Saturday, February 28, 2009

And that was the week...

Yay, a truly hectic working week is finally over. I spent all day today running around taking pix of the latest Singaporean skyscrapers. Even bumped into the world's largest cruise liner in the harbor.

I spent 5 out of 5 days regaling high school students with tales of cloning and animal experiments, A*STAR scientists with insights into academic publishing rules (and ethics), as well as staff at the Singapore General Hospital with a workshop on publishing ethics. Last but not least I gave a colloquium in the philosophy department at the National University of Singapore. The paper I presented was co-authored with Christopher Lowry. Chris is currently a doctoral student at Queen's and soon to be an Assistant Professor of Philosophy at the Chinese University of Hong Kong (yep, he is one of the few who managed to score jobs in the current climate). Probably didn't hurt that he published quite a bit of peer reviewed content during the last year and a half!

Anyhow, Russell Blackford with whom I currently edit a volume on atheist thought, and I managed to send the corrected manuscript back to the copy-editor, so it should soon enter the typesetting stage. Quite excited about this piece of work. Look out for the book, it's gonna be called '50 Voices of Disbelief: Why We Are Atheists'. It's coming with Wiley-Blackwell in a few months time.

Talking about Wiley-Blackwell, on Monday I will meet Cindy Chong, the Production Editor here in Singapore of two journals I co-edit for said company. It's funny how this stuff is being put together by diligent people literally all over the world. Our authors work in the most far flung corners of the world, and even us at the editorial side of things are in North America (yours truly, Ricardo Smalling), Europe (Ruth Chadwick, Clancy Pegg, Celia White and colleagues), Latin America (Debora Diniz) and Asia (Cindy Chong and colleagues). Without the advent of the internet that plain would not be possible. It's a remarkable thing really, when you think about it.

Talking about the net. I joined - ugh, terrible to admit, Facebook. Actually, it's an amazing site/ Within a week or two I gathered some 100+ 'friends', that's people making contact with you and ask that you kinda add them as 'friends'. Turns out to be an excellent tool to track 'lost ones'. I was found by folks who I haven't heard off for oodles of years. Bit of a waste of time otherwise. Would you believe that I posted a thing saying that I enjoyed Tim Tam's. I mean... please!

In case you're really bored, here's a link to images taken during my various 'performances' (there were stages on some occasions :).

Friends in Need - why not lend em a helping hand...

To our colleagues in bioethics:

We need your help. We need you to write letters, and we need it fast.

Here at the University of Tennessee medical school, the Dean has informed us that he intends to eliminate our entire department. Last summer he informed our chair, Dr. Terry Ackerman, that he wanted to do this, and now the machinery to effect his plan is in motion.

Earlier today the UT Board of Trustees approved a revised policy for "discontinuing academic units," thereby activating the process in earnest. A final decision about us will ultimately require the approval of the Chancellor at this campus, the President of UT, and finally the Board of

UT's medical ethics department ("Human Values and Ethics") is one of the oldest in the country. It began as a program in the mid-'70s and became a full-fledged department of the medical school in the mid-'80s. All three of us (Terry Ackerman, Carson Strong and Haavi Morreim) are tenured at the rank of professor and, other than "for cause," the only way that tenured faculty
can be removed is if their positions are eliminated.

Here are the dean's exact and complete words, as communicated to the Trustees, for including our department in his list of units to be discontinued:

"Primary goals of this department are to teach and do research to increase awareness of ethical and moral issues associated with healthcare. Human Values & Ethics, with 3 tenured faculty, is under consideration for discontinuation as it has minimal funded research programs and limited
teaching of medical students. Training of human values and ethics is necessary in medical school; however this will continue to be done primarily by experienced physicians as students go through clinical rotations. Immediate plans call for retaining one faculty at half-time to
coordinate this training. Long-term effects of discontinuance on UT and the State of Tennessee are anticipated to be minimal."

First problem: the Dean's proposed alternative is a clear violation of LCME standards (Liaison Committee on Medical Education) for accrediting medical schools. In ED-23 and ED-17A (,), LCME requires that students receive ethics instruction in preclinical years, and *formally* during clinical rotations. The dean's plan eliminates preclinical instruction and provides only informal teaching during clinical
rotations. To our knowledge, there are no MDs or other PhDs who have any advanced qualifications in ethics at this institution.

Second problem: contrary to the Dean's statement, our primary goal is not merely to "increase awareness." We co-teach a required course for the first- and second-year students that has a major ethics component; conduct seminars for third-year students rotating through pediatrics and ob/gyn; and participate extensively in clinical teaching during regular patient-focused rounds and conferences for such departments as pediatrics, ob/gyn, and internal medicine. We also have a substantial involvement in teaching residents.

Third problem: the dean's comment on research does not discuss the quality of our work, only its lack of extramural funding. We have informed him that funding for research in bioethics is very limited, particularly as compared to the monies available for medical research; also, that much of what is available is directed toward social science exploration of topics of
relevance to ethics (e.g. empirical studies of informed consent), rather than the more purely philosophical and ethics-oriented research that this department has historically produced.

We ask you to write letters to the Chancellor, to the President and to the Trustees. Their names and addresses are just below‹one letter will do it for all the Trustees. We have known our campus' Chancellor, Dr. Pat Wall, to be a fine human being with a strong sense of value and priorities. He is no moral coward. We believe he in particular will take seriously your
thoughtful expressions. Letters to the President and Trustees will provide him with important reinforcement.

The content of the letter can be the same for each recipient, but: *sending one letter to one person will not be as helpful as sending that letter to all three (Chancellor, President, Trustees);
*sending one letter from a department/program as a whole is good, but not nearly as good as if each willing member of the department sends letters.

We would deeply appreciate an earnest letter explaining why saving money by eliminating ethics is unwise for a medical school. It would also be helpful to comment on our national reputations, as that is one of the factors to be considered.

Please help. We send our heartfelt thanks to you all.

Terry Ackerman
Carson Strong
Haavi Morreim


Pat Wall, M.D.
Chancellor, UTHSC
409 Hyman Administration Building
University of Tennessee Health Science Center
Memphis, TN 38163

Jan Simek, Ph.D.
Interim President, University of Tennessee
Office of the President
831 Andy Holt Tower
University of Tennessee
Knoxville, TN 37996-0180

You can use one letter for all trustees. When your letter is received in the
Trustees' office, they'll scan it an email it to all members.

Board of Trustees Office
University of Tennessee
719 Andy Holt Tower
Knoxville TN 37996-0170

If you wish to do so, it would be helpful to us if you would send a copy of
your letter to:
Dr. Terrence F. Ackerman
Chair, Dept. of Human Values and Ethics
910 Madison Avenue, Suite 311
University of Tennessee Health Science Center
Memphis TN 38163

Saturday, February 21, 2009

A380 and such

Yours truly is currently in Singapore, on a work visit to the NUS bioethics centre. Will also be giving a talk here in the philosophy department. You might hear from me, on and off, but don't expect too much, the weather is such that I'd rather be outside than to go on blogging...

Hey, on the bright side, the dreaded flight on BAs 777 to Singapore from London turned out to be a Qantas A380 trip. The plane, according to its pilot, is a mere 4 weeks old. And guess what, it worked a treat. Being 'just' an academic, I flew of course torture class, and had it not been for an exit row 'window' (there's no window) seat and 7mg of diazepam I probably would have 'died'. Well, so I slept roughly 10 out of the 12 hours and am reasonably fit. Funny enough, these meds are not supposed to be used for this purpose. Btw, you probably don't want to go for the exit row seats in BA 777 fleet's economy section, just about all their monitors were broken. I wonder why. They fall back and hit people's knees all the time. They eventually upgraded me to Premium economy. Seems well worth it, to be honest. Lufthansa's business class just a few years back would have been what premium economy is today on most carriers. OH well, enough of this babble, I have this obsession with comparing airline services (well, disservices these days, mostly). I am pleased to report, however, that I avoided again Air Canada, so arrived on time without hick-up's.

Singapore is still as crazily efficient as it has been 10 or 15 years ago when I ventured here first time round. No queues at customs, luggage waiting, clean reliable taxi taking me to my residence, security waiting to take me to my lil flat (which turns out to be huge, 2 bedrooms and no less than three bathrooms...). Funny enough, I ended up in the supermarket next door to buy some of life's basic necessities, only to be told that they're not taking credit cards (in hi-tech Singapore of all places).

On that note, enjoy your day. I will do the same :).

Sunday, February 15, 2009

Defending freedom of speech against religious fundamentalism

I'm reproducing here a piece by Johann Hari. Johann is a columnist with the British Independent newspaper. He wrote there a piece on how Western liberal democracies continue to ever reduce their citizen's freedom of speech in order to accommodate the otherwise 'hurt' feelings of religious people. In fact, he reports on how the UN Human Rights Commission has been perverted into a tool aimed at censoring religion critical speech of free-thinking people (I blogged about the same issue in April 2008.) Since then his piece was reproduced by a leading Indian paper. True to form religious fundamentalists demanded that paper's editor resign. She was eventually arrested. How dare you to offend non-reality based folks... tsk tsk tsk. Well, here's Johann's piece. It also includes a link to his original piece in the Independent newspaper. Well worth a read. I'm flabbergasted that nobody seems to appreciate that one of the main reasons for protecting freedom of speech is to protect someone's right to offend someone else without the state stepping in and incarcerating that person. There's no point in protecting the freedom to say things that ruffle no one's feathers... -

Despite the Riots and Threats, I Stand By What I Wrote

Last week, I wrote an article defending free speech for everyone -- and in response there have been riots, death threats, and the arrest of an editor who published the article.

Here's how it happened. My column reported on a startling development at the United Nations. The UN Special Rapporteur on Human Rights has always had the job of investigating governments that forcibly take the fundamental human right to free speech from their citizens with violence. But in the past year, a coalition of religious fundamentalist states have successfully fought to change her job description. Now, she has to report on "abuses of free expression" including "defamation of religions and prophets." Instead of defending free speech, she must now oppose it.

I argued this was a symbol of how religious fundamentalists -- of all stripes -- have been progressively stripping away the right to freely discuss their faiths. They claim religious ideas are unique and cannot be discussed freely; instead, they must be "respected" -- by which they mean unchallenged. So now, whenever anyone on the UN Human Rights Council tries to discuss the stoning of "adulterous" women, the hanging of gay people, or the marrying off of ten year old girls to grandfathers, they are silenced by the chair on the grounds these are "religious" issues, and it is "offensive" to talk about them.

This trend is not confined to the UN. It has spread deep into democratic countries. Whenever I have reported on immoral acts by religious fanatics -- Catholic, Jewish, Hindu or Muslim -- I am accused of "prejudice", and I am not alone. But my only "prejudice" is in favor of individuals being able to choose to live their lives, their way, without intimidation. That means choosing religion, or rejecting it, as they wish, after hearing an honest, open argument.

A religious idea is just an idea somebody had a long time ago, and claimed to have received from God. It does not have a different status to other ideas; it is not surrounded by an electric fence through which none of us can pass.

That's why I wrote: "All people deserve respect, but not all ideas do. I don't respect the idea that a man was born of a virgin, walked on water and rose from the dead. I don't respect the idea that we should follow a "Prophet" who at the age of 53 had sex with a nine-year old girl, and ordered the murder of whole villages of Jews because they wouldn't follow him. I don't respect the idea that the West Bank was handed to Jews by God and the Palestinians should be bombed or bullied into surrendering it. I don't respect the idea that we may have lived before as goats, and could live again as woodlice.... When you demand "respect", you are demanding we lie to you. I have too much real respect for you as a human being to engage in that charade."

An Indian newspaper called The Statesman -- one of the oldest and most venerable dailies in the country -- thought this accorded with the rich Indian tradition of secularism, and reprinted the article. That night, four thousand Islamic fundamentalists began to riot outside their offices, calling for me, the editor, and the publisher to be arrested -- or worse. They brought Central Calcutta to a standstill. A typical supporter of the riots, Abdus Subhan, said he was "prepared to lay down his life, if necessary, to protect the honour of the Prophet" and I should be sent "to hell if he chooses not to respect any religion or religious symbol... He has no liberty to vilify or blaspheme any religion or its icons on grounds of freedom of speech."

Then, two days ago, the editor and publisher were indeed arrested. They have been charged -- in the world's largest democracy, with a constitution supposedly guaranteeing a right to free speech -- with "deliberately acting with malicious intent to outrage religious feelings". I am told I too will be arrested if I go to Calcutta.

What should an honest defender of free speech say in this position? Every word I wrote was true. I believe the right to openly discuss religion, and follow the facts wherever they lead us, is one of the most precious on earth -- especially in a democracy of a billion people rivven with streaks of fanaticism from a minority of Muslims, Hindus and Sikhs. So I cannot and will not apologize.

I did not write a sectarian attack on any particular religion of the kind that could lead to a rerun of India's hellish anti-Muslim or anti-Sikh pogroms, but rather a principled critique of all religions who try to forcibly silence their critics. The right to free speech I am defending protects Muslims as much as everyone else. I passionately support their right to say anything they want -- as long as I too have the right to respond.

It's worth going through the arguments put forward by the rioting fundamentalists, because they will keep recurring in the twenty-first century as secularism is assaulted again and again. They said I had upset "the harmony" of India, and it could only be restored by my arrest. But this is a lop-sided vision of "harmony". It would mean that religious fundamentalists are free to say whatever they want -- and the rest of us have to shut up and agree.

The protesters said I deliberately set out to "offend" them, and I am supposed to say that, no, no offense was intended. But the honest truth is more complicated. Offending fundamentalists isn't my goal -- but if it is an inevitable side-effect of defending human rights, so be it. If fanatics who believe Muslim women should be imprisoned in their homes and gay people should be killed are insulted by my arguments, I don't resile from it. Nothing worth saying is inoffensive to everyone.

You do not have a right to be ring-fenced from offense. Every day, I am offended -- not least by ancient religious texts filled with hate-speech. But I am glad, because I know that the price of taking offense is that I can give it too, if that is where the facts lead me. But again, the protesters propose a lop-sided world. They do not propose to stop voicing their own heinously offensive views about women's rights or homosexuality, but we have to shut up and take it -- or we are the ones being "insulting."

It's also worth going through the arguments of the Western defenders of these protesters, because they too aren't going away. Already I have had e-mails and bloggers saying I was "asking for it" by writing a "needlessly provocative" article. When there is a disagreement and one side uses violence, it is a reassuring rhetorical stance to claim both sides are in the wrong, and you take a happy position somewhere in the middle. But is this true? I wrote an article defending human rights, and stating simple facts. Fanatics want to arrest or kill me for it. Is there equivalence here?

The argument that I was "asking for it" seems a little like saying a woman wearing a short skirt is "asking" to be raped. Or, as Salman Rushdie wrote when he received far, far worse threats simply for writing a novel (and a masterpiece at that): "When Osip Mandelstam wrote his poem against Stalin, did he 'know what he was doing' and so deserve his death? When the students filled Tiananmen Square to ask for freedom, were they not also, and knowingly, asking for the murderous repression that resulted? When Terry Waite was taken hostage, hadn't he been 'asking for it'?" When fanatics threaten violence against people who simply use words, you should not blame the victim.

These events are also a reminder of why it is so important to try to let the oxygen of rationality into religious debates -- and introduce doubt. Voltaire -- one of the great anti-clericalists -- said: "Those who can make you believe absurdities can make you commit atrocities." If you can be made to believe the absurd notion that an invisible deity dictated The Eternal Unchanging Truth to a specific person at a specific time in history and anyone who questions this is Evil, then you can easily be made to demand the death of journalists and free women and homosexuals who question that Truth. But if they have a moment of doubt -- if there is a single nagging question at the back of their minds -- then they are more likely to hesitate. That's why these ideas must be challenged at their core, using words and reason.

But the fundamentalists are determined not to allow those rational ideas to be heard -- because at some level they know they will persuade for many people, especially children and teenagers in the slow process of being indoctrinated.

If, after all the discussion and all the facts about how contradictory and periodically vile their 'holy' texts are, religious people still choose fanatical faith, I passionately defend their right to articulate it. Free speech is for the stupid and the wicked and the wrong -- whether it is fanatics or the racist Geert Wilders -- just as much as for the rational and the right. All I say is that they do not have the right to force it on other people or silence the other side. In this respect, Wilders resembles the Islamists he professes to despise: he wants to ban the Koran. Fine. Let him make his argument. He discredits himself by speaking such ugly nonsense.

The solution to the problems of free speech -- that sometimes people will say terrible things -- are always and irreducibly more free speech. If you don't like what a person says, argue back. Make a better case. Persuade people. The best way to discredit a bad argument is to let people hear it. I recently interviewed the pseudo-historian David Irving, and simply quoting his crazy arguments did far more harm to him than any Austrian jail sentence for Holocaust Denial.

Please do not imagine that if you defend these rioters, you are defending ordinary Muslims. If we allow fanatics to silence all questioning voices, the primary victims today will be Muslim women, Muslim gay people, and the many good and honourable Muslim men who support them. Imagine what Europe would look like now if everybody who offered dissenting thoughts about Christianity in the seventeenth century and since was intimidated into silence by the mobs and tyrants who wanted to preserve the most literalist and fanatical readings of the Bible. Imagine how women and gay people would live.

You can see this if you compare my experience to that of journalists living under religious-Islamist regimes. Because generations of people sought to create a secular space, when I went to the police, they offered total protection. When they go to the police, they are handed over to the fanatics -- or charged for their "crimes." They are people like Sayed Pervez Kambaksh, the young Afghan journalism student who was sentenced to death for downloading a report on women's rights. They are people like the staff of Zanan, one of Iran's leading reform-minded women's magazines, who have been told they will be jailed if they carry on publishing. They are people like the 27-year old Muslim blogger Abdel Rahman who has been seized, jailed and tortured in Egypt for arguing for a reformed Islam that does not enforce shariah law.

It would be a betrayal of them -- and the tens of thousands of journalists like them - to apologize for what I wrote. Yes, if we speak out now, there will be turbulence and threats, and some people may get hurt. But if we fall silent -- if we leave the basic human values of free speech, feminism and gay rights undefended in the face of violent religious mobs -- then many, many more people will be hurt in the long term. Today, we have to use our right to criticise religion -- or lose it.

If you are appalled by the erosion of secularism across the world and want to do something about it, there are a number of organizations you can join, volunteer for or donate to.

Some good places to start are the National Secular Society, the Richard Dawkins Foundation for Science and Reason, or - if you want the money to go specifically to work in India - the International Humanist and Ethical Union. (Mark your donation as for their India branch.)

Even donating a few hours or a few pounds can really make a difference to defending people subject to religious oppression - by providing them with legal help, education materials, and lobbying for changes in the law.

An essential source of news for secularists is the terrific website Butterflies and Wheels.

Thursday, February 12, 2009

Good ol British hypocrisy

There it is the land of the free, the defender of freedom of thought and speech, notorious for tolerating people with quirky habits and beliefs... that is, unless you're criticizing Islam. Why did I add hypocrisy in the title of today's post? Well, there's different standards for different people. A notorious, rightwing Dutch MP by the name Geert Wilders called the Koran a 'fascist book' in an anti-Islamic video some time ago. As we know by now, many Muslims respond to this sort of stuff with mayhem - you know, burning effiges of people who are not Muslims, killing other Muslims while they're at it, that sort of thing. So, one arguably over-the-top and offensive statement by Wilders leads to an even more problematic and out of proportion response by Muslims. Wilders, an EU citizen, wanted to visit the UK but has been banned by the UK Home Office on the grounds that his presence would threaten 'public security'. So, the presumed Muslim response determines whether one of Islam's critics may enter the country. It would follow then that the more out of proportion Muslims' responses to critics' views of that ideology is, the less likely it is that people who publicly hold such views would be permitted to enter the UK.

Here's the bit that really interests me in this: The UK Home Office also permits Caribbean singers to enter the UK, even though these shady characters routinely call for violence against gays and lesbians in their songs (including the murder of such people, just for good measure). It seems to me as if gays and lesbians are well advised to go on the streets, burn cars and create a lot of mayhem, because according to the screwed logic of the UK Home Office, that would then constitute a sufficient reason for not letting such 'artists' enter the country. If on the other hand you protest peacefully, 'public security' is not threatened and people advocating violence against gays and lesbians may freely enter the country.


ps, in case you care to find out... here's an ineresting piece Russell Blackford wrote on the same issue:

Tuesday, February 10, 2009

Darwin Award competition continues

Four other serious contenders for the Darwin Awards, this time in South Korea. People there celebrate Lunar New Year by, among other activities, burning a large pile of dried grass to the ground. In this instance, ie in Changnyeong, about 275 km (170 miles) southeast of Seoul, they carefully chose to burn it surrounded by fields of even more dried grass. Gusty winds developed as the show was on the road, and the meager fire-proof fencing didn't do the trick. Guess what: the fire spread quickly, killing at least four on-lookers, leading to a stampede among the folks attending the event. Clever, clever.

Sunday, February 08, 2009

2009 season contenders for the Darwin Awards

A group of particularly idiotic fishermen and women in the US. They entered a frozen iceshield on a lake in the USA, happily drilling holes thru the ice in order to fish thru the holes. Well, the whole iceshield broke off the shoreline, including the bunch of fishermen and women, their equipment, cars, tents, the lot. At least one of them is a serious contender for the actual award as he died as a result of exposure to the icy water. A massive rescue operation and concomitant wastage of resources took place in order to rescue those fools lest their genes would otherwise also be withdrawn from the gene pool for good.

Here is some background on the Canadian runners-up in this competition.

Vatican governs Italy

Silvio Berlusconi, Italy's best-known playboy, has officially been appointed to be the Vatican's permanent representative in his own government. According to reports in THE GUARDIAN newspaper today, after frantic forth and backs with Vatican officials, he is aiming to change Italy's laws in order to prevent doctors from executing a Supreme Court of Italy approved case of removing life-sustaining medical care from a woman in persistent vegetative state. This saga reminds very much of the Bush meddling in the Schiavo case a few years back in the USA.

Here are the basics of the case: Eluana Englaro is a 38-year-old woman who has been in a coma for the past 17 years. She was left in a persistent vegetative state after a car accident. Her family wanted her life-preserving care removed from her, both because that is what Ms Englaro would have wished, and also because her brain injuries are such that there is no chance she will ever rejoin us in this life. She will not ever be able to live a life worth living again.

Eventually after a long long march thru the legal instances the Italian Supreme Court granted the family's request. Doctors have begun to reduce her nutrition since. Her PVS means that she won't feel any of this happening. The 'v' in PVS really means that her state of consciousness is vegetable like. Veggies don't feel pain or suffer.

Well Italy's first playboy, after consulting Italy's governor general, the Pope, declared that this court decision was akin to murder and issued an emergency decree aiming to prevent the withdrawal from life-sustaining medical care. One of his - on the record - rationales was that she is still physiologically capable of making babies...

Reports THE GUARDIAN: Giorgio Napolitano, Italy's president, has refused to sign the decree, but if it is ratified by the Italian parliament doctors may be obliged to resume the feeding of Eluana early this week. One can only hope that the Italian parliament will show more insight and realise that there is nothing to be gained by this patient remaining in PVS for another few decades. As the anaesthetist caring for her, Professor Antonio de Monte, said: "Eluana died 17 years ago."

UPDATE: Eluana has died yesterday peacefully.

On another note, commiserations to my Melbourne based compatriots. The scale of the catastrophe in Victoria truly boggles the mind! Just read that among the people who perished were Brian Naylor and his wife.

Friday, February 06, 2009

octuplets and all :)

Here's a piece from today's Toronto Star (they're using quite a bit from an interview they did with me, so it's probably ok to dump it into my blog):

Patients have the right to help guide their own medical treatment, ethicists agree, but there are limits. And the case of a California woman who used a fertility clinic to have octuplets – on top of the six children she already has – goes way, way beyond any reasonable confines, they agree.

"This is the most bizarre case of patient autonomy I have ever seen," says medical ethicist Udo Schuklenk, a philosophy professor at Queen's University.

Schuklenk has been following the case with personal and professional interest since Nadya Suleman gave birth to the octuplets two weeks ago, months after visiting a fertility clinic telling the doctors there that she wanted to have more children.

"This is one where all the ethicists, for a change, seem to all agree."

Schuklenk says that whatever Suleman's motivation is in wanting more children, her doctors had a duty to refuse her request, calling it "irresponsible" for them to simply comply with her wishes.

"Somebody needs to slap these people," Schuklenk says. "A statutory body should seriously look into the conduct of the health care professionals in that clinic."

Some of the doctors' colleagues would seem to agree.

"This makes our jaws drop," Dr. Mary Hinckley, a physician with the Reproductive Science Center in San Francisco, told a local paper. "It violated all of our standards here in the United States."

A 2005 study by Toronto's Joint Centre for Bioethics ranked doctor-patient disputes over treatment plans the top ethical challenge facing medicine today, ranking above such issues as waiting lists and doctor shortages.

"Thirty years ago, the issue was when patients could say no (to a doctor). Now it's when can a doctor so no (to a patient)," says Jonathan Breslin, co-author of the report.

Such questions are not limited to fertility issues, but also to cancer or HIV treatments, the continued use of life supports, cosmetic surgery, what medicines to prescribe (or not prescribe), participation in other therapies, and more, the study says.

Last month, a study in the American Journal of Bioethics examined what might be the most extreme example of patients seeking medical care they don't need: people demanding that a perfectly healthy arm or a leg be amputated.

People with body integrity identity disorder become convinced that an appendage such as an arm or a leg should not be there, and demand that it be amputated to fit their image of themselves. Such a person believes he or she was meant to be, say, a one-legged person, but was born with two legs by mistake.

For those with the disorder, it can be very frustrating. If thwarted, they will sometimes injure themselves to force an amputation.

While the study's author, German ethicist Sabine Müller, comes out against cutting off healthy limbs, there is no consensus on the issue.

Schuklenk counts himself among those sympathetic to patients who, despite having two arms or legs, feel they really should have only one.

"That falls into the same category as transsexuals and sex change operations," says Schuklenk, adding that a generation ago, the idea of a man trapped in a woman's body was not as widely accepted as today.

Schuklenk is not aware, however, of a similar disorder driving women to have multiple children to fulfil their personal self-image.

And if Suleman did feel a need to have a lot of children, he points out, "she already had six kids."

Schuklenk is glad the paternalistic days when doctors had almost complete say about treatments are largely a thing of the past.

Patients have much of value to add to their treatment plans, he says. "Patients often know more about their conditions than their doctors."

That's because patients often have time to research their ailments in greater depth than a general practitioner who treats a variety of patients with myriad complaints.

Books, newspapers, the Internet and even television commercials have educated patients about their health, making them more informed when they go to the doctor.

But that can also lead to a greater sense of entitlement, Schuklenk says, and a growing tendency to treat doctors like any other service provider – there to take orders and not ask questions.

"They see something on TV and think, `That sounds like me.' So they go to the doctor and demand a prescription," he says.

Schuklenk fears that's what might have happened in California. The doctors, he says, had a responsibility to set aside benefits they might receive – fees and fame – and confirm that Suleman could afford to raise the children and had the emotional strength and family support to do so.

"In her case, the answer each time would be no, no, no," he says.

Breslin says the doctor-patient relationship also can often be the place where issues such as limited health care resources or long waiting lists are played out, complicating the relationship.

Shawn Winsor, a bioethicist at the Joint Centre for Bioethics, uses dispute resolution strategies much like those used in legal circles to navigate the often tricky waters of the doctor-patient relationship.

"It's about helping them through the process," he says. "In the end, the doctor-patient relationship is a collaborative one."

Sunday, February 01, 2009

Not all philosophy is pointless - action against extreme poverty

Philosophers have a bad name in society. It's mostly well-paid academics going on about stuff that serves no real point, and certainly no real people. Most mainstream philosophers happily repay this compliment by talking down to colleagues concerned with real-world problems such as poverty, public health issues and such topics. Real philosophy, to them, to be good, has to be inconsequential, but inconsequential in a formally elegant way.

Well, the good news is, and I'm trying to rehabilitate practical philosophy here, that an ever-growing number of philosophers disagrees with such sentiments. A trail blazer for useful applied philosophy has been the Australian utilitarian philosopher Peter Singer. Singer is the author of countless books, some of which made it even on to the New York Times bestseller list. His most recent project is very much worthy of support.

He is responding to a growing debate among philosophers about how we ought to respond, as citizens of the wealthiest parts of the world, to the continuing occurrence of extreme poverty. Political philosophers such as Thomas Pogge came up with a couple of grand theoretical ideas, including a rejigging of the world economic order and the institutions that support them. It goes without saying that their impact on the real world outside academic talkfests has been non-existent (much as I would also like to see some of the changes Pogge and his acolytes are aiming for - albeit for different reasons, I'm a closetted philosopher after all).

Singer is not so much concerned with building grand theoretical edifices and singing the song of human rights and ever growing human dignity, he's concerned about practical changes that would immediately benefit real people.

Coinciding with the launch of his latest book he also started a campaign trying to get as many of us to pledge to donate immediately a percentage of our annual income to charities that have a proven track record at improving the living conditions and quality of life of those of us living in extreme poverty. I urge you to check it out and consider supporting a charity that has an immediate positive effect on the living conditions and quality of life of those living in extreme poverty.

This should not prevent you from participating in academic philosophical talkfests on poverty reduction of course, just don't delude yourself into thinking that that in itself would make any discernible difference to anyone at all.