26, 2009

Among the many public-service roles of national academies around the world, one of the most important is the preparation of expert assessments on critical issues of public policy. The national academies in the United States are the most active in this regard, but the senior academies in other nations, notably in England, France, and other European countries, have been very active on this front for many years. Such reports are designed to be balanced, thorough, independent, free from conflict of interest, and based on a deep knowledge of all of the published research that is pertinent to the questions that have been posed.

The Royal Society of Canada (RSC) also has a long record of issuing definitive reports of this kind, either on its own initiative, or in response to specific requests from governments or other parties. The project being announced today, “End-of-Life Decision Making,” is one of a new series that the Society has commissioned, at its own initiative, on issues of significant public interest and importance at the present time. Announcements on the other projects will follow over the course of the coming months.

The Society relies on the advice of one of its senior committees, The Committee on Expert Panels (CEP), in formulating new projects of its own and in responding to requests for panel projects from external parties. In addition, the members of the Society’s CEP are responsible for selecting the membership of panels, including the chair; overseeing the conduct of panel activities; managing the peer review of the draft final report; and assisting the panel members with any difficulties that arise during the conduct of their work.

Over the course of the past year, the CEP has brought forward suggestions on a new series of expert panel reports for consideration by the Society’s governing board. The board has approved a number of these suggestions, including the project on “End-of-Life Decision Making.” The additional information, below, identifies the members of the panel who have agreed to write this report, as well as the preliminary terms of reference for this project.

Questions about this project may be directed to:

Professor Udo Schuklenk (panel chair), Queen’s University:

udo.schuklenk@gmail.com

Telephone: Office 613-217-8659

Professor Daniel Weinstock, Université de Montréal:

daniel.marc.weinstock@umontreal.ca

Telephone: Office 514-343-7345

Members of the RSC/SRC Expert Panel

(6 Panel Members)

Chair: Udo Schuklenk, PhD:

· Professor of Philosophy and Ontario Research Chair in Bioethics, Queen’s University

· http://www.udo-schuklenk.org/

· Publications: http://www.udo-schuklenk.org/researchs.htm

Before coming to Canada he worked at Australian, British, German, and South African universities, including Monash University’s Centre for Human Bioethics and at the University of Central Lancashire’s Centre for Professional Ethics. He is currently Joint Editor in Chief of Bioethics and founding editor of Developing World Bioethics. Both journals are listed in major indices including MedLine.

Members:

1. Johannes J. M. van Delden, MD, PhD:

Julius Center for Health Sciences, University Medical Center, Utrecht University, Utrecht, The Netherlands; Chair, Ethical Commission of the Medical Council of the Royal Netherlands Academy of Arts and Sciences (KNAW)

http://people.juliuscentrum.nl/profile.aspx?id=10959

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1331141

http://jme.bmj.com/cgi/content/extract/33/4/187

2. Jocelyn Downie, S.J.D.:

Canada Research Chair in Health Law and Policy
Professor, Faculties of Law and Medicine, Dalhousie University

http://law.dal.ca/Faculty/Full_Time_Faculty/Bios/Jocelyn_Downie/index.php

3. Sheila McLean, PhD, LLD, LLD, FRSE, FRCGP, FRSA:

First holder of the International Bar Association Chair of Law and Ethics in Medicine at Glasgow University and Director of the Institute of Law and Ethics in Medicine at Glasgow University.

http://www.gla.ac.uk/departments/schooloflaw/staff/academic/mcleans/

4. Ross Upshur, MD, MSC:

Canada Research Chair in Primary Care Research and Associate Professor, Departments of Family and Community Medicine and Public Health Sciences, University of Toronto; Director, University of Toronto Joint Centre for Bioethics

http://www.sunnybrook.ca/team/member.asp?t=13&page=1199&m=175

http://www.jointcentreforbioethics.ca/people/upshur.shtml

5. Daniel Weinstock, PhD:

Canada Research Chair in Ethics and Philosophy, University of Montreal

Professeur titulaire, Département de Philosophie, and Directeur du Centre de recherche en éthique de l'Université de Montréal (CREUM)

http://www.philo.umontreal.ca/prof/daniel.marc.weinstock.html

End-of-Life Decision Making

Context and Preliminary Terms of Reference (June 18, 2009)

Introduction

The purpose of these preliminary terms of reference is to indicate some of the main boundaries of the project description. At its initial meetings the panel will do a careful review of this preliminary statement and will indicate more precisely the ultimate scope and focus of the project, which is expected to be more limited than what is presented here. The final terms of reference will be released by RSC at that time.

Objectives

This is one the most serious social and ethical issues facing all advanced countries. The many and varied perspectives relevant to the issue are rarely presented to the public in a balanced, thorough, and informed way. A RSC expert panel report could make a significant contribution to the public policy debate on this issue.

1. There is a large body of medical science evidence that, if summarized for the public, would be helpful to their consideration of the issue.

2. The public could also benefit from a presentation of evidence about actual experience from the various jurisdictions that permit physician-assisted death.

3. The public would also benefit greatly from having a careful, balanced review of various pros and cons of decriminalization of physician-assisted death from well-reasoned ethical and legal standpoints.

4. Many medical personnel would also benefit from having all the issues laid out in a comprehensive and sensitive way.

5. The panel should consider proposing policy recommendations for public consideration that are the results of its review.

Questions that may be considered by the panel

1. Is either physician-assisted suicide [PAS] or voluntary euthanasia [VE] ever morally justifiable and should either be decriminalized under certain carefully defined conditions? If so, under what conditions?

2. Is there a morally significant difference between withholding and withdrawing life-prolonging treatment, on the one hand, and hastening a patient’s death by VE or PAS, on the other?

3. Is “terminal sedation” (sometimes referred to as “palliative sedation”) a morally and legally preferable option to VE or PAS? Does the distinction between terminal sedation and life-shortening symptom relief make sense in practice? What is the situation with regard to the provision of potentially life-shortening symptom relief? It is a practice that is, to a certain extent, in the shadows. It has not been addressed explicitly and comprehensively in the law and leaves some wondering whether it is legal or not and therefore whether some people may not be getting adequate symptom management.

4. Is cessation of eating or drinking (or of artificial hydration and nutrition) a morally and legally preferable option to VE or PAS?

5. Is there evidence of abuse with respect to PAS and VE in jurisdictions in which PAS or VE have been decriminalized (particularly those with contexts comparable to Canada)? What types of data should be considered germane and persuasive to this question?

6. What, if any, safeguards could prevent abuse and exploitation of VE and PAS without erecting insuperable barriers for people who wish to access these forms of assisted dying?

7. Is the concept of human dignity a useful one for discussions of VE and PAS?

8. Is either VE or PAS consistent with traditional medical ethics? What has the Hippocratic Oath to say with regard to this? Would either be likely to undermine the bond of trust between doctor and patient? Would either be likely to enhance the bond of trust between doctor and patient?

9. Are Advance Directives reasonable, ethically and legally defensible instruments to express a formerly competent patient's wishes? What is the value (or lack thereof) of Advance Directives in this context? Is there a difference between positive and negative directives?

10. If it is determined that VE and PAS should be legally permitted, how should the issue of incompetent dying patients be approached?

11. What is the legal and ethical status of unilateral withholding and withdrawal of potentially life-sustaining treatment? (It is a hotly-contested area of end of life practice in Canada right now and is one that is causing significant moral distress for everyone involved.)

12. Why does consent (or refusal), which has the effect of legitimizing some behaviours, not seem to have the same effect in the case of PAS or VE?

13. How should we evaluate false positives and false negatives? Is it worse to have a system in place that allows for a lot of needless suffering and thwarting of individual autonomy, but never generates a single false positive, or is the converse true? (This makes a difference to how we calibrate the safeguards.)

Suggested approach to the topic

(a) Begin by asking: What is the state of current knowledge with respect to the following?

· What are the current states of practice with respect to end of life care in Canada (with respect to withholding and withdrawal, potentially life-shortening symptom relief, PAS, and VE)? What are the main variables in this area? Who are the main decision-makers? What are the default positions (what usually happens unless someone protests strongly)? What is the current state of the empirical evidence with regard to PAS and VE?

· How do families of patients, patients and health care providers feel about the current states of practice?

· What trajectory of development are we on in this area?

· How are providers, patients and families being educated?

· What is the law in this area in Canada? What are Canadians' beliefs about the law? What are Canadians' views about what the law should be like?

· What is driving current decision-making in this area – e. g., is it economics, shortages of providers, lack of training, normative stances, etc.?

(b) Then ask: What are the main value positions (normative stances) in play and to what extent are they actually motivating decisions?

(c) Then move on to the substantive normative questions in the light of the above. The panel's report should aim not to duplicate work already undertaken in other reports. Instead, the panel will undertake a review of such work prior to formulating its own analysis of the issues.

******************************************************

Bonjour,

Demain, la SRC : Les Académies des arts, des lettres et des sciences du Canada (la Société royale du Canada) annoncera un groupe d’experts commandé, de son propre chef, sur « La prise de décisions en fin de vie». Le communiqué suit.

Groupe d’experts de la SRC sur la prise de décisions en fin de vie

Le 26 octobre 2009

Parmi les nombreux rôles de service public que jouent les académies nationales dans le monde, l'un des plus importants est sans doute la production de rapports d'experts sur les enjeux importants de la politique gouvernementale. Les académies nationales des États-Unis sont les plus actives à cet égard, mais celles d'autres pays, notamment de l'Angleterre, de la France et d'autres nations européennes, sont aussi très actives sur ce front depuis de nombreuses années. Ces rapports doivent être équilibrés, exhaustifs, indépendants, libres de tout conflit d'intérêts et fondés sur une connaissance approfondie de la recherche publiée se rapportant aux questions qui ont été posées.

La Société royale du Canada (SRC) a également une longue feuille de route en matière de production de rapports définitifs de ce genre, qu'elle les produise de sa propre initiative ou en réponse à des demandes précises des gouvernements ou d'autres parties. Le projet annoncé aujourd'hui, « La prise de décisions en fin de vie » fait partie d'une nouvelle série de projets que la Société a commandés, de son propre chef, concernant des enjeux d'intérêt public d'une grande importance. Les autres projets seront annoncés au cours des prochains mois.

La Société se fie aux conseils d'un de ses principaux comités, le Comité sur les groupes d'experts, pour élaborer les nouveaux projets qu'elle met en œuvre de sa propre initiative ou en réponse à des demandes provenant de parties externes. Les membres de ce Comité sont également responsables de sélectionner les membres du groupe d'experts, y compris le président, de superviser les activités du groupe, de gérer l'examen par les pairs de la version préliminaire du rapport final et d'aider les membres du groupe d'experts si des difficultés surviennent durant leurs travaux.

Durant la dernière année, le Comité sur les groupes d'experts a suggéré au conseil d'administration de la Société une nouvelle série de rapports d'experts. Le conseil a approuvé un bon nombre des suggestions, y compris le projet sur les « La prise de décisions en fin de vie ». Les renseignements ci-dessous indiquent qui sont les membres du groupe d'experts, qui ont accepté de rédiger ce rapport, ainsi que le cadre de référence préliminaire de ce projet.

Les questions concernant ce projet peuvent être adressées à :

Professor Udo Schuklenk (panel chair), Queen’s University:

udo.schuklenk@gmail.com

Téléphone: 613-217-8659

Professor Daniel Weinstock, Université de Montréal:

daniel.marc.weinstock@umontreal.ca

Téléphone: 514-343-7345

Composition du groupe d'experts de la SRC

(six membres)

Président : Udo Schuklenk, Ph. D. :

· Professeur de philosophie et directeur de la chaire de recherche en bioéthique, Université Queen’s

· http://www.udo-schuklenk.org/

· Publications : http://www.udo-schuklenk.org/researchs.htm

Avant son arrivée au Canada, il a travaillé dans différentes universités en Australie, en Grande-Bretagne, en Allemagne et en Afrique du Sud, dont au Centre de bioéthique humaine de l’Université Monash et au Centre d’éthique professionnelle de l’Université du Central Lancashire. Il est actuellement corédacteur en chef de la revue Bioethics et rédacteur en chef fondateur de la revue Developing World Bioethics. Ces deux publications figurent dans les principaux index, y compris MedLine.

Membres :

1. Johannes J. M. van Delden, M.D., Ph. D. :

Centre Julius pour les soins de la santé, Centre médical universitaire, Université d’Utrecht, Pays‑Bas; chaire, commission d’éthique du Conseil médical de l’Académie royale des arts et des sciences néerlandaise (KNAW)

http://people.juliuscentrum.nl/profile.aspx?id=10959

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1331141

http://jme.bmj.com/cgi/content/extract/33/4/187

2. Jocelyn Downie, S.J.D. :

Chaire de recherche du Canada sur le droit et la politique de la santé

Professeure, facultés de droit et de médecine, Dalhousie University

http://law.dal.ca/Faculty/Full_Time_Faculty/Bios/Jocelyn_Downie/index.php

3. Sheila McLean, Ph. D., LL.D., FRSE, FRCGP, FRSA :

Première titulaire de la chaire de droit et d’éthique médicale de l’Association internationale du barreau et directrice de l’Institut de droit et d’éthique médicale, University of Glasgow

http://www.gla.ac.uk/departments/schooloflaw/staff/academic/mcleans/

4. Ross Upshur, M.D., M.SC. :

Chaire de recherche du Canada dans le domaine des soins primaires et professeur, départements de médecine familiale et communautaire et des sciences de la santé publique, University of Toronto; directeur, Centre conjoint de bioéthique du University of Toronto http://www.sunnybrook.ca/team/member.asp?t=13&page=1199&m=175

http://www.jointcentreforbioethics.ca/people/upshur.shtml

5. Daniel Weinstock, Ph. D. :

Chaire de recherche du Canada en éthique et en philosophie, Université de Montréal

Professeur titulaire, département de philosophie, et directeur du Centre de recherche en éthique de l'Université de Montréal (CREUM) http://www.philo.umontreal.ca/prof/daniel.marc.weinstock.html

Groupe d’experts de la SRC sur la prise de décisions en fin de vie

Principes généraux préliminaires (le 18 juin 2009)

Introduction

Ces principes généraux préliminaires ont pour but d’établir certaines balises essentielles en ce qui a trait à la description du projet. Au cours de ses premières réunions, le groupe d’experts examinera attentivement cette description préliminaire et précisera la portée et le but du projet, qui devraient être plus limités que ce que nous présentons ici. Les principes généraux finaux seront établis par la SRC à ce moment-là.

Objectifs

Cette question est celle qui, dans tous les pays avancés, pose les problèmes sociaux et éthiques les plus sérieux. Les très nombreux points de vue sur la question sont rarement présentés au grand public de façon objective, approfondie et éclairée. La publication d’un rapport par un groupe d’experts de la SRC pourrait contribuer de façon importante au débat public sur la question.

1. Il existe une volumineuse documentation médicale qui, résumée à l’intention du grand public, pourrait appuyer sa réflexion sur la question.

2. Le grand public pourrait également profiter de la présentation de documents sur l’expérience menée en différents endroits où l’euthanasie médicalement assistée est autorisée.

3. Le grand public pourrait aussi grandement profiter d’une revue approfondie et rigoureuse des pour et des contre de la décriminalisation de l’euthanasie médicalement assistée d’un point de vue éthique et juridique bien raisonné.

4. De nombreuses personnes exerçant dans le domaine médical auraient avantage à voir tous les enjeux exposés de façon claire et sensible.

5. À la suite de son étude, le groupe d’experts devrait envisager de soumettre des recommandations en matière de politique à l’intention du grand public.

Questions que le groupe d’experts pourrait examiner

1. Le suicide médicalement assisté et l’euthanasie volontaire sont-ils moralement justifiables et devraient-ils être décriminalisés dans certains cas bien définis? Si oui, quels seraient ces cas?

2. Y a-t-il une différence importante, sur le plan moral, entre le refus et le retrait d’un traitement de prolongation de la vie, d’une part, et l’accélération de la mort d’un patient par l’euthanasie volontaire ou le suicide médicalement assisté, d’autre part?

3. La « sédation terminale » (appelée parfois « sédation palliative ») est-elle préférable, sur le plan moral et juridique, à l’euthanasie volontaire ou au suicide médicalement assisté? Dans la pratique, y a-t-il une distinction entre sédation terminale et soulagement des symptômes susceptible d’abréger la vie? Où en est-on sur la question du soulagement des symptômes abrégeant la vie? C’est une pratique qui, dans une certaine mesure, se trouve dans une zone d’ombre. Elle n’a pas été examinée de façon explicite et exhaustive par les législateurs et l’on ignore encore si elle est conforme à la loi. Par ailleurs, dans le cas de certaines personnes, on peut se demander si la gestion des symptômes est adéquate.

4. Cesser d’alimenter le patient ou de lui donner à boire (ou cesser toute hydratation et alimentation artificielle) est-il préférable, sur le plan moral et juridique, à l’euthanasie volontaire ou au suicide médicalement assisté?

5. Y a-t-il des preuves d’abus en ce qui a trait au suicide médicalement assisté et à l’euthanasie volontaire là où ces pratiques ont été décriminalisées (particulièrement dans des contextes comparables à celui du Canada)? Sur quel type de données, pertinentes et convaincantes, pourrait-on s’appuyer pour répondre à la question?

6. Quelles mesures, le cas échéant, pourraient prévenir l’abus et l’exploitation de l’euthanasie volontaire et du suicide médicalement assisté sans ériger d’obstacles insurmontables pour les personnes qui souhaiteraient accéder à ces formes d’aide à la mort?

7. Le concept de dignité humaine est-il utile aux discussions sur l’euthanasie volontaire et le suicide médicalement assisté?

8. L’euthanasie volontaire et le suicide médicalement assisté sont-ils conformes à l’éthique médicale traditionnelle? Que dit le serment d’Hippocrate sur la question? Ces pratiques risquent-elles de compromettre le lien de confiance entre le médecin et le patient ou, au contraire, peuvent-elles le resserrer?

9. Les directives préalables sont-elles des outils raisonnables et justifiables sur le plan éthique et juridique pour formuler de façon adéquate les souhaits des patients qui avaient auparavant la capacité de décider? Quelle est la valeur (ou la non‑valeur) des directives préalables dans ce contexte? Y a-t-il une différence entre directives positives et directives négatives?

10. Si l’on établit que l’euthanasie volontaire et le suicide médicalement assisté devraient être légalement autorisés, comment doit-on approcher la question des patients mourants qui sont dans l'incapacité de décider?

11. Quel est le statut, du point de vue juridique et éthique, du refus ou du retrait unilatéraux d’un traitement susceptible de maintenir la personne en vie? (Cette question est vivement contestée au Canada et cause une grande détresse morale chez toutes les personnes concernées.)

12. Pourquoi le consentement (ou le refus), qui a pour effet de justifier certains comportements, n’a-t-il pas la même incidence dans le cas de l’euthanasie volontaire ou du suicide médicalement assisté?

13. Comment devrions-nous évaluer les faux positifs et les faux négatifs? Est-il plus grave d’avoir un système en place qui donne lieu à beaucoup de souffrance inutile et qui nie l’autonomie individuelle, mais ne génère jamais de faux positifs, que l’inverse? (Cela fait une différence sur la façon de calibrer les balises.)

Suggestion d’approche

(a) Demandez-vous d’abord : Quelle est l’état de nos connaissances en ce qui a trait à ce qui suit?

· Quelles sont les pratiques actuelles en matière de soins de fin de vie au Canada (relativement au refus ou au retrait des soins, au soulagement des symptômes susceptible d’abréger la vie, au suicide médicalement assisté et à l’euthanasie volontaire)? Quelles sont les principales variables dans ce domaine? Qui sont les principaux décideurs? Quelles sont les positions par défaut (ce qui se passe généralement, à moins que quelqu’un proteste fermement)? Quelles sont les connaissances empiriques actuelles en ce qui a trait au suicide médicalement assisté et à l’euthanasie volontaire?

· Que pensent les familles des patients, les patients et les fournisseurs de soins de santé des pratiques actuelles?

· Quelles sont les perspectives dans ce domaine?

· Comment les fournisseurs de soins de santé, les patients et les familles sont-ils informés?

· Quel est le contenu de la législation en la matière au Canada? Comment les Canadiens perçoivent-ils cette législation? Quel devrait être le contenu de la législation selon les Canadiens?

· Qu’est-ce qui sous-tend la prise de décisions dans ce domaine, p. ex., l’économie, l’insuffisance de fournisseurs, le manque de formation, les positions normatives, etc.?

(b) Demandez-vous ensuite : Quels sont les principaux énoncés de valeur (positions normatives) en jeu et dans quelle mesure influent-ils sur les décisions?

(c) Passez ensuite aux questions normatives essentielles, à la lumière de ce qui précède. Le groupe d’experts doit veiller à ne pas reproduire les travaux déjà effectués dans le cadre d’autres rapports. Il doit plutôt prendre connaissance de ces travaux avant d’entreprendre sa propre analyse de ces questions.

no answers to 'big questions'

Sunday morning in Britain ... and for those of us who have no life (your writer included) or nothing better to do, there's TV. The BBC offers religious fare under the cloak of a program called 'the big questions'. Today they're discussing issues such as whether there still is a moral duty to provide overseas aid, whether the body is 'sacrosanct' after death and other such genuinely important and interesting topics. It's a panel type program where experts give their take on the answers and an audience that agrees or disagrees.

Here's the weird bit: their 'experts' on moral questions are not ethicists (there isn't one on the program among the featured panelists), but representatives of major religions (ie there's a woman in red dress - the Anglican priest, a guy with a round cap on his head - the Jewish rabbi, and of course your Labour MP - last week they had a rabid, slightly nuttish Catholic woman raving against IVF, making up 'facts' on the run).

The thing is, often I find myself in agreement with their answers to the questions at hand (often I do not), BUT there is no moral argument, no moral analysis, it's people in funny cloth waving the magic God wand and voila there's (NO) answer. Plain bizarre.