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.

fun

Tauriq Moosa interviews Russell Blackford and Udo Schuklenk

Interview With Russell Blackford and Udo Schüklenk


By Tauriq Moosa

With atheist best-sellers flying off the book-shelves, people are now finding their beliefs questioned, probed and examined. Lumping all arguments together, many dismiss the new wave of intellectual concern as a crass form of schoolyard bullying, calling all those critical of religion “new atheists”. But what is forgotten in these discussions is the human side, the reasons for not believing and what that means in our lives. Many know the arguments against belief but now the point has come to ask another question: why does that matter? In an effort to do just that, two philosophers, Russell Blackford from Australia and German-born Udo Schüklenk have co-edited a book which seeks to solve recent problems for the modern non-believer. 50 Voices of Disbelief: Why We are Atheists, was published recently by Wiley-Blackwell.

For many who have spent some time involved in any form of engagement in these matters, the names should appear familiar: from the great AC Grayling to the revolutionary Maryam Namazie. Finally, in one book we can hear their stories – if not about themselves, then about the aspects of religion or lack thereof they find most important. If all these contributors were speakers at a convention, it would be sold out many times over. Udo and Russell kindly agreed to delve further into the background of the book.

Someone with no knowledge on this subject might ask why is a project like 50 Voices of Disbelief is so important in today's climate? And what does this project do that other "atheist" books don't?

Udo: As we say in our Introduction, it's important because there are numerous attempts made the world all over the stifle atheists' and humanists' freedom of speech, in our case the right to criticise religion. Even the UN and its misnamed human rights council is in on it. So yes, it is more important than ever before to let voices of reason and rationality be heard. There cannot be special rules for religious organisations that exempt them from critical inquiry and scrutiny.

Our anthology is unique because it gives a voice to a very wide range of contributors, including philosophers, writers, journalists, even a magician! They all responded to our call to explain in their own words why they do not believe in the God the monotheistic religions have been peddling to us for centuries. The book is eminently readable and fun, to my mind, because it includes so many personal accounts of well-known writers on why they are atheists.

You have a range of spectacular contributors, ranging from AC Grayling to Maryam Namazie. But I imagine there were many more to choose from. How did you decide on the contributors and why?

Udo: We chose them based on professional standing, expertise and capacity to say something original and readable.

All three of us study philosophy academically and a common question is asked about philosophy's purpose in the modern world. How big a part did philosophy play in your views and in the creation of this project?

Udo: Of course, I am very strongly influenced by the values of enlightenment philosophy. Works by Holbach, Descartes, Voltaire, Kant and others had a huge impact on how I formed my views of the world. Their work and that of others like them, undertaken under much more difficult circumstances, motivates me to keep the light of reason alight.

Russell: My own reasons for disbelief are philosophical, and I realized over 30 years ago that the Christian view of the world, which concerned me most among the world's religions, just doesn't add up. Take the problem of evil, for example. Many people claim to have solved it, or that someone else has solved it, or in any event that it has been solved or is solvable. But the supposed solutions are highly implausible, often even absurd or irrelevant, and anyone who thinks the problem has been solved doesn't really understand it (or doesn't take it seriously).

Again, the doctrine of sacrificial atonement makes no moral or other sense, and we have no rational grounds to accept claims about the empty tomb and the resurrection of the apocalyptic Jewish prophet known to us as Jesus of Nazareth. However, my motivation to speak up, and express my disbelief publicly, after keeping my peace somewhat for quite a long time now, is not just philosophical; it is more political. Various religious groups, often deeply reactionary in one way or another, have been consolidating their social and political influence in Western societies, even though the percentage of believers has declined. In developing countries, Christianity and Islam are rapidly winning adherents - and the varieties of Christianity and Islam we are talking about are in no sense liberal or even moderate. All in all, "God is back", and I think that we've reached a point in human history when silence is not an option for people of reason.

What books do you recommend to those who have not really considered these questions before? Aside from obvious choices like Dawkins and Hitchens, are there any other talented writers that people should be aware of?

Russell: There are many writers beyond the so-called Four Horsemen (Dawkins, Hitchens, Dennett, and Sam Harris), so much so that any list will be extremely incomplete. The state of the art in academic philosophy by atheists continues to advance. A generation ago, the writer to watch out for was John Mackie, whose work is still very worth reading. But now the leading books are probably those of Michael Martin and Graham Oppy. Also watch out for the work of Michael Tooley, Nicholas Everitt, J.L. Schellenberg, among many others.

For a slightly more popular level of work that challenges Christian apologetics, try Dan Barker or John W. Loftus. I recently read Barker's Godless: How an Evangelical Preacher Became One of America's Leading Atheists, and I totally recommend it. Ayaan Hirsi Ali's personal story in Infidel is compelling, and there are now many feminist writers tackling the way religions treat women - Ophelia Benson, Maryam Namazie, and Christine Overall come to mind.

On the origins of the Christian texts, see Bart Ehrman. For wide-ranging discussion of Islam, see Ibn Warraq. Then, not always focused on religion, there is the whole body of work by Michael Shermer. Victor J. Stenger and Taner Edis are among those who tackled the issues from a perspective very much grounded in current science. I also recommend Richard Carrier's Sense and Goodness without God: A Defence of Philosophical Naturalism.

Really, though, there is such a rich body of work now available, and I am failing to mention many superb contributors to the debate. If you're not looking for something highly academic, perhaps start with the book by Barker that I mentioned. If you want the full academic approach, try Mackie's The Miracle of Theism and then perhaps tackle Oppy's Arguing About Gods. Or start with 50 Voices of Disbelief and sample the ideas of many contemporary writers and activists.

Udo: If you don't mind, may I take this question as asking what works have most influenced me in this context? Truth be told, it's not so much recent literature, even though there is some excellent work out there. I have been greatly influenced and impressed by works such as Jean (Abbe) Meslier, Testament de J. Meslier (Mémoire contre la religion), d'Holbach's Christianisme dévoilé, as well as his Le Système de la nature, Voltaire's Candide of course, Russell's Why I am not a Christian as well as the German author Karl-Heinz Deschner's works. Not surprisingly most, if not all of these works were critical of Christianity as the hegemonic ideology in Europe. I am glad today we find more works addressing the ideology of Islam, such as for instance Warraq's analyses or Ali's Infidel.

Speaking of Ali and Benson, why do you think there are so few women engaged in the great god debates? Do you think this is a problem?

Russell: First, it's a problem in many ways. Partly because the situation will tend to replicate itself over time. That's unfortunate, because women have much to gain by freeing themselves from religion, and also because the broad rationalist movement needs the involvement of people with widely varied experiences of the world, not just wide variations in male experiences of it. Even with little or no overt discrimination against them in some enlightened places, women still face more subtle kinds of discrimination, and even if that is overcome, they need to see other women as role models and potential colleagues. Women will be more attracted to write books, produce movies, generally become active in defending atheist and rationalist positions, when they see other women doing so. All that acknowledged, we should not forget the enormous contributions that some women are, indeed, making right now - Margaret Downey, comes to mind, as does Maryam Namazie for her ongoing opposition to political Islam and the Islamic Republic of Iran, Sumitra Padmanabhan in the humanist movement in India, and many many others.

Udo: I think this is much to do with the fact that the traditional domain of secular analysis and thinking was philosophy and that discipline has historically been male dominated. This is changing and so we see increasingly women's involvements with these sorts of questions - think of Overall's works, Purdy's, as well as downright - and very much needed - activism such as Downey's, Namazie's and others. I have no doubt many of the early feminists would have been secular in outlook, but their focus - understandably so - wasn't to do with the God delusion but women's reproductive rights and such issues that were closer to home.

What are the implications for religious pandering occurring in the upper echelons of the UN and other bodies? And what would you say to those who think it is intellectual imperialism to criticise people's religions?

Russell: The implications won't be as straightforward as the creation of a binding UN convention in some horribly onerous form, or the enactment of massive restrictions on freedom of speech in, say, the US. Nonetheless, the more resolutions we see from UN bodies, such as the Human Rights Council, the more the high moral ground is given to theocrats and dictators, and the more the morale and effectiveness of local opponents of free speech in Western countries are strengthened. In the West, there are plenty of opponents of free speech, especially speech that criticises religion. Those opponents exist on both the Right and Left of politics - the Right because of its religiosity, the Left because of its sensitivity to traditional cultures. As for the second question, I am very suspicious of this whole idea of intellectual imperialism. Intellectual ideas, both good and bad, belong the whole world and all its people - otherwise we wouldn't have now have worldwide use of algebra and the zero sign. This talk of intellectual imperialism often seems like an excuse for theocrats and dictators to deny rights and liberties to their local populations.

Udo: Well, this coming from the German-born Pope during a recent visit to Africa where he propagated his ideology to the African peoples is a tad bit rich! Anyhow, I am not a friend of the currently existing UN, its corruption and its many utterly useless agencies, so I don't care too much about the shenanigans in this organisation that reminds me so very strongly of Andersen's naked emperor. Stopping my exasperated UN-related hand-waving now, there's a serious issue, however: these attempts at shielding religious beliefs (as opposed to any other beliefs) from sharp criticism and - yes - ridicule sets a dangerous precedent for free speech and, indeed free inquiry. That's why we got to oppose it. We should all deliberately and routinely be subversive on blogs, in letters to newspapers, in articles, on Facebook and other networking sites and so on and so forth, by way of overstepping the boundaries set by the UN Human Rights Council on this issue. The more people there are who undertake such actions the less likely it is that these rules will actually become societally acceptable norms of behaviour.

Talking about free-speech, do you think outright mockery is a necessary step in the ongoing debate? Or should we, as Paul Kurtz has suggested, defend those who mock but not criticise in such crass ways ourselves (by "ourselves", he was referring to his organisation the Centre for Inquiry, which publishes numerous magazines that your contributors have written for. James Randi, for example, has a column in one)?

Udo: A necessary step to achieve what end? It's difficult answering this question without knowing what the ends are that such means are supposed to realise. Mockery has traditionally had a legitimate place in political debates and arguments. Enlightenment philosophers have often used mockery to show how absurd an ideological (frequently religious) stance was that was considered sacrosanct during their times. Mockery is one way of saying 'this view does not deserve to be taken seriously', and that is fair game to my mind, if one is also able to show on a more serious level, why the view in question does indeed not deserve to be taken seriously.

Russell: I think it's reasonable for a corporation, or some other kind of collective, to establish a brand image that appeals to a certain membership or potential membership. E.g., it might want to welcome a broad range of people, some of whom would be offended by certain tactics. In that sense, Paul Kurtz may have a legitimate point about what the CFI should be doing. The CFI needs to sort that out, and I'm not sure in this particular instance, but people who take Kurtz's view of its approach are certainly entitled to argue for it.

Does that mean that atheists, in general, should never engage in "crass" tactics? Not at all. My own view is that it is, indeed, crass to mock religious believers just for the sake of it - or simply to offend them. But there is certainly a place for satire, comedy, even outright mockery. When we are confronted with absurd ideas and practices, it can sometimes be futile, and seem rather ponderous and silly, to try to demonstrate exactly why they are absurd. It might be possible in principle, but not concise or rhetorically persuasive. Sometimes you just do have to cut through and expose the absurdity for what it is, by making humorous comparisons, calling names (as when I call the Catholic Church "the Cult of Misery"), or engaging in whatever forms of ridicule and disrespect are needed to get the point across. When absurd dogma is combined with abuses of human rights, threats to liberties, dangers to human life or flourishing, I think the gloves should come off. In those cases, ridicule can be our best weapon against religious bullying or outright theocratic oppression.

Perhaps, Udo, “the necessary step” should be “a necessary step” - one of many, in ascension toward contentment with uncertainty. This is to realise that nothing we say is beyond failure and in the sense you describe, nothing is therefore beyond mockery. Are you saying that mockery, though delivered in a humorous way, is serious in scope?

Udo: Yes, mockery can well be a more 'deadly' argumentative tool than the best logical argument.

Do you think that there can be such a thing as a militant atheist, a dogmatic scientist or are they merely terms of dismissal? It seems that some people do completely revoke religion and replace it with something else. I am inherently cautious of standing behind labels but do you think it is necessary to call oneself an atheist, a humanist and so on? As AC Grayling has pointed out, humanism isn't even a philosophy, it is a mode of thought (similar to what Michael Shermer says about science).

Udo: There 'can' be militant atheists as well as dogmatic scientists. There could be atheists that bully and threaten, atheists that discriminate pro-actively against those who disagree with their views, and so on and so forth, i.e.: there could be atheists that on their atheistic crusade (sic!) take no prisoners, much like adherents of militant Islam take no prisoners. However, I was careful to say that there 'could be'... I have yet to meet an atheist that behaves like that. So, while it is theoretically possible, I have yet to encounter a militant atheist. The same applies to the question of the dogmatic scientist.

Russell: I'm not as worried as some people by the term "militant atheist". Militancy is sometimes just the opposite of passivity or gentility; it doesn't necessarily connote violence or bullying. I attempt to be civil in debate and to be kind to people even when I'm being tough on issues, but sometimes a certain degree of forthrightness or aggression is needed. Atheists are entitled to be militant in that sense. Of course, we are usually about the last people to resort to violence.

I don't doubt that some atheists and scientists can be stubborn or opinionated, like anyone else, but the one expression that I despise is "fundamentalist atheist". A fundamentalist atheist would have to be someone who adheres to the literal words of something like a holy book, even in the face of evidence. Okay, there may be some atheists like that somewhere in the world (perhaps some doctrinaire Marxists for example), but they are rare. They are very atypical of what we see in the current wave of explicit atheism, represented by people like Dawkins and Dennett, and our contributors. Generally, people become atheists because of the lack of evidence for particular religious beliefs, or because of positive evidence against certain beliefs. It is not because they have been socialised, or otherwise convinced, to put their blind faith in Das Kapital, or On the Origin of Species, or Why I Am Not A Christian, or The God Delusion. That's not how it works.

As for accepting or adopting labels, I'm ambivalent. I do identify as an atheist, if asked ... and sometimes even if not asked. But I completely understand why some people prefer to call themselves humanists, skeptics, or agnostics, or something fancier (philosophical naturalists, perhaps ... I like that one myself).

All of these terms can have varied meanings in different times or places, or for different people, so no one should be pressured to label herself in a particular way.

Also, in many circumstances, we may not need to identify as atheists (or whatever) at all. E.g., I think that atheists have good reasons to be active in the defence of freedom of speech. However, our arguments, once we become active on that issue, are much the same as anyone else's. In defending freedom of speech, we should concentrate on the arguments, not on the fact that we might have a particular motivation for getting involved. The same applies to other issues that we might wish to take up, whether or not our views about religion give us some of our motivation.

Why are you philosophers as opposed to, for example, scientists, physicians or presidents?

Udo: I have become a philosopher mostly because I am interested in investigating normative issues in our daily lives. Other professionals focus on other kinds of questions.

Russell: When I was younger I contemplated politics - but not for long! I have too many skeletons in my various cupboards to be a politician of any sort, let alone a president or a prime minister. They may not be large, very disreputable, skeletons ... but they're large enough to be a liability. And I keep doing my best to add to them - just in small ways such as making fun of the pope whenever I get a chance. My record of doing that wouldn't help me in politics.

Besides, there are few jobs in the world that enable you to say what you really think and explore the truth as you see it. Provided they can make a living, philosophers can do that. By contrast, politicians are bound by party discipline and the need to court popularity with the public. I've worked for two or three years as a lawyer, and for many years in quasi-legal work. I especially enjoyed courtroom advocacy, which I was quite good at - and I strongly considered becoming a barrister at one stage. Actually, that would have been great, but ultimately I chose to do a second doctorate (in philosophy). As a result I am much poorer than I might have been. I think it's too late for me to start at the bar now that I'm on the wrong side of fifty, so I'm unlikely to make my fortune at this late stage. Still, I have the luxury of thinking, writing, and speaking about the things that really matter to me.

Finally, who have you encountered - aside from your contributors of course- that you think will be making a difference in today's world for the better? Organisations and maybe individual people, perhaps?

Udo: I think anyone who is prepared to think about how their actions can contribute to increases in the happiness of people or others who are capable of enjoying their lives. If each of us made the life of just one other person who is worse off than we are a bit better the world would be a much better place. I suspect there are plenty of people like that.

Russell: Many people are making a positive difference. Some are our contributors, of course, but there other people who are fighting hard to protect our liberties, or to extend the basic requirements for human survival more widely. Others are creating art that lifts our spirits or provokes our thoughts. Still others are pushing back against superstition or extending human knowledge. You know, this world does not look much like one that an all-benevolent God would create. Look at all the suffering, malice, and preventable loss of life. Yet it could be a lot worse, and there are plenty of people who are working hard to make it better.

First Reviews of Voices of Disbelief

The advance copies the publisher of our most recent book, 50 Voices of Disbelief sent out have already been reviewed in some prestigious professional publications. Here's what the Kirkus Reviews reported:

50 Voices of Disbelief: Why We Are Atheists
Edited by Russell Blackford and Udo Schüklenk
Wiley Blackwell / October / 9781405190466 / $29.95

In their excellent collection of essays exploring and defending the philosophical stance of atheism, Russell Blackford (Kong Reborn, 2005, etc.) and Udo Schüklenk (Philosophy/Queen’s University, Canada) had an inclusive vision. “The selection criteria aimed at creating a diverse group of contributors from very different spheres of public life, including academia, novelists, artists, philosophers and so on,” says Schüklenk. “We thought that this diversity should make the volume attractive to people from quite different walks of life.” Contributors to the book range from those with science-fiction backgrounds to modern-day philosophy. “We…thought that this diversity of backgrounds should translate into a rich mosaic of personal and professional views,” says Schüklenk. While atheism has of late acquired some high-profile advocates, such as scientist Richard Dawkins and philosopher Daniel Dennett, it is, of course, not a topic without controversy. There has been backlash against those who have courted it. “Dawkins has
been demonized with some success, i.e. a myth has been created that his tone is simply angry or strident and that he has only a crude understanding of religion,” says Blackford. “Neither of these is true. The myth provides an excuse to avoid his actual arguments, which are quite nuanced and carefully qualified…[It’s] doubtless [that] Udo and I will encounter some critics who’ll distort our arguments and misrepresent our motivations. It comes with the territory.

And a snippet from the Library Journal (courtesy of Russell Blackford):

"In more than 50 brief statements organized by Blackford and philosopher Schüklenk ... contributors share views—their routes toward nonbelief and their feelings about the place of religion in the world ... including James (the Amazing) Randi, a well-known magician and debunker of spurious psychic phenomena. Considering the popularity of Richard Dawkins's The God Delusion, Christopher Hitchens's God Is Not Great, and Sam Harris's The End of Faith, [these] memoirs and observations will be of interest to disbelievers." (Library Journal, October 2009).