Sunday, February 28, 2010

Animal abuse

-RANT BEGIN-

Seriously, what's wrong with people going to places like Seaworld? So, a day or two ago this 'trainer' is dragged by an orca wale under the water and killed in the process. CNN offered two experts on the matter, a bloke looking like Indiana Jones and on the opposing side a Captain Ahab lookalike. As good experts are wont to do they disagree on who's 'fault' this was. Indiana Jones insisted that it was the 'trainer's' fault (her pony tail supposedly triggered the wale's response), vs Ahab who insisted that it was wrong for Seaworld to have a wale amongst its animals that has killed twice before. And so it went forth and back in typical CNN/FOX/MSNBC style.

My questions are these: isn't it obvious that you don't keep such massive animals in the smallish ponds where Seaworld is keeping them? It's a clear case of animal abuse (whatever Indiana Jones thinks). And what is it with these people going to these shows? Why are so many people running to see these shows to begin with? Is our only way to show affection or admiration for huge wild animals to put them into small prisons and make them do stupid things to entertain us? Pretty much in line with why many people go to watch Formula 1 races folks queued forever to watch the first Orca show after the killing of the 'trainer'. Someone hoping for a repeat of the disaster there??

Here's the LA Times reporting on this: 'Hundreds of patrons packed into Shamu Stadium on Saturday for the return of SeaWorld Orlando's "Believe" show, three days after a killer whale dragged a veteran animal trainer underwater to her death. Despite a morning drizzle, visitors stood in line for two hours beginning at 9 a.m. to see the first performance.'

The obvious lessons to be learned from this event should have been:
  • It's wrong to keep animals for entertainment purposes.
  • We should not support businesses such as Seaworld because they rely on animal abuse to make profits.'

What really happened is that the killing boosted visitor numbers. Sickening! People queued for hours to have a look at the Orca that killed three folks. How annoying is that? It seems that PETA at least got the response to this one right. Close down outfits like Seaworld and release the captive wales back into the sea. In case you really need to have a look at Orcas, watch a nature documentary!

-RANT END-


Saturday, February 27, 2010

The things that are

Update: March 02, 2010. I have received further information on the issue discussed in the middle part of this blog, from Catholics for a Free Choice in the USA.

Here's an excerpt from a report they published in 1998: '
The US bishops' Ethical and Religious Directives for Catholic Health Care Services, which strongly prohibit abortion in Catholic hospitals, also say that "operation, treatment, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child."

"It may seem that this directive permits all life-saving abortions, but that is not the case. The language closely mirrors Catholic teaching on abortion, which forbids direct abortions in all circumstances, even to save the life of the mother. The word "direct" is critical. Indirect abortions are allowed - but there are only a few cases where this applies. In a case where a woman's life was threatened by pregnancy, abortion is directly intended and therefore not permitted.

"The full meaning of the directive played out in 1998 when a pregnant woman on Medicaid in need of an emergency abortion was denied services at a merged hospital in Manchester, N.H. The 35-year-old patient, who had miscarried in the last year, rushed to Elliot Hospital when her water broke at 14 weeks. When she arrived her physician determined she needed an emergency abortion in order to prevent a life threatening uterine infection and other complications. However, because Elliott had merged with Catholic Medical Center in 1994, abortions were banned in 1997 from Elliot at the insistence of its Catholic partner.'

This week I had a look at how our collection of atheist thought, 50 Voices of Disbelief, is doing on amazon. I was delighted to see that it has received a reasonable 4.5 rating (out of 5) on amazon.com and some 11 or so reviews. Check out the comments some of the readers left behind,
here. I thought the most critical review (aka 3*** out of 5) is still quite complimentary. Glad the volume is holding up nicely in terms of sales!

In other news: I have been attacked as 'puerile' by an anti-choice organization in Canada for suggesting in said volume that there are Catholic hospitals where pregnant women are sacrificed for the sake of rescuing the fetus in case there is a conflict between the two. I have not, of course, suggested that this is a standard operating procedure in every single Catholic hospital (if it were, we surely would have heard about it). The anti-choice writer wheeled out that lovely Catholic concept of the Doctrine of the Double Effect (DDE) to explain why I am puerily (I made that word up) off the mark. This Doctrine, in turn, depends on your buying into another distinction, namely that of intention-foresight.

Here's what this argument is all about: The DDE holds essentially that we should distinguish between the intended outcome of actions and outcomes that we are able to predict (or foresee) but that we do not intend. The DDE, historically, goes back to an argument advanced by St Thomas Aquinas. He used the example of permissible homicide in self-defense. Aquinas imagined a situation where someone’s intention is to fend off an attacker. However, while he succeeds in fending off the attacker the attacker dies as a result of the defender’s actions. The attacker’s death was unintentional here, and, according to Aquinas is permissible ‘because self-preservation is a legitimate aim and a person who is unjustly attacked has a greater duty to preserve his own life than he has to preserve the life of the attacker.’ The morally important claim here is that the person who is attacked permits the death of the attacker to occur but does not intend for it to happen. The implicit understanding is that the death of the attacker is something that is undesirable and if possible ought to be avoided. One assumption here is that our victim (ie the attacked person) is acting from good motives. The argument from the DDE relies on us accepting a further concept, namely that of the Intention-Foresight Distinction (IFD). This distinction upholds the view that there is a moral difference between intending a patient’s death and foreseeing that it might or will happen, but not intending it. So, in the case of the conflict that I started of with, the doctor who rescues the pregnant woman and foresees but doesn't intend the death of the fetus could be in the clear, according to this Doctrine. The idea, that there is more to the evaluation of a person’s actions than the consequences that that person’s actions produced, is based on a modus of moral theorizing that is best described as deontological. Consequentialists will maintain that both the DDE as well as the IFD are irrelevant consideration in our evaluation of the morality of actions. However, for many health care professionals, as well as in law, the IFD matters a great deal. In homicide investigations, for instance, the determination of the intention of the assailant will make a significant difference in terms of making a deciding on whether she will be prosecuted under a murder or manslaughter charge. I doubt that this is ethically defensible, but there you go. To my mind outcomes are the only thing that matters.

While it is possible to draw this distinction (it is perfectly possible to say that I foresee that A is going to happen as a result of my intending to achieve B, but that I do not intend for A to occur), I cannot see why I should be any less responsible for the foreseen consequences of my actions. What makes A an acceptable cost to incur is surely the greater benefit derived from achieving B, as opposed to anything to do with my intentions.

In any case, the other question is whether or not there is evidence that Catholic hospitals sacrifice the lives of pregnant women in order to rescue fetuses. The answer to this is unequivocally 'yes'. In Catholic Nicaragua, for instance this position is even government policy (law in this case). As I write this, a cancer stricken pregnant woman is not given access to life preserving chemotherapy in that country, because this would risk the fetus' well-being. Just check out recent amnesty international reports on this matter. There have also been bona fide reports of health care professionals working in Catholic hospitals in the USA transporting pregnant women on to secular hospitals, so they could have access to life-preserving (life of the pregnant woman that is) abortions.

While I understand where the anti-choice position is coming from on this issue, I am surprised that anyone from that political corner would deny that these sorts of things are happening in the Catholicism controlled parts of our little universe. These sorts of policy positions do not come cost neutral no matter how hard they might intend (pun intended) for them to be.

There is more in the anti-choice site's article, in particular a rant on the conscientious objection issue. It is noticeable that the defense advanced there is essentially a legal response to an ethical/political argument I made. I did not argue that conscientious objection is illegal currently, I lamented that it is not. Oh well...

Hey, on to one last thing. I worked yesterday busily with the audio/video folks at Queen's University on a virtual presentation (I just couldn't be persuaded it's worth flying/traveling for more than 30 hours in economy class to do a 30 min presentation). The topic was a bit dicy as I am not really an expert in chronic disease issues, but it's been great fun doing this. Check the video out here. I am looking forward to discussing this with the conference participants in about a fortnight!


Monday, February 15, 2010

Christian campaigners' evaporating evidence - news you won't hear on CNN

You might recall the case of the Belgian patient who after 23 years in a locked-in kind of state, and who had been reportedly misdiagnosed as being in persistent vegetative state (PVS), suddenly began 'communicating'. In case you don't remember, here's my report (and take) on the case. The odds are that the patient in question has indeed been misdiagnosed for years as being in PVS. The thing is also, unfortunately, that the case was quickly hijacked by Christian campaigners to further their own ideological agenda. Understandably, every misdiagnosed patient is a cause of concern in the context of ongoing arguments about the question of whether or not it is acceptable to dehydrate PVS patients and let them die. A true PVS patient would not suffer due to his/her brain condition. A patient in a locked-in state would note that this is happening and might well suffer. The Christian campaigners are presumably aware of the fact that public opinion ain't on their side with regard to true PVS patients. One reason for this is that a PVS patient can't truly benefit in any meaningful way from his/her continued existence.

My own view on the issue is that the lack of benefit to the patient in its own right would not be a good reason to discontinue his/her existence, especially if - as is the case in PVS patients - there is no pain or suffering involved in their continued existence. While there are people about who care about such patients' ongoing existence and who would find the patients' discontinuation distressing, we have a good reason to keep them alive. The only counter argument I can see on this front is that resource allocation concerns might tilt the scales toward discontinuation.

In any case, back to the Belgian man. Imagine the excitement of our Christian campaigners when the Belgian doctor of the patient demonstrated that the locked-in man was even able to 'talk' to us. He 'talked' to us by means of a helper who assisted him typing his words (aka answers to the questions asked by the attending physicians) onto a touchscreen computer. I was skeptical in my original blog entry that this widely discredited method of communication was to be trusted this time around. I mean, how likely is it that a guy who hadn't moved for more than two decades would suddenly engage in (albeit assisted) small-talk. Well, it turns out that I was right. An investigation of the matter by the German weekly newsmagazine DER SPIEGEL confirmed that it wasn't the patient who said anything but his assistant (thanks to Art Caplan for bringing this to my attention!). So, now we know what his assistant thought the patient would have answered if he hadn't actually been unable to answer. Here's what the magazine reports:

'The staff at Houben's care center first tried an on-screen keyboard that he could operate using his right index finger, which is not fully paralyzed. For a while, it seemed like a good idea and, after some practice, Houben was able to type rather quickly. He made many mistakes, but his messages were understandable. Still, using that method required the assistance of a speech therapist, who stood behind him to support his hand. At one point, Laureys, the neurologist, claimed that he had ruled out the possibility that it was actually the speech therapist doing the writing. But it turns out that his checks weren't quite thorough enough. Obtaining reliable results requires a rather protracted procedure. Patients with serious traumatic brain injuries are not always capable of following difficult instructions. They also sleep a great deal, and sometimes they sink into extended periods of delirium. In order to rule out false negative results, repeated tests need to be conducted over the course of several weeks.

Laureys has now carried out those tests, and his results hold that it wasn't Houben doing the writing after all. The tests determined that he doesn't have enough strength and muscle control in his right arm to operate the keyboard. In her effort to help the patient express himself, it would seem that the speech therapist had unwittingly assumed control. This kind of self-deception happens all the time when this method -- known as "facilitated communication" -- is used. (As a result, the things that Houben was attributed as saying to SPIEGEL for an article printed in November 2009 were also not authentic.) In the more recent test, Houben was shown or told a series of 15 objects and words, without a speech therapist being present. Afterward, he was supposed to type the correct word -- but he didn't succeed a single time.

This doesn't necessarily discredit facilitated communication altogether. Laureys analyzed another paralyzed test subject who answered all 15 control questions correctly despite having a comparable brain-damage diagnosis. "That means it is really necessary to verify every single case," Laureys says. Now the work with Houben will have to start all over again. But there is one thing for sure -- images taken of his brain activity reveal that it is behaving only slightly differently from that of a healthy brain. As a result, researchers are fairly certain that Houben is conscious -- and they find themselves in the desperate position of a rescue team trying to dig out a person from under the rubble.'

It is troublesome that no major news organisation has picked up on this revelation, so their flawed initial reporting about the ongoing communications from this patient remains uncorrected.

Sunday, February 07, 2010

The Week

It's difficult for me to pick my 'favourite' news item this week to blog about. Two stand out, a study published in the New England Journal of Medicine, and the latest news from spokespeople of the cult of misery as my good friend Russell Blackford likes to call the Roman Catholic Church. The study in the NEJM was mistaken by large media organisations to further substantiate the claim that folks diagnosed to be in persistent vegetative state (PVS) or minimally conscious state (MCS) actually are not in such states, but rather that they're fully conscious persons trapped in a completely unresponsive body. Researchers in Belgium and France measured brain reactions in 54 such people in both countries and discovered to their surprise that some of them had the same brain regions light up that did light up in the healthy control group. This does indeed suggest that there's a possibility that in those folks a functional brain capable of understanding and responding to questions is kind of stuck in an unresponsive body. That is scientifically truly interesting and deserves further research. However, it's worth noting that despite the media hype (and hype by 'pro-life' activists) of the 54 PVS participants only a 5 responded in the manner I have just described, and 'in three of these patients, additional bedside testing revealed some sign of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment.' The researchers sadly failed to ask how these 'responsive' people felt about being stuck in an unresponsive body, whether they wanted to continue living, questions that have been for a long time central in ethical and policy debates about the proper treatment of people in such states.

Stan Terman, MD, PhD of Caring Advocates commented (sensibly): "The finding that while bedside behavioral testing detected NO awareness (the hallmark needed for the diagnosis of Permanent Vegetative State), a high tech scan (fMRI) allowed one patient (out of 23) [not 4] to answer five simple Yes-or-No questions such as, “Is your brother’s name Alex?” Sensational news reports claimed that technology allowed this patient “to communicate for the first time since [the accident].” This may be an overstatement in terms of what we mean by “communication.” While the authors intend to ask patients about pain in the future, they did not suggest posing the ultimate existential Yes-or-No question, “Do you want to live in this state?” Surveys indicate that most people answer “No,” but there are still some who may this limited finding as a reason to never give up hope. Family members of patients with severe disorders of consciousness, especially if they are people of faith may use this finding to bolster their argument to continue to provide aggressive medical care and tube feeding when physicians consider such medical treatment to be futile. In addition, powerful faith-based health organizations, that determine their institutions’ policies regarding refusal of medically administrated food and water, may cite this result from one patient to continue tube feeding, indefinitely. Yet there is something I do not hear: So far, no professional has proposed, based on the finding that fMRI could help NONE of the patients whose PVS resulted from loss of oxygen (as opposed to physical trauma), it is therefore now both morally and ethically correct to withdraw feeding tubes from those PVS patients. I suppose the news media would prefer to report findings as providing hope—that’s what people want to hear. Unfortunately, bolstering false hope could lead to an inappropriate allocation of scarce medical resources." Stay tuned for more to come on this issue. I suspect the debate is far from over!

Well, then there are my friends from the Roman Catholic Church. Reeling from - by now - substantial numbers of (sexual) abuse cases involving children in their care across the globe, the organisation is being hit with the same scandal in Germany, where the number of abuse cases has reached more than one hundred (and counting). Of course, this ain't really newsworthy, we're used by now to the fact that some of its celibate staff are anything but celibate, particularly so when kids are about. Since 1995 about 100 of them were investigated in the context of child abuse allegations in Germany alone. Quite a number! As usual senior management tried as long as possible to protect its staff from prosecution - while busy preaching to the rest of society what proper sex and morals are all about. It is this bit that annoys me ever more. I do not understand why anyone in this day and age would even bother listening to representatives of this organisation the moment they say 'ethics' or 'morality'. Routinely historical truth is being mutilated in the name of the ideological cause, when bishops declared at one point or other that the holocaust is abused as a propaganda instrument by Jewish people, and, of course, that abortion is akin to genocide (tell that to the folks who were slaughtered in Rwanda, for instance). Incidentally, Christians fanatics from a southern state of the USA have been on the road again, in good colonial style, to grab kids in third world countries. It looks like in Haiti a whole bunch of them will be prosecuted for kidnapping kids (whose parents and/or relatives are alive and kicking). The official version is that they planned to hand them over to adoptive parents in the USA. It goes without saying that it all was a misunderstanding now. I pray to the non-existing Gods that they will be sentenced and put in Haitian jails and won't be simply extradited to the USA. There got to be some justice in this world every now and then.