Monday, June 24, 2013

Medical cannabis use? Sure!

I received an invite a few weeks ago, by a medical user group, to present my take on the issue of medical cannabis use in Canada . Unlike the Brockville General Hospital, that cancelled my keynote address in response to pressure from well-connected religious pressure groups, the medical cannabis folks didn't cancel my presentation, even though they had no idea whether I would be supportive of their cause. Truth be told, they probably did not like much of what I had to say, but attending their meeting permitted me to learn quite a bit about the bizarre status quo in Canada.

Here's what I learned (small detail might be slightly off, but the gist of this is correct, as far as I can tell). Some years back the Canadian courts forced the federal government to permit access to medical cannabis users. This decision was made in the absence of conclusive medical research demonstrating that THC (the biochemical substance at the heart of it all) works. There are a bunch of studies suggesting that THC works as a complementary substance in palliative care, that it helps people with appetite issues to get hungry again, etc. The thing is though, no conclusive research was undertaken that would have determined what dosage should be given to what patients for what duration. So, medical cannabis is NOT a prescription drug.

Strangely, under the current system (to be changed in March 2014) doctors must confirm that a patient suffers from a condition listed by Health Canada in response to the court finding. This, of course, is a quasi-prescription for a non-medication. Doctors were rightly concerned about this. After all, why should they fill in such a form? If Canadian courts want biochemical substances made available to particular patients - in the absence of conclusive clinical research evidence - why should doctors oblige them? Well, the thing is, THC clearly does some patients good. So, doctors obliged government - when, to my mind, the profession should have declined. How can you participate in getting someone access to non-drug drugs in the absence of uncontroversial clinical evidence?

Well, the current system sort of worked. Patients could either get permission to grow their own cannabis or purchase it from a government facility. Comes in the Canadian Tea Party, ie our current federal government. A new system will kick in. Crucially, the government facility that produced medical cannabis will shut down, and self-produced cannabis - ie self-produced by users -  will be a thing of the past. Commercial enterprises (because government is pro-business, even when it comes to cannabis!) will now sell cannabis to approved medical cannabis users. According to evidence presented by medical users during said meeting, their bills would increase from 200$ (self-produced) to in excess of 50,000$ commercial-enterprise produced. Even if you take that claim with a pinch of salt, you can see that users will be taken for a ride here by government approved commercial producers, and you can also see that a whole bunch of users likely won't be able to access medical cannabis any longer. Giver the current government's ideological commitments... ein Schelm were boeses dabei denkt.

Clinical research to investigate whether cannabis actually works uncontroversially for particular patient groups is not on the horizon, after all, cannabis is a prohibited substance, so for clinicians to undertake the necessary research would be truly difficult. It goes without saying that this is a pretty bad status quo, but that's where we are.

I suggested during the conference that medical cannabis users should take a leaf out of early AIDS activism's book and engage in activism aimed at bringing political pressure to bear on government and research funding agencies so that the necessary research is undertaken. Turns out, the users were primarily concerned to get the right back to grow their own cannabis. They didn't care about much else. This is understandable, if you think the drug works for your pain, appetite issues etc, but it is bad health policy. It is also understandable on the background of the conservative government's pernicious attempt at increasing prices for medical cannabis to such an extent that only the very wealthy can access it. Surely there is an equity issues here, as far as the Charter of Rights and Freedoms is concerned.

Well, I began my talk by saying that I thought access to cannabis ought to be decriminalised, because a) there isn't a hell of a lot of evidence that cannabis is harmful, b) there isn't a hell of a lot of evidencethat it is an entrance drug, leading users to move on to more dangerous substances, c) the war against drugs has been a dismal failure in any case, and d) last but not least, more dangerous drugs (alcohol comes to mind) are currently legally available, which doesn't seem sound policy. Conveniently, the Sun Media journalist (for you outside Canada, that's a conservative media organisation) forgot to mention this and proceeded to quote me at great length about the need to undertake the necessary clinical research (which is something I did actually emphasise). Here's the newspaper report in the Ottawa Sun. 

Saturday, June 15, 2013

Natural? Yes! - Abnormal? Yes!

Goodness, reading stuff from gay activists is sometimes as annoying as reading stuff from religious fanatics. There has been this fight between the two sides over two questions: 1) whether homosexuality is natural; and 2) whether homosexuality is normal.

Well people, let me settle it for ya. Homosexuality is, of course, natural unless you assume that something that has been occurring in nature for as long as we can trace natural history back isn't natural. Oh, your god says 'unnatural'. Well, that proves it then, doesn't it? Umpf, your god, natural or unnatural? Just asking. - Anyhow, admit it: you really have a normative understanding of naturalness, not a scientific understanding of nature. Let me put it to you then: You're cheating. Surely in physics you wouldn't suddenly redefine laws of physics to suit your bible stuff, or would you? Well, may be you would do even that.

The good news for you Bible people out there is that it actually doesn't matter whether homosexuality is natural or unnatural. There is so much nasty stuff going on there that is natural (rape being just one of those things) and that is immoral, that you can stick to your righteous condemnation of homosexuality. Enjoy!

Now, is homosexuality abnormal? Well, I must say, likely much to the horror of my fellow gays, of course homosexuality is abnormal. Any sensible understanding of normality would acknowledge that normal must refer to a statistical average. The statistical average behaviour, last time I checked, is heterosexuality. So, we are abnormal.

God people, hold your guns. The problem is that this ain't going to win you anything. I'm a university professor, my job security is higher than that of our prime minister, pretty abnormal wouldn't you say? I'm also someone who lived all his life without ever holding a driver's license. Pretty abnormal. I love collecting really expensive watches. Pretty abnormal. I do own a smartphone based on android, pretty normal. I'm Caucasian living in a town that is overwhelmingly Caucasian as far as its population is concerned, I'm pretty normal here. Try for your own person and ask yourself which features by the standards of your local community are average and how many of the features (or dispositions) are abnormal. You are the only Caucasian person in a rural area of sub-Saharan Africa? Abnormal! Anyhow, do the exercise for yourself. You will find that it's probably going to be a mixed bag. You will likely find that much of what you do is normal, that is, most around you, or even most around the globe do what you do (eat every day, for instance). If you are honest to yourself (or honest to your god) you will also find that some of the stuff you do (watching the Met Opera performances in your local cinema in a live broadcast) is pretty abnormal. Hell, for  all I know you might be driving a Rolls Royce around town. Abnormal!

The thing is, whether something is normal or abnormal tells us nothing, zero, zilch about the question of whether that something is a morally good or bad thing. It would be a naturalistic fallacy (ie a logic error) to assume that we could deduce from how certain things are like (or the majority of things) that they are morally good or bad or neutral. The same, incidentally applies to the naturalness questions I addressed earlier.

So, can we all move now on from here and argue our respective cases without engaging in these skirmishing activities?

Friday, June 14, 2013

'Gays Made, Not Born' - On the Confused State of the Religious Mind

Call it an easy target, blame me for going after the intellectually weak, but what is it about the Catholic pre-occupation with other people's sex lives and identities. And why are they consistently so confused both about the meaning of facts when it comes to sexual orientation as well as about the normative issues?

Jamaican Catholic Deacon Peter Espeut is as good an example as any to show what I am concerned about. Jamaica being a militantly anti-gay country where anti-gay discrimination was recently even enshrined in the country's constitution, courtesy to a large extent of campaigners like Catholic-Deacon-sociologist-turned-sex-expert Peter Espeut. Espeut writes in today's edition of the Jamaica Gleaner that gays are made, and that we are not born that way. Do read his contribution to public debate on that island to make sense of what follows below.

He takes the current absence of conclusive evidence of a genetic causation of homosexuality as evidence of a non-genetic causation of homosexuality. To give you just one example to illustrate how absurd this view of the nature of scientific inquiry is: According to Espeut's logic, HIV could not have been the cause of AIDS when it hadn't been discovered. Now, I am not suggesting that there is a genetic cause of sexual orientation, but to claim, as Espeut does, that it cannot have one because there isn't conclusive evidence at a certain point in time (ie today), is remarkably stupid. Perhaps that level of critical thinking skills is what predestines one to become a columnist for one of Jamaica's daily papers. Let's just note that this view on the causation issue constitutes a basic logic error and move on.

He then makes another logic error, and compounds it with plenty of excited exclamation marks. The exclamation marks have to do with not-blameworthy human characteristics such as the colour of our skin. As Espeut notes, 'we are born that way.' Implied is that we didn't choose to be that way, and that we are what we are in an immutable sense. Well, the thing is, there's plenty of things we have not chosen, yet they are immutable. Think about our language. Did we consciously choose it? Can we consciously dump it? Not quite. So, immutability is quite unrelated to the 'born that way' proposition. I do apologise for not using exclamation marks here, but do feel free to add them for emphasis in your mind.

Not surprisingly, Espeut being a sociologist, he then moves on to the next mistake, namely seeing the cause of sexual orientation in some parental behaviour. After all, having unjustifiably excluded genetic factors (and presumably, even though he doesn't say it, any number of possible non-social environmental factors), Espeut moves right on to his favourite possible causes of sexual orientation. Being a good sociologist he offers a lot of possible - but entirely speculative! - stuff, just in case.

He writes, 'But what causes gender-conforming and gender-non-conforming behaviour? Hormone imbalances may be one explanation. Others suggest that domineering mothers and ineffectual fathers may interfere with socialisation; and still others suggest that homosexuality may be triggered by having sexual encounters with members of one's own sex at an early age that prove to be very satisfying.'

As I noted before, Catholic Church staff and lay people have a perverse fascination with other people's sex lives. For the fun of it, let me note that 'hormone imbalances' invariably would invariably have causative genetic components. But hey, sociologists... - It is also worth noting that the language that is deployed here isn't exactly descriptive sociology, rather it is Catholic theology dressed up in pseudo-academic language. 'Domineering mothers', 'ineffectual fathers', plus (we are in Jamaica after all, so this still flies in public discourse) the invariable bullshit about pedophile homosexual grooming. Who, among serious sociologists or psychologists suggests the latter? Nobody that I'm am aware of. What is remarkable about Espeut's pet causes of homosexuality is that there is no more evidence for any of them then there is for his much-hated genetic causes. But that's what he believes in, so with all the weight that a degree in sociology and deaconessing in the Catholic Church provides, much credence is given to these baseless claims about the causes of homosexuality.

Espeut concludes thus, 'Let us not fall into line with 'gay-rights' propaganda by speaking as if LGBT behaviour is normal and natural. Unless you want to say that improper socialisation and dysfunctionality are normal and acceptable.' I have alerted you already to the Deacon's favourite rhetorical tool of using pejorative language ('improper', 'dysfunctional' etc) where argument would be required. Let me address the issue of homosexuality being abnormal and unnatural issue by copying here content from a Hastings Center Report article I published back in 1997. It's still true and shows us how little progress has been made on this subject matter. The fundamentalist religious in the world will turn around and continue their little flat-earth tirades as if nothing had happened at all. And mass media still give them outlets to vent their rage instead of asking them to seek professional help.

'Why is there a dispute as to whether homosexuality is natural or normal? We suggest it is because many people seem to think that nature has a prescriptive normative force such that what is deemed natural or normal is necessarily good and therefore ought to be. Everything that falls outside these terms is constructed as unnatural and abnormal, and it has been argued that this constitutes sufficient reason to consider homosexuality worth avoiding.[16] Arguments that appeal to 'normality' to provide us with moral guidelines also risk committing the naturalistic fallacy. The naturalistic fallacy is committed when one mistakenly deduces from the way things are to the way they ought to be. For instance, Dean Hamer and colleagues commit this error in their Science article when they state that "it would be fundamentally unethical to use such information to try to assess or alter a person's current or future sexual orientation, either heterosexual or homosexual, or other normal attributes of human behavior."[17] Hamer and colleagues believe that there is a major genetic factor contributing to sexual orientation. From this they think it follows that homosexuality is normal, and thus worthy of preservation. Thus they believe that genetics can tell us what is normal, and that the content of what is normal tells us what ought to be. This is a typical example of a naturalistic fallacy. Normality can be defined in a number of ways, but none of them direct us in the making of moral judgments. First, normality can be reasonably defined in a descriptive sense as a statistical average. Appeals to what is usual, regular, and/or conforming to existing standards ultimately collapse into statistical statements. For an ethical evaluation of homosexuality, it is irrelevant whether homosexuality is normal or abnormal in this sense. All sorts of human traits and behaviors are abnormal in a statistical sense, but this is not a sufficient justification for a negative ethical judgment about them. Second, 'normality' might be defined in a functional sense, where what is normal is something that has served an adaptive function from an evolutionary perspective. This definition of normality can be found in sociobiology, which seeks biological explanations for social behavior. There are a number of serious problems with the sociobiological project.[18] For the purposes of this argument, however, suffice it to say that even if sociobiology could establish that certain behavioral traits were the direct result of biological evolution, no moral assessment of these traits would follow. To illustrate our point, suppose any trait that can be reasonably believed to have served an adaptive function at some evolutionary stage is normal. Some questions arise that exemplify the problems with deriving normative conclusions from descriptive science. Are traits that are perpetuated simply through linkage to selectively advantageous loci less 'normal' than those for which selection was direct? Given that social contexts now exert 'selective pressure' in a way that nature once did, how are we to decide which traits are to be intentionally fostered? Positions holding the view that homosexuality is unnatural, and therefore wrong also inevitably develop incoherencies. They often fail to explicate the basis upon which the line between natural and unnatural is drawn. More importantly, they fail to explain why we should consider all human-made or artificial things as immoral or wrong. These views are usually firmly based in a non-empirical, prescriptive interpretation of nature rather than a scientific descriptive approach. They define arbitrarily what is natural and have to import other normative assumptions and premises to build a basis for their conclusions. For instance, they often claim that an entity called "God" has declared homosexuality to be unnatural and sinful.[19] Unfortunately, these analyses have real-world consequences. In Singapore, unnatural acts are considered a criminal offence, and "natural intercourse" is arbitrarily defined as "the coitus of the male and female organs." A recent High Court decision there declared oral sex "unnatural," and therefore a criminal offence, unless it leads to subsequent reproductive intercourse.

In the United States, several scholars and lesbian and gay activists have argued that establishing a genetic basis for sexual orientation will help make the case for lesbian and gay rights. The idea is that scientific research will show that people do not choose their sexual orientations and therefore they should not be punished or discriminated against in virtue of them. This general argument is flawed in several ways.[23] First, we do not need to show that a trait is genetically determined to argue that it is not amenable to change at will. This is clearly shown by the failure rates of conversion therapies.[24] These failures establish that sexual orientation is resistant to change, but they do not say anything about its ontogeny or etiology. Sexual orientation can be unchangeable without being genetically determined. There is strong observational evidence to support the claim that sexual orientation is difficult to change, but this evidence is perfectly compatible with non-genetic accounts of the origins of sexual orientations. More importantly, we should not embrace arguments that seek to legitimate homosexuality by denying that there is any choice in sexual preference because the implicit premise of such arguments is that if there was a choice, then homosexuals would be blameworthy.

Wednesday, June 12, 2013

Bioethics 11th World Congress Special Issue

Cover image for Vol. 27 Issue 6Volume 27, Issue 6 Pages 291 - 355, July 2013

Special Issue: International Association of Bioethics 11th World Congress

SPECIAL ISSUE PAPERS

IAB Presidential Address: Contextual, Social, Critical: How We Ought to Think About the Future of Bioethics (pages 291–296)
Angus Dawson
Article first published online: 29 MAY 2013 | DOI: 10.1111/bioe.12037
Global Health and Justice: Re-examining our Values (pages 297–304)
Solomon R. Benatar
Article first published online: 29 MAY 2013 | DOI: 10.1111/bioe.12033
Climate Change is a Bioethics Problem (pages 305–308)
Cheryl Cox Macpherson
Article first published online: 29 MAY 2013 | DOI: 10.1111/bioe.12029
Grandparents' entitlements and obligations (pages 309–316)
Heather Draper
Article first published online: 29 MAY 2013 | DOI: 10.1111/bioe.12028
They Can't Have My Embryo: The Ethics of Conditional Embryo Donation (pages 317–324)
Lucy Frith and Eric Blyth
Article first published online: 29 MAY 2013 | DOI: 10.1111/bioe.12034
Not the Usual Suspects: Addressing Layers of Vulnerability (pages 325–332)
Florencia Luna and Sheryl Vanderpoel
Article first published online: 29 MAY 2013 | DOI: 10.1111/bioe.12035
Vulnerability in Research Ethics: a Way Forward (pages 333–340)
Margaret Meek Lange, Wendy Rogers and Susan Dodds
Article first published online: 29 MAY 2013 | DOI: 10.1111/bioe.12032
Toward a Critical Ethical Reflexivity: Phenomenology and Language in Maurice Merleau-Ponty (pages 341–347)
Stuart J. Murray and Dave Holmes
Article first published online: 29 MAY 2013 | DOI: 10.1111/bioe.12031
The New Genetics and Informed Consent: Differentiating Choice to Preserve Autonomy (pages 348–355)
Eline M. Bunnik, Antina de Jong, Niels Nijsingh and Guido M.W.R. de Wert
Article first published online: 29 MAY 2013 | DOI: 10.1111/bioe.12030

Tuesday, June 11, 2013

Egypt well on its way to becoming a decent Middle Eastern theocracy

Given the drama currently unfolding in Turkey, a significant development affecting a critic of Islam in Egypt has probably been missed by many of us. The German news magazine DER SPIEGEL has reported prominently about the case, alas only in German language, thereby not exactly helping the situation.

The German-Egyptian intellectual and author Hamed Abdel-Samad gave a talk in Cairo last week where he publicly criticised the ideology of Islam (the religion as much as what goes under the label of political Islam). He specifically criticised tendencies in this ideology that he described as 'religious fascism' and that he suggested are a direct result of its prophet Mohammed's teachings.

Abdel-Samad might be right, he might be wrong, I am not an Islam expert. Whether this political scientist and Islam expert is right or wrong is neither here nor there to be honest. What happened subsequently is the real scandal: Just to prove him wrong close allies of Egypt's President Mursi were quick to denounce him on national TV and called for him to be killed. True to form this sort of stuff goes these days down well in Egypt's academia, namely in its centre of Islamic academic excellence, al-Azhar university. Mahmud Schaaban, professor of rhetoric and himself an explicit opponent of secularism in any form, calls Abdel-Samad an apostate and notes that even if he regrets what he has said, he must be killed. His regret might help him in his afterlife, but meanwhile he just must get killed. Noteworthy perhaps that the university has not called its rhetoric expert to order over his call for mob justice. I kinda doubt that this is covered by academic freedom and might just constitute a form of academic misconduct conducive to bringing the institution where he works into disrepute. It's a firing offense elsewhere. But hey, perhaps I am assuming too much here.

Welcome to Egypt 2.0, where this sort of stuff can be propagated on various national TV channels without any critical comment from government officials. Calls from the German government's human rights czar upon the Egyptian government to distance itself from this call for mob justice remain until now unanswered.

Abdel-Samad has since gone underground, knowing that there are now folks out there to get him, in the name of Islam.

Thursday, June 06, 2013

On Not Speaking at Brockville General Hospital - and, Why Re-scheduling and Cancelling Are Different Things

Something pretty outrageous happened to me today, I have essentially been cancelled as the keynote speaker at Brockville General Hospital's Annual General Meeting in mid June. How did I find out? Its new CEO, Tony Weeks, called me at home early this morning.

He explained to me that the reason for the 're-scheduling' was that there's so much interest in said keynote presentation that they'd need a bigger room. I was a bit surprised, but it is true that the topic in question (assisted dying) tends to generate a lot of interest and large turn-outs. Well, shortly thereafter I received an email with a press release from the hospital. It turns out that the 're-scheduling' actually was a bit of a euphemism, cloaking what's actually a cancellation of the event in question. Here's an excerpt from the medial release:

'“We received a mixed response to our keynote presentation,” says BGH President  and CEO Tony Weeks. “Naturally, people are divided on this important issue. The clear message from our community was that a debate is needed, not just a single presentation. As our AGM cannot accommodate a full debate, we have decided to reschedule Dr. Schuklenk’s presentation to a larger venue as part of a community information and debate event on this topic.”'

So, my keynote lecture is transformed from a single presentation to one with several presentations. Because even during the AGM a Q&A session was planned. In other words, the event I was invited to as keynote speaker was not re-scheduled, it was cancelled. A new event is seemingly now envisaged with a debate format (for and against, that sort of thing). There's nothing wrong with having for and against type of events (I recently debated the activist chief of the Euthanasia Prevention Coalition at Queen's, so I've been there, done that sort of event, too). However, it is disingenuous (I can think of stronger terms) to pretend that a re-scheduling is taking place when really a different event altogether is envisaged.

Now, what was the bone of contention, ie what was I invited to speak about? I meant to present in about 30-35 min the main arguments from the Royal Society of Canada Report on the issue of assisted dying. In those 30-35 minutes I proposed to present the positive case for decriminalisation and deal with two serious concerns about such a policy change, namely the risk of abuse and the question of whether or not assistance in dying is compatible with health care professional roles.

It seems at Brockville General Hospital such a presentation must not be given without someone disagreeing, as part of a panel debate. It is disconcerting that the hospital has given in to activist pressures (aka 'community concerns') to accommodate the anti-choice views. How often speak folks like anti-choice academic Margaret Somerville in health care settings without anyone requiring that the other point of view must be heard exactly at the same time. It is pretty silly stuff to be honest.

This whole thing begs also the question why the hospital didn't ask me to present arguments for and against the decriminalisation of assisted dying, as any decent ethicist would be able to do. I also wonder why no effort was made to communicate the activists' concerns and discuss what I could do in my presentation to address them. Nope, just give him a ring roughly a fortnight before the event and call the cancellation a re-scheduling. Should do the trick.

None of this reflects well on Brockville General Hospital. I hope they will be able to source speakers for their next events, because who of sane mind would prepare a presentation (scheduled for many many months ahead of the event) knowing that anything can happen if the right people call and email the right people.

Yay! We are 'Available' - Sort of

 Another milestone on the road to the final release of our up-coming '50 Great Myths About Atheism' ... it is available for pre-order on amazon.com. Check out the wonderful praise it has received: “It has been my lot to have encountered all but three of the 50 Great Myths about Atheism listed by Blackford and Schüklenk, most of them many times. It is useful to have them all listed in one book – and so readably and authoritatively refuted. The long final chapter treats theological arguments with more respect than I would have bothered with, but the refutation is all the more convincing for that. The whole book builds inexorably to its conclusion: the Reasonableness of Atheism.”
—Richard Dawkins, author of The God Delusion
“With humor, wisdom and sound philosophy, Blackford and Schüklenk dismantle 50 important myths about atheism.  In doing so, they have done atheists and religious believers a great service, for putting aside the myths enables us to see where real differences remain.”
—Peter Singer, Princeton University
"Atheists are routinely called ‘aggressive,’ but their strong values include a tolerance rarely shown them by the religious. This book's calm ripostes defend atheists everywhere against unreasoned assaults from the dwindling faithful. " 
—Polly Toynbee, The Guardian
“Busted! Fifty times over! So say Blackford and Schüklenk — the New Mythbusters—with reason, conviction and style. I enjoyed this book immensely.”
—Graham Oppy, Monash University
“A brilliantly wide-ranging exploration of misconceptions about atheism and their relationship to our ideas about minds, human nature, morality – for pretty much everything we care about.”
—Ophelia Benson, co-author of Does God Hate Women?
“This is a book that’s as enjoyable to read as it is informative. Sharp, clever, and witty, it systematically dismantles misconceptions about atheism. Even God could learn something from it!”
—Ronald A. Lindsay, President, Center for Inquiry