Royal Society Report on End-of-Life Issues makes it into Oxford UP textbook

How delightful little surprises such as this can be :). Talking about the wonders of social networking. So here it goes. Samantha Brennan and Charles Weijer (two friends and colleagues at Western University) posted a link on Facebook, advertising their new bioethics textbook. It's called Bioethics in Canada and found no less a publisher than Oxford University Press. The author list certainly reads like a list of the Who is Who in Bioethics internationally and in Canada. Imagine my delight when I discovered - by chance! - that our Royal Society of Canada Report on End-of-Life Decision-Making was reprinted in part in said textbook. Thank you!

Open Access a threat to academic freedom?

It is no secret to people following my academic writings or this blog for that matter: I am no great fan of Open Access. Its low barriers to market entry have led to a proliferation of dodgy OA outfits that by now easily outnumber the decent OA publishers, and there is no end in sight.  Beall's List of Predatory Publishers flags the magnitude of the problem at hand. Budding academics and those not quite competitive enough to actually get published in decent journals fall prey to their money making schemes in breathtaking numbers. There's more to be said about the business as well as academic flaws of current OA business models, but that isn't the topic of this blog entry.

Recently humanities scholars have woken up to the threat that OA causes to their academic freedom to publish, or so they claim. At the heart of their complaint is this: A whole bunch of research funders insist that the research they fund must be published in an OA journal. Several problems with this: It is probably fair to say that there are only a handful - if that many - decent OA humanities journals out there, and they likely are not in medieval history. If scholars in those disciplines whose work is publicly funded were forced to publish in whatever OA 'journal' (aka webserver) exists in their discipline they would effectively be forced to publish in a location where - really - they would not want to be seen dead. Subscription based journals - often needed to fund academic society activities, something conveniently forgotten in the rush to the economic bottom pit that is OA - would see their submission base diminished as funded academics would no longer be able to choose them as their preferred outlets.

Truth be told, most humanities published research these days isn't funded research to begin with. This is the reason why OA hasn't taken off in our neck of the woods. However, many of us are working in public universities, our salaries are fully or partially funded by taxpayer $$. Forcing us to submit to OA outlets the moment we get our hands on the meagre research funds that are out there for us, would have detrimental consequences for our ability to communicate our findings to colleagues, because they would have to look for our work in the dodgiest of places. It would likely have a deleterious effect on the places (specialist journals with often low circulation) where we discuss and advance our research. It would also likely destroy the viability of some academic societies. Subscription based journal publisher now frequently offer OA options, proposing fairly high fees (>3000$ isn't unusual) to those with spare cash. I must say that I like this idea a lot, because it keeps established loci of academic conversations alive and kicking. I am not so sure what this means in the long-term for the viability of their subscription business model though. Say, if you would make 50% of content in a given volume OA, why should any librarian continue paying the full subscription fee for a journal that's available half-way to anyone who isn't a subscriber. There are undoubtedly challenges ahead, suffice it to say though that I like these latter developments both as an author as an editor.

Some universities have begun to offer funding to humanities researchers who have no external research funding but want to submit to OA publications. Obviously this is only sustainable if dramatic cut-backs at the subscription journals front happen, or if you work for a bank (Harvard, Princeton, Oxbride, etc). Humanities scholars are well-advised to monitor carefully what's happening in their research publishing domains as governments and research funders have decided to revolutionise the way we communicate our research fundings to each other, whether we like it or not. I do think there's a potential threat to our academic freedom to publish in a location of our choosing, but it doesn't seem to be as dramatic as some academics make it to be. After all, there ARE other ways to communicate your work to the world and your colleagues, for instance via social networking, blogging, repositories such as SSRN, academia.edu, university based OA repositories and so on and so forth. Of course, should you need an actual academic job, you'll find that these sorts of outlets are not going to get you one... Incidentally, at least for the humanities this is true also for pretty much any OA (online only) publication you chose to go for.

Post scriptum: As an aside, it seems university libraries have been at the forefront of pushing for OA. Makes one wonder, in time of diminishing library funds, whether that's a classic example of having your cake and eating it. Be that as it may, it turns out, the same libraries have also been busy robbing students of their copyright to their own research theses stored on library servers. Remakable times!

Taxing junk food?

Nice story on the BBC World website. Leading UK medical bodies, among them the Royal College of Paediatrics and Child Health, propose that soft drinks should be hit with a special tax (about 20p per litre). The objective, obviously, is to reduce demand for such products. Why would one want to reduce demand for such products? Mostly because they can be linked to the obesity epidemic in the country. According to the BBC report, 'one in four adults is classified as obese and one in three children is already obese or overweight before they finish primary school.' 

Basically these experts propose to treat soft drinks pretty much like smoking and alcohol are being treated in taxation term. The argument is that consumption of such junk food leads predictably to an increase in obesity and a whole range of known, and expensive to treat, illnesses caused by obesity. Reducing obesity would overall result in an increase in individual (and aggregative societal) well-being and longevity. These are clearly all desirable goals.  

To make things look good, their proposal also includes suggestions such as how government should spend the extra tax dollars (well, Pounds). It is proposed that government spends it on subsidies for fruit and school meal improvements in general. Great idea, considering that school meals in many school in that country qualify at best as junk food. 

There is no great risk that the current Conservative/Liberal UK government will run with this proposal. It has been busy trying to get industry to volunteer improvements on the soft drink frontiers. Industry folks claim that the addition of sugar to soft drinks has already decreased significantly. Well, assuming that that is true, I guess soft drinks that ain't directly linked to obesity could be exempted. I don't know, of course, whether there might be other problems with soft drinks beyond the sugar, indeed, I don't even know whether the industry guy who points out that 61% of soft drinks contain no added sugar tells the truth. He also points out that the consumption of soft drinks containing added sugar has fallen while obesity has increased anyway. If he's right, one can't help but think of other worthy targets for higher taxes.

I am not opposed to punitive tax rates on demonstrably unhealthy food products...but, the moment you look at this sentence, you can't help but wonder where this will end? Glasgow's fried Mars bars anyone? Fries with mayonaise anyone? Cake? The list of crap we eat and enjoy is pretty endless. FWIW, I recently had a fried Mars bar, because I wanted to know how this ur-Scottish culinary delight tastes. Well, it's gross. Tax it to the hilt as far as I care. Just kidding :). 

There's a serious point to this though: it seems to me that if one wanted to do this truly fairly one would have to balance the quality-of-life benefits folks derive from gobbling down junk food of any kind against the societal quality-of-life costs. People don't enjoy junk food only because they live in food deserts, or because they're poor and can't help it/don't know better (add your favourite assumption/prejudice about the kinds of people that eat junk food), etc. Many folks enjoy junk food because they enjoy the taste of it. Being a proper continental European I love my fries with mayo. We know our lifestyle choices ain't particularly healthy, and we don't care in the end. Health is only one value among many that make life worth living. It is a very important value, but it isn't uncontroversially on top of anyone's hierarchy of values. So, taking pleasure out of our lives (or making our pleasures more expensive by means of tax policies) requires sound justifications that go beyond pointing to health consequences. 

It seems to me that such taxes can probably be justified - and they might ultimately be a good idea. It should be interesting to see whether this experiment would result in the desirable health outcomes its proponents are hoping for. However, in a just society there should then be equal taxation for other products that are equally detrimental to our health. Guess one could quantify what kinds of damages what kinds of products cause and tax (or insure) accordingly. That is, provided the choices those make who indulge are reasonably their own and not choices determined by forces beyond their control (eg food deserts). 

Anyhow, guess I am just thinking aloud here. One worry I have is clearly to do with the question of where this will end. But then, in philosophy we know that slippery-slope arguments are typically terrible, unsustainable arguments, so I suspect reasonable, definsible lines can probably be drawn in the sand. How and where would you draw them? 

'Discrimination' - always a wrong?

I recall teaching in South Africa, in this case a large class of medical students (likely 300+ were in the lecture theatre). For some reason or other that I do not recall a student replied in response to a particular scenario (I think it was a resource allocation justice case study) that that would be discriminatory, implying that that in its own right would make it a wrong.

Indeed, in common language usage people often wield the discrimination flag when they think they have been wronged in an unfair way. Gay people in Russia claim that they are discriminated against, and that therefore they have been wronged. Some religious people claim discrimination in various contexts, for instance when they are asked to do certain things that their profession requires of them as professionals. They consider this form of religious discrimination wrong. British readers will see these sorts of claims frequently pop up in reporting of the Daily Telegraph.

What people tend to miss is that discrimination simply describes that someone is making choices for or against something. Say, I choose coffee over other beverages in the morning, that means I discriminate against those other beverages. Or I choose to fly in the front of the bus if I can afford to avoid the back of the bus, certainly on all flights longer than, say 5 hours or so. I discriminate against the cramped seating conditions in the back of the bus.

Discrimination is about making choices between options, it is about drawing distinctions.

Now, it seems to me that someone just claiming 'discrimination' is begging the question then. What question? The question of whether or not a particular discriminatory act is justifiable or not. Many people claiming 'discrimination' tend to beg this question. Think of discrimination based on ethnicity. Is it always wrong? If so, most affirmative action programs in operation today would then be wrong, too. Perhaps we should try, in our common usage of the term, to distinguish between 'just discrimination' and 'unjust discrimination'. 'Discrimination' claims without the qualifier should probably be ignored because it is unclear wether there is a problem to begin with. They constitute mere handwaving in the public sphere kind of activities. Once someone claims 'unjust discrimination' we should ask for a justification of the 'unjust' claim. It certainly is not the case, that 'Discrimination of any kind is wrong.'

Simple enough, isn't it?

Quebec at the forefront of assisted dying effort in Canada

Exciting developments in Quebec. There is a cross-party consensus in the provincial parliament that assisted dying ought to be available to certain patients, namely those who are on palliative care, who suffer from a terminal illness and who consider their lives not worth living any longer. There is currently contradictory information in the media-reporting about whether assisted dying extends all the way to voluntary euthanasia or just assisted suicide. What seems clear is that the legislators avoid - likely for legal reasons - from calling what they proposing what it is. 

I have not been able to get my hands on an English version of what is reportedly a 400pp legal document indicating that Quebec is on firm legal grounds, constitutionally, if it decided to go ahead with this plan.

Here is how the Huffington Post has reported the gist of it: 

'Under the recommendations, patients themselves would have to make the request to a doctor on the basis of unbearable physical or psychological suffering. Two physicians would have to approve the request, which would have to be made in writing.

Doctors would not face criminal charges in these circumstances, the report said. Any law should state that the refusal, interruption, abstention from care or the application of a terminal sedative in those circumstances could not be considered a suicide.

The Quebec panel, which was headed by lawyer Jean-Pierre Menard, said people suffering from an incurable or degenerative illness should be allowed to ask for medical assistance to help them die.'

Table of Contents Bioethics 2013; 27(2)

Bioethics © Blackwell Publishing Ltd Volume 27, Issue 2 Pages ii - ii, 59 - 116, February 2013 The latest issue of Bioethics is available on Wiley Online Library EDITORIAL Saving Lives (page ii) Ruth Chadwick DOI: 10.1111/bioe.12014 ARTICLES USE OR REFUSE REPRODUCTIVE GENETIC TECHNOLOGIES: WHICH WOULD A ‘GOOD PARENT’ DO? (pages 59–64) JANET MALEK DOI: 10.1111/j.1467-8519.2011.01890.x THE ETHICS OF UTERUS TRANSPLANTATION (pages 65–73) RUBY CATSANOS, WENDY ROGERS and MIANNA LOTZ DOI: 10.1111/j.1467-8519.2011.01897.x STIGMATIZATION AND PUBLIC HEALTH ETHICS (pages 74–80) ANDREW COURTWRIGHT DOI: 10.1111/j.1467-8519.2011.01904.x WELLBEING, SCHIZOPHRENIA AND EXPERIENCE MACHINES (pages 81–88) DAVID RHYS BIRKS DOI: 10.1111/j.1467-8519.2011.01894.x UNCERTAIN TRANSLATION, UNCERTAIN BENEFIT AND UNCERTAIN RISK: ETHICAL CHALLENGES FACING FIRST-IN-HUMAN TRIALS OF INDUCED PLURIPOTENT STEM (IPS) CELLS (pages 89–96) RONALD K.F. FUNG and IAN H. KERRIDGE DOI: 10.1111/j.1467-8519.2011.01896.x OVERSTATING VALUES: MEDICAL FACTS, DIVERSE VALUES, BIOETHICS AND VALUES-BASED MEDICINE (pages 97–104) MALCOLM PARKER DOI: 10.1111/j.1467-8519.2011.01902.x IS PAYMENT A BENEFIT? (pages 105–116) ALAN WERTHEIMER DOI: 10.1111/j.1467-8519.2011.01892.x

On (Not) Travelling on Delta Airlines between Xmas and NY

Here's a true story befalling some 200 travellers on a Delta Airlines flight from Syracuse to Atlanta on December 22. We were scheduled to depart Syracuse at 6:40 am, accordingly many travellers booked the night before into hotels in close proximity to the airport. We pretty much showed up on time, checked diligently in, even boarded the plane in a timely fashion for our 6:40 am departure. The simple reason for this was that we needed the plane to depart in a timely fashion for most of us to catch our connecting flights to our vacation destinations (or home) in Atlanta. In my case the plan was to head to Fort Lauderdale where hotel and rental car were waiting (and had to be paid regardless of whether I would make it there or not).

Well, it turned out that Delta staff had no problems letting passengers board a plane they knew full well wasn't roadworthy so to speak, given that it arrived with a broken generator the night before. So the charade began. We were stuck for about 2 ours, some fiddling with the engine, the generator, the ice and whatnot. Eventually we were kicked off the plane (could have slept a few hours longer I thought at the time). Well, an hour or two later we were herded back on to the plane only for the crew to discover further mechanical and electrical problems. an hour or so later we were again kicked off the plane.

Meanwhile Delta had ordered a bunch of junkfood items for us, muffins, bagels and tons of the cheapest pizzas available. I understand that by US airline standards that was a kind gesture, and to be fair to Delta, the food outlets at the airport in Syracuse do simply not sell healthy food items (short of overpriced fruit salads).

We waited and waited and waited, only to be eventually told that Delta was trying to get a replacement jet and crew to Syracuse. This, of course, should have happened over night, and not in a haphazard activity late afternoon on December 22. Pretty much everyone on the plane had by then missed their connecting flights, many had in fact decided to return home and forget about their holidays altogether.

Eventually, at around 5:30 pm or so the replacement plane arrived. Delta staff quickly dumped another load of pizza on us, lest it would have to provide us with cash vouchers to purchase proper dinner in Atlanta where virtually everyone was stuck for the night. We eventually departed - irony of ironies - at 6:40 pm, a full 12 hours after our scheduled departure time to Atlanta.

Some people on the plane were stuck in their quest to reach their holiday destination for up to three days in Atlanta - it goes without saying that they were not dressed for winter, yet Delta thought nothing of it to book them into airport hotels instead of nicer downtown Atlanta hotels. So there they were over the Xmas holidays, in airport hotels in Atlanta. Why? Because of Delta's incompetence. The airline knew full-well for a full night that their plane wouldn't be able to take off, yet it chose not to act on this information when it should have (namely over night). Its own ground staff in Syracuse was flabbergasted about the airline's decision not to replace the broken-down plane over night when it could and should have.

200 passengers were severely hit by this airline misconduct during their holidays. We had significant additional costs that were caused entirely by Delta's mistakes. Just to be clear, this cannot be an argument for taking out travel insurance to cover those extra costs, because the fault for these extra costs was Delta's. Why should travellers have to insure themselves against costs incurred due to airline incompetence? Delta offered a voucher of 100$ toward future flights. It goes without saying that that voucher didn't cover the actual additional expenses incurred.

Well, we arrived eventually in Atlanta and ended up receiving a voucher for a truly terrible airport hotel (the restaurant closed early - thanks Sheraton Atlanta airport hotel - despite a large queue of passengers checking in, all of whom hungry for real food after a day's worth of Delta's junk food). True to form the hotel voucher included no meals and no internet access. We continued our trip the next morning, being among the lucky ones able to continue their journey after losing only one full day of their vacation courtesy of Delta Airlines.

This has been a shocking experience, mostly because it became clear to everyone of the 200 passengers on said flight that this all would have been avoidable if Delta had acted on the problem when it should have. Delta clearly chose the course of action it thought would be cheaper, even though this would come at significant cost to about 200 of its passengers. Eventually it saved nothing at all, a replacement jet had to be send after a day's worth of fiddling with the broken equipment in Syracuse, plus there were 200 irate passengers realizing that their all-important vacation plans meant nothing to this airline, a large number of hotel rooms booked, the list goes on.

The lesson out of this all: Delta is probably not much better or worse than any other US airline, so passengers will have to accept such misconduct until these companies are better regulated. The real lesson to me: If Xmas/NY travel is avoidable at all, don't travel during that time of the year. I had two out of two trips during that time of the year stuffed up during the last 4 years. So, it's not only that airlines charge you a lot, they also often don't deliver. A pretty miserable record.

Delta's Twitter guy or girl #DeltaAssist suggested I complain with Delta's 'not my problem', aka its complaints folks. I mentioned that that likely would mean throwing good money after bad, knowing that US airlines could not care less about customer experiences. Against my better judgment I tried anyway. I  received precisely the response that you'd expect from such an outfit:

'I understand the frustration you experienced when your plans were
disrupted due to the delay of our flight for mechanical reasons causing
you to miss your connecting flight.  I can only imagine how dissatisfied
you must have been to have your travel plans disrupted at the last
minute.

Additionally, I am truly sorry you were unhappy with the Electronic
Transportation Credit Voucher (eTCV) and hotel voucher provided.  The
gesture extended was not meant to place a value on your experience;
rather it was an attempt to make amends for your disappointment with our
service.  Respectfully, additional consideration would not be due.  I
apologize, as I understand this is not the answer you were hoping to
receive.'

My truly favorite line is this, 

'I want to thank you, again, for writing regarding flight

irregularity.  We appreciate your interest in our company and look
towards your future travel with us.'

2013 here we come

I'm off to a good start into 2013, at least on the work-related fronts. Russell Blackford and I submitted in the dying days of 2012 the final copy of our up-coming 50 Great Myths about Atheism to Wiley-Blackwell, our publisher. I have also been working diligently with Helga Kuhse and Peter Singer on the 3rd edition of Bioethics - An Anthology, which should also be out some time this year. It's going to be an 800+ pages doorstopper. The question is what to do with the remainder of my sabbatical, roughly another 9 months worth of no teaching and administrative responsibilities at the university. I need to get going on a book project on Global Health Ethics, but there's also a tempting new introductory bioethics textbook to produce that's heavily oriented toward the inclusion and utilisation of on-line networking tools. Difficult call, but a decision has to be made. I have also written a piece that's forthcoming during the next few days in the Journal of medical ethics. Using the debate on infanticide I show how bioethics journal editors come under ever-increasing scrutiny by political campaigners and other pressure groups to publish whatever it is that these campaigners and organizations deem 'right', and that we cease and desist from publishing content they disapprove of. These are worrying developments. Keep your eyes open for the article. I understand that it will be an Open Access document, but if it isn't, ask me for the pdf and I shall post it your way. With Ricardo Smalling I have co-authored a paper that also coming out in the next few days, this one in the Journal of Medical Humanities. We are looking there at the impact religiously motivated anti-gay sentiments have on the professional (or not so professional) conduct of some health care professionals. Not terribly original is our suggestion that tighter regulations are required to protect queer patients from such health care personnel's unprofessional conduct. But it had to be said. We are also taking head-on the silly idea that conscience based objections to homosexuality should be a valid reason to treat queer patients different to other patients. Right now I am revising the entry on 'Utilitarianism' for the 4th edition of the Encyclopedia of Bioethics. I had written pretty much what I thought ought to be said and passed it by a number of colleagues. I received plenty  of very constructive feed-back in the middle of the holiday season (who says academics are lazy!). During the rest of this week I will revise what I got, and then submit to the editors of the encyclopedia.

2013 will see in Canada a number of exciting landmark cases being decided by the Supreme Court (well, by virtue of them coming to the Supreme Court they got to be landmark cases, of course). Among them a case where the family of a patient in persistent vegetative state wants the taxpayers to fork out 2,000 C$ per day for futile medical care vs doctors who think they'd have the last word on cessation of treatment. I am not in favour of either party here, so I am curious what the Court will make of it all. Then, of course, presumably by the middle of the year, the Court should issue a finding on the constitutionality of the criminal code prohibition of any form of assisted dying in the country. I suspect that a lot will hang on whether the judges on the Court can be persuaded by one side or the other that there is or isn't a slippery slope from decriminalizing assisted dying in some form or shape to the killing of people who do not wish to see their lives terminated.  I have seen no proof for the existence of such a slippery-slope, but who knows what the judges on the Court will make of the arguments and evidence presented to it. If you were to ask me for a prediction, I would guess that the Court will find that the absolute prohibition of assisted dying in all cases simply is too broad, and that it will open the door for decriminalization in a restricted number of clearly defined cases. But then, your guess is as good as mine.

2013 promises to be an exciting year for us bioethics and health policy wonks.