Friday, August 30, 2013

On ethical tourism

My latest OpEd in the Kingston Whig-Standard
Clearly the time has already come for some of the snowbirds among us to organize our trips down south during the coming winter months. Holiday resorts across the Caribbean are busily advertising their latest, best deals to us. And aren’t they nice, these ads? Lush rain forests, carefree, friendly locals, drinks on the beach, romance, the lot. You can’t help but think you’re heading to paradise. The reality, in at least some of these countries, is quite different.
Take Jamaica as just one example. I don’t know whether you have missed the easy-to-overlook news about the nearly weekly occurrences of anti-gay violence in Jamaica. A transgender teenager was hacked to pieces by a local lynch mob very recently. During the next few weeks there were several other reported incidents of mobs attacking other gay individuals, prompting the local police to mount rescue missions.
The Jamaican government does precious little to improve the situation of gay people in the country. Male homosexuality is illegal courtesy of an unholy coalition of colonial laws kept alive by the influence of fundamentalist preachers and the sub-standard level of education of the general population. It’s a dreadful situation, no matter how you look at it.
Gay and lesbian Jamaican ex-pats have quietly begun to organize a tourism boycott campaign. Their analysis suggests that, given Jamaica’s dependence on tourism, the government would begin to listen to their concerns if more and more tourists stayed away in disgust at the human rights situation in the country. Of course, one would want to ensure that the Jamaican High Commission in Ottawa hears about our decision. After learning about these issues I wrote to Her Excellency this week that Jamaica, with regret, was off my list of holiday destinations until things change.
But ethical tourism? Really? Should we make choices about our holiday destinations on issues other than location, time, price and quality of the resort? Believe it or not, despite being an ethics teacher, I’m not a fanatic on these or any other matters of ethics. There is little point in asking others to make sacrifices they consider unreasonable, even if I might be prepared to make those sacrifices.
But is it unreasonable to switch from, say, Jamaica to Costa Rica or to a Mexican state that supports marriage equality? How should we decide where to go? Surely Costa Rica or Mexico are also going to have some ethical issue or another! And how long would this whole thing take, anyway, given that all I want is to book a carefree vacation? Fair enough questions to ask.
How should we decide? My suggestion would be to use fairly uncontroversial criteria such as a country’s human rights record, its environmental protection efforts and possibly issues such as educational attainment, health care and other human welfare indicators.
So, with all that, you say, we might not go on vacation at all, because realistically we would spend the next few years figuring out how particular holiday destinations are doing instead of actually going there.
Not quite. It turns out that the Internet, as so often is the case, offers a whole host of websites that actually have done the work on our behalf already. To give you just one example, the site evaluates every country based on the criteria I have proposed. It makes no bones about the fact that there is no perfect holiday destination, but some clearly are way better than others. For this year it has the following top 10 ranking: Barbados, Cape Verde, Costa Rica, Ghana, Latvia, Lithuania, Mauritius, Palau, Samoa and Uruguay.
You could, if you really cared enough, do the legwork yourself. Amnesty International provides excellent country-based reviews of the human rights situations in particular countries that you might consider visiting as a tourist. This would matter to you if you thought human rights should take priority over environmental issues. Environmental organizations provide similar rankings, and the United Nations Development Program (UNDP) produces annually a freely accessible Human Development Report. The latter gives you a good indication on whether a particular country government does well by its people.
Are there good reasons against tourism boycotts? Of course there are. For starters, for a tourism boycott on ethical grounds to be useful it should target countries that rely heavily on tourism. It would be foolish to target China with a tourism boycott, because whether or not tourists come or stay at home makes little to no difference to China’s continuing rise.
All you would do is harm businesses and their employees without effecting any policy change at all. That would be a pointless boycott to begin with. So there you have a good argument against a particular tourism boycott.
Another argument goes that if you go as a tourist to places that violate human rights you have a chance to influence what’s happening locally by supporting those oppressed by the country’s majority culture or government. That is somewhat doubtful, isn’t it? In the case of Jamaica you would likely be holed up in a holiday resort and your interactions with “the locals” would be pretty limited.
Also, in all honesty, when we are on vacation we are not usually on a crusade to fix a country’s social ills by organizing demonstrations in the wake of another senseless mob attack, even if we were not prevented by the country’s laws from doing so in the first place. When I’m on vacation I want a break!
But why should we care at all? My view is that we should assist others in attaining better lives, or even just lives worth living, as long as we don’t pay an unreasonably high price for doing so. Even if it does sound a tad bit bombastic, the world really would be a better place if more of us followed this rule. In the particular case of choosing a holiday destination it seems that we would pay a fairly small price by deliberately choosing one Caribbean holiday destination over another based on the country’s treatment of all of its people, its environmental record or any other issues that matter to us.
Udo Schuklenk teaches bioethics at Queen’s and tweets @schuklenk

Sunday, August 25, 2013

First reader reviews for 50 Great Myths About Atheism are in

Our book is finally out, virtually at least. Since mid August 50 Great Myths About Atheism is available on amazon as a Kindle edition. The print version should be rolling out in Europe in early September, North America in early October etc. We are on, so to speak. The first reviews of the Kindle version have already appeared on the site. Here's a flavour:

4.0 out of 5 star Ambitious, and mostly very satisfying Aug 25 2013
By J.A. Rousseau - Published on
Format:Kindle Edition|Amazon Verified Purchase
I spent a little time mulling over whether this should be a four- or a five-star review. In truth, I'd have liked to award a 4.5 star rating, because the book is perhaps slightly too ambitious, with the authors setting a standard that was always going to be difficult to full satisfy. The main concern I have can perhaps be summarized in saying that it's sometimes unclear who the audience of the book is intended to be, and the tone and content of various chapters ends up seeming slightly inconsistent as a result. Sometimes one gets the impression that the book is "arming" atheists against the caricatures of theists, and at other times, that theists are being addressed in an attempt to dispel their confusions. This gives rise to an unevenness in the level of detail, and also the tone, of various chapters.

As for the reasons why I'd want to award at least 4, and ideally 4.5 stars, the book is enormously instructive. For the patient reader, the level of detail in many of the chapters is superb, and even for "myths" that you're already very familiar with, you'll often find a citation or example you didn't yet know about. The book begins by asking you to consider what are quite tricky questions, even before proceeding with discussing the myths - namely in discussions of who "counts" as an atheist, and what should count as myths. In my view, this could be described as one of the more challenging elements of the book to write, in that there are all sorts of opportunities for readers to take issue even at that early stage, rejecting the authors' definitions, and choosing to adopt an uncharitable attitude to the rest of the book as a result.

However, Blackford and Sch√ľklenk set the tone for the rest of the book in those introductory sections, explaining with great clarity and to good persuasive effect that certain questions can be set aside, or at least resolved to a sufficient extent to make the myths that are dealt with worth focusing on. As I say, that rhetorical and argumentative skill is then carried throughout the book, leaving the reader feeling both enlightened and entertained in the reading of it.

I'd highly recommend this book for (at least) two sets of readers: first, the honestly curious theist, who is suspicious of the easy dismissals that some of his or her kind deploy against atheists. Second, the atheist who wants to develop a thoughtful, well-reasoned set of defenses against some of the stereotypes that are assigned to atheists - not only by theists, but also in popular culture.

(Disclosure: I am personally acquainted with both of the authors, and one is a colleague of mine. I do not however regard that as having influenced my comments unduly.)
5.0 out of 5 stars As good as the editorial reviews said Aug 24 2013
By peter veitch - Published on
Format:Kindle Edition|Amazon Verified Purchase
Excellent thinking about this important topic. Some good ideas that are new to me. I have changed some views after reading this.

Saturday, August 24, 2013

A long overdue Open Letter to the Jamaican High Commissioner

Dear High Commissioner:

I have noticed increasing reports about breathtaking levels of discrimination (as well as hate crimes) that are meted out against gay and lesbian Jamaicans. Like others reading about this I have drawn the conclusion that I will not visit Jamaica as a tourist. It would be unconscionable to support a society that violates the civil rights of its sexual minorities in the way your society does.

Udo Schuklenk

Friday, August 23, 2013

time to decriminalise assisted dying in canada

Here's this weekend's OpEd on Assisted Dying in the Kingston Whig-Standard.

This last week doctors organized under the Canadian Medical Association met for their policy convention in Calgary. A whole bunch of sensible policy recommendations came out of this meeting, including the suggestion that our kids should no longer be able to purchase energy drinks.
But commentators writing for national news organizations concluded, in typical handwringing style, that the CMA failed us terribly by not issuing a recommendation on the issue of the decriminalization of assisted dying.
I don’t think that was much of a failing. In fact, I don’t quite understand why it should matter more what doctors think than what you or I think about our own death. Why should they have a bigger say or stake in the manner of our own dying? I guess it could matter if they were to be forced to participate in assisted dying if it were to be decriminalized. The thing is, that would not be the case, anyway, so why get overly excited about our doctors’ views on the matter?
Where are we in the assisted dying stakes, anyway? Quebec has decided that assisted dying is no more than part of continuing medical care, and so, by its lights, it is its decision alone how it regulates this matter since health care is one of those powers entrusted to the provinces through the Constitution. The provincial government is intent on making assisted dying a possibility.
Quebecers overwhelmingly support this. There is even cross-party support in the province for the proposed legislation. The National Assembly is currently debating it. You can be sure that the federal government – currently controlled by conservative Christians – will try to have this provincial law set aside by the courts, and to be fair, there is a serious constitutional issue at stake here! The constitutional issue isn’t – as you might expect – about assisted dying, but about the question of whether our provinces should be able to set aside the parts of the federal Criminal Code that prohibit assisted dying by redefining it as a provincial health matter. If they were able to do so, what parts of the Criminal Code might be next?
Independent of the goings-on in Quebec, the Supreme Court of British Columbia declared in a 2012 ruling those parts of the Criminal Code that criminalize assisted dying unconstitutional. The federal government has appealed this decision and we should hear within the next few months how that went. However the Court of Appeals decides, the losing party will undoubtedly try to get this matter heard by the Supreme Court of Canada.
It is always tricky to predict how court judgements, especially Supreme Court of Canada judgements, will pan out. The latter, protests from legal eagles notwithstanding, has plenty of leeway to determine the course of assisted dying in this country.
I’m optimistic that decriminalization in some form or shape will eventually occur. The reason for this is essentially that our Charter of Rights and Freedoms places a very high value on respect for the autonomous choices we make for ourselves. That explains why suicide is legal in Canada. That also explains why we have the legal right to stop life-extending medical care at any time. Short of having us declared incompetent, doctors cannot treat us against our wishes.
Given this context, it doesn’t seem to be a great stretch for a court to determine that we also have the right to assistance in dying. Respect for our individual freedom will win out. It has on the abortion fronts, it has on the marriage equality front, and it will win on the assisted dying issue, too. As a species we seem bent on placing individual rights and freedoms, as far as self-regarding actions are concerned, above conservative values that have others determine what’s best for us.
The countervailing arguments against decriminalization are pretty thin - and that is putting it mildly. In the old days the same anti-euthanasia campaigners who busily contribute to public debate today were pretty clear that assisted dying would violate their religious rules, and so none of us should have access to it, regardless of our own worldviews. They have since realized that this kind of arguments doesn’t exactly help their cause among the wider Canadian public. Accordingly, they switched their campaigning to concerns about possible abuses of never-clearly defined “vulnerable” people.
Given that pro-choice campaigners are concerned about individual free choice and also our quality of life, the strategic shift in the anti-choice rhetoric to testable claims about worrying slippery slopes is actually to be welcomed. It is a fair enough question to ask whether disabled people, the poor and others you could reasonably describe as more vulnerable than some other classes of patients would be put at risk if we decriminalized assisted dying. No doubt the courts will look at this issue in great depth and detail.
The reason for my optimism on this front is that we know from jurisdictions that have decriminalized that there is no evidence that vulnerable people are disproportionately represented among those who receive assistance in dying. From some jurisdictions we even have firm data demonstrating that abuse has actually decreased since decriminalization. Even if there were a limited number of clear, uncontroversial cases of abuse in societies that have decriminalized, we would still need to establish that that abuse was a result of decriminalization.
The anti-choice campaigners have a habit of carefully fudging the issues here. Their claim that decriminalization has led to reductions in the quality and availability of palliative care also turns out to be without any basis in fact. None of the actual evidence we have fits the anti-choice campaigners’ scaremongering tactics, hence their ever-more-hysterical-sounding claims on that front.
With the exception of Quebec, I think it is fair to say that this country has been let down disgracefully by its elected representatives. Opinion poll after opinion poll - and this includes polling undertaken by anti-choice campaigners, too - concludes that an overwhelming majority of Canadians support the decriminalization of assisted dying. That, combined with the lack of evidence of a slippery slope to unwanted killings as a result of decriminalization in societies that have legalized assisted dying in some form or shape, makes a pretty powerful case for the decriminalization agenda.
Not so in the eyes of our elected representatives. They have caved in to the religious right’s lobbying and scaremongering on this issue, instead of showing the leadership we can rightfully expect of them. For what it’s worth, this failing cuts across party lines. Even the so-called Liberal Party of Canada, whose very name suggests that it should proudly support decriminalization, is to be found on the wrong side of history on this issue. The good news for us is that the courts will not be susceptible to pressure from religious and other campaigners.
Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen's University. He has chaired a panel of international experts drafting a landmark report on end-of-life issues on behalf of the Royal Society of Canada. He tweets @schuklenk

Australian hotels, racists and Qantas' long-haul business class

Talking about anecdotes... I stayed in four different hotels in Melbourne and Sydney this month: Common features, lousy cable TV selection and absolutely obscene internet charges. Right back at the airport hotel in Toronto, back to normal, no internet charges, pleasant staff. Anecdotes, I know, but: You read it here first :-).

Also, having left Australia some 15 years ago, I was shocked about the level of racism that is standard political operating procedure in that country today. Much of what leading politicians and newspaper columnists spouted there on a daily basis in that regard would be a career-killer in Canada, thankfully. Truly mind-boggling stuff.

Well, I was also able to fly in Qantas' long-haul business class in its Airbus 380 fleet. I love the A380. It's such a more quiet, overall smoother ride than any other plane on the market. The seats are comfy, even though the recline doesn't seem to be completely vertical. One big issue: For some reason the aisles don't seem to be cushioned properly. As a result, each time a passenger or flight attendant passes by at your seat you'll be awoken by the feel of an elephant passing by. Clearly a design problem. Compared to what American Airlines calls 'business class', well, it's a no brainer. Qantas' premium economy is superior to American's business class product, let alone Qantas' stellar business class. Even the business class lounges were remarkably different. Qantas offered decent food and drinks, while American tried hard to sell even that to you in its lounges.  Makes you wonder why anyone would fork out money for a business class fare on American Airlines.

Other than that, I cannot believe how much Melbourne and Sydney have changed since I left. The mining boom brought obviously tons of money and people into the country. New gleaming everythings have transformed the city scapes, and not necessarily for the better.

I gave talks both in Melbourne and Sydney on assisted dying and managed to catch up with old friends and colleagues in both cities. Overall it has been a delightful trip. Oh, did I mention the weather? No point in that, it's been fabulous, in Sydney more so than in Melbourne.

Thursday, August 22, 2013

Research ethics scandal in Canada

So there we have our own research ethics scandal, and as is the habit with scandals, they tend to widen. Initially we learned that aboriginal children in the residential school system were subjected to research with nutritional supplements. Now we learn about even more exploitative clinical research. And the Truth and Reconciliation Commission is still digging.
Quite possibly this research was undertaken with the best of intentions, namely to improve the lot of malnourished aboriginal people. To some extent there seem to be parallels to research that is undertaken even today in some developing countries, where cheaper medicines are tested on impoverished trial populations because they are unable to afford the patented mainstream medicines that we take for granted.
There is an argument to be had that such research could be ethically acceptable if reasonable measures are taken to ensure that the trial populations will ultimately benefit from the research findings. After all, it is not the researchers’ fault that pharmaceutical companies price many life-preserving medicines out of the reach of the world’s poor. To blame them for trying to develop cheaper drugs to address genuine health issues seems unfair.
The intellectual property rights system leads to this unfortunate situation, and it should probably change, but it’s not something individual clinical researchers have any chance to influence one way or another.
Quite possibly similar motivations drove the researchers at the time in Canada. There they had a population that was severely malnourished. It was beyond their means to implement policies that would have ensured a supply of foods capable of ensuring a balanced diet for aboriginal Canadians living in remote areas of the country.
That the situation aboriginal people found themselves in was unacceptable is obvious, and the government of the day should be condemned for failing Canada’s aboriginal peoples. Where it gets trickier is to understand what exactly it was that made this research unethical. After all, quite possibly the motives were actually noble.
If it had turned out to be the case that nutritional supplements could have been a substitute for more expensive-to-provide regular food products, it might have been possible to improve the well-being of aboriginal Canadians. In all fairness, I am guessing here. I don’t know whether this is what motivated the researchers of the day. Even if it didn’t, this could have been a possible outcome. Unfortunately, the research (remember, it occurred during the 1940s and 1950s) wasn’t terribly methodologically sound, so it turned out to be time well wasted, even on that front.
A crucial issue in any kind of clinical research is the need for first-person informed consent, or consent given by a properly authorized legal guardian acting in the best interest of the potential trial participant who is unable to consent on her or his own behalf. A good example of the latter are underage people.
So, with regard to the research involving nutritional supplements, what exactly went wrong? For starters, consent was not sought and was not given. A clear no-go, certainly not only today, but also at the time. International standards at the time rightly declared clinical research with human participants in the absence of voluntary first-person informed consent unethical.
What else was unethical, even at the time? Withholding food (e.g. milk) from the involuntary trial participants to establish a particular clinical baseline for comparison was unethical. Not providing dental care to the involuntary participants in order to see clearer what impact the nutritional supplements or their absence would have was unethical.
Why was it unethical? It was unethical because the involuntary trial participants did not agree to the risk to their health. In addition to that: one principle of research ethics has always been that any worsening of a trial participant’s baseline needs to be well justified and is usually subject to some kind of compensation. For instance, today trial participants in sub-Saharan Africa who become HIV-infected in HIV vaccine trials typically receive a life-time supply of AIDS medication to compensate them for the harm they incurred as a trial participant.
The aboriginal Canadians received nothing to make up for the harm they incurred while they were reduced to the status of involuntary lab rats by government researchers.
Since the nutritional research was unearthed it has been reported that other research was also undertaken. This time it’s not just about nutritional supplements. It turns out clinical research was undertaken in aboriginal communities and residential schools. Again, informed consent was neither sought nor given. Incredibly, the drugs that were investigated were – insofar as they were successful – provided to the general population but not to the aboriginal communities without whose involuntary sacrifices they were made possible in the first place.
This kind of exploitation increases the ethics failures of those involved at the time quite significantly. Whereas in the initially reported nutritional supplement research we could have given the investigators the benefit of the doubt at least as far as their motives were concerned, we cannot reasonably do the same with regard to the now-reported clinical research.
What I find most disturbing about this widening scandal is that these events occurred right during the Nuremberg trials. Admittedly, there was no Internet at the time, but still, the crimes of the Nazi doctors in the German concentration camps were front-page news the world over. And yet, in Canada, at about the same time, a vulnerable, arguably captive population of aboriginal Canadians was essentially coerced into clinical research as if the reports about what happened during Nazi researcher Josef Mengele’s reign didn’t happen.
The 1947 Nuremberg Code established that first-person informed consent is essential for any clinical research involving human participants to be ethical. It is clear now that Canadian clinicians continued their research as if the worldwide outcry about the Nazi research never occurred. Nazi research happened in Nazi Germany; clearly that had nothing to do with their activities here in Canada, or so they must have thought.
There is a court order in place asking our government to turn over all related documents to these events to the Truth and Reconciliation Commission. This court order was issued in January. The Commission is still waiting for the relevant documents to be forwarded to its staff. Given that the Commission’s mandate expires in less than a year’s time, time is of the essence.
Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen’s University. Follow him on Twitter @schuklenk

Sunday, August 11, 2013

Should we be permitted to use prescription drugs to upgrade our brain capacity?

My latest OpEd in our local paper, the Kingston Whig-Standard.

Let’s face it - most of us spend a lot of time competing against each other. It might not be a terribly nice thing to do, but what choice do we really have in a world that has decided to shoot for progress through competition?
We try to look better, usually not just for ourselves, but also to look better than whomever we have chosen as our favourite competitor. If we have the financial means we send our kids to take extra lessons so they compete more successfully at school. It seems many professional athletes resort to doping in order to compete more successfully.
When I look at the other middle-aged blokes at the gym, it is clear to me that they do it not just to push death away by a year or two, but also to stay fit in the daily competition at their workplace. Anyone who has ever wondered why so many law and medical school students manage to pull 24- to 48-hour stints in the library close to exam time should be disabused of the idea that it was just coffee or the occasional energy drink that kept many of them going.
In the United States, drugs approved to assist children with Attention Deficit Hyperactivity Disorder, or ADHD, are prescribed by doctors to many children, as well as adults, who don’t actually suffer from that condition. Why? Well, despite the absence of conclusive clinical evidence, parents - as well as many students in high-pressure, high-stakes fields of study - have long voted with their feet and decided to move heaven and earth to upgrade their kids, or themselves, respectively, by means accessing these same ADHD drugs.
They believe these drugs increase our attention span as well as our knowledge retention capacity for significant periods of time. Studies suggest that about 5-10% of high school students and up to 35% of college students use these drugs for non-medically approved purposes.
A large number of society’s best-educated take a gamble on such drugs actually working. Clearly, after they try them once, many students continue to use them, because in their best judgment they do the trick.
Many doctors are opposed to the prescription of drugs for what they describe as non-medical purposes. Being able to focus better in college and to retain your knowledge for longer periods of time are such non-medical purposes. But what is a medical and what is a non-medical use of a particular medication?
This, of course, isn’t purely a clinical question. It’s inextricably linked to this question: what should the purpose of medicine be?
In my view, medicine should aim to achieve the twin objectives of keeping us alive as long as possible at as high a quality of life as is feasible. You can, of course, try to achieve that by fending off disease. Disease certainly impacts negatively on our lives, and all too often it cuts them short.
However, if there were drugs out there that could improve how our brains function, we would undoubtedly be able to improve the quality of the lives of many of those who choose to use them. Assuming that such drugs work – and it doesn’t matter whether the current drugs actually work for this purpose, because a future drug, inevitably, eventually will – our enhanced brain capacity would also mean that we would be more productive and more creative.
Yes, we could do more with our lives for a longer period of time. And this is one of the reasons why doctors who limit their professional activities to fighting disease as opposed to working toward the maximization of our biological and psychological well-being have a wrong understanding of what their job should be all about.
Today you can’t blame them, because the regulatory frameworks we have in place limit their professional activities, in quite conservative ways, to disease-fighting. A few attempts are made to prevent the occurrence of disease - for instance, by way of vaccinating us. The idea, though, that our health and well-being could also be improved from a status quo currently considered healthy is not something seriously considered by the medical profession. That is a profound mistake.
Worse, because of this conservative understanding of the nature of what it means to be a health care professional, no serious research is currently under way with a view toward upgrading our minds. Any such knowledge would be an accidental byproduct, likely of ADHD- or Alzheimer’s-related research.
There are obvious problem with the kind of change that I am proposing. For starters, we should be concerned that access to brain-capacity enhancers isn’t limited to those already well-off, because otherwise we would continue to increase the gap between society’s haves and the have-nots, with a nasty and harmful societal fallout eventually coming our way.
We should also be worried about fairness in the societal marketplace with regard to those who choose not to upgrade their mental capacities. They might do so because they could be, in principle, opposed to 21st-century medicine, or they might be worried about the long-term side-effects of the medication, or for any number of other reasons.
Given that we do compete on a global scale, these choices could well have ramifications for our national ability to compete against other nations. It will be a difficult regulatory balancing act, but I suspect that it is one we will eventually have to confront.
There is something of more immediate concern, and that is the current use of such drugs by students for non-medically approved purposes. Arguably, the playing field between students with access to such drugs and those who do not have access is not level any longer. It is a matter of fairness that we ensure that students with access do not gain a competitive advantage over those students who do not have access. I do think administrators of higher-education institutions should look carefully into the question of whether it is possible to test students for the use of such drugs in order to ensure that the playing field is level again.
No doubt privacy advocates will be up in arms against this proposal. I actually sympathize, but we do need to find a way to ensure that no competitive advantage is gained by those who access memory-enhancing drugs for not currently clinically approved purposes.
Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen’s University. Follow him on Twitter @schuklenk