Royal Society of Canada End-of-Life Decision-Making Panel

RSC: The Academies of Arts, Humanities and Sciences of Canada (the Royal Society of Canada) will announce “End-of-Life Decision Making”, an expert panel commissioned at its own initiative. The press release follows.

RSC/SRC Expert Panel on End-of-Life Decision Making

October 26, 2009

Among the many public-service roles of national academies around the world, one of the most important is the preparation of expert assessments on critical issues of public policy. The national academies in the United States are the most active in this regard, but the senior academies in other nations, notably in England, France, and other European countries, have been very active on this front for many years. Such reports are designed to be balanced, thorough, independent, free from conflict of interest, and based on a deep knowledge of all of the published research that is pertinent to the questions that have been posed.

The Royal Society of Canada (RSC) also has a long record of issuing definitive reports of this kind, either on its own initiative, or in response to specific requests from governments or other parties. The project being announced today, “End-of-Life Decision Making,” is one of a new series that the Society has commissioned, at its own initiative, on issues of significant public interest and importance at the present time. Announcements on the other projects will follow over the course of the coming months.

The Society relies on the advice of one of its senior committees, The Committee on Expert Panels (CEP), in formulating new projects of its own and in responding to requests for panel projects from external parties. In addition, the members of the Society’s CEP are responsible for selecting the membership of panels, including the chair; overseeing the conduct of panel activities; managing the peer review of the draft final report; and assisting the panel members with any difficulties that arise during the conduct of their work.

Over the course of the past year, the CEP has brought forward suggestions on a new series of expert panel reports for consideration by the Society’s governing board. The board has approved a number of these suggestions, including the project on “End-of-Life Decision Making.” The additional information, below, identifies the members of the panel who have agreed to write this report, as well as the preliminary terms of reference for this project.

Questions about this project may be directed to:

Professor Udo Schuklenk (panel chair), Queen’s University:

udo.schuklenk@gmail.com

Telephone: Office 613-217-8659

Professor Daniel Weinstock, Université de Montréal:

daniel.marc.weinstock@umontreal.ca

Telephone: Office 514-343-7345

Members of the RSC/SRC Expert Panel

(6 Panel Members)

Chair: Udo Schuklenk, PhD:

· Professor of Philosophy and Ontario Research Chair in Bioethics, Queen’s University

· http://www.udo-schuklenk.org/

· Publications: http://www.udo-schuklenk.org/researchs.htm

Before coming to Canada he worked at Australian, British, German, and South African universities, including Monash University’s Centre for Human Bioethics and at the University of Central Lancashire’s Centre for Professional Ethics. He is currently Joint Editor in Chief of Bioethics and founding editor of Developing World Bioethics. Both journals are listed in major indices including MedLine.

Members:

1. Johannes J. M. van Delden, MD, PhD:

Julius Center for Health Sciences, University Medical Center, Utrecht University, Utrecht, The Netherlands; Chair, Ethical Commission of the Medical Council of the Royal Netherlands Academy of Arts and Sciences (KNAW)

http://people.juliuscentrum.nl/profile.aspx?id=10959

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1331141

http://jme.bmj.com/cgi/content/extract/33/4/187

2. Jocelyn Downie, S.J.D.:

Canada Research Chair in Health Law and Policy
Professor, Faculties of Law and Medicine, Dalhousie University

http://law.dal.ca/Faculty/Full_Time_Faculty/Bios/Jocelyn_Downie/index.php

3. Sheila McLean, PhD, LLD, LLD, FRSE, FRCGP, FRSA:

First holder of the International Bar Association Chair of Law and Ethics in Medicine at Glasgow University and Director of the Institute of Law and Ethics in Medicine at Glasgow University.

http://www.gla.ac.uk/departments/schooloflaw/staff/academic/mcleans/

4. Ross Upshur, MD, MSC:

Canada Research Chair in Primary Care Research and Associate Professor, Departments of Family and Community Medicine and Public Health Sciences, University of Toronto; Director, University of Toronto Joint Centre for Bioethics

http://www.sunnybrook.ca/team/member.asp?t=13&page=1199&m=175

http://www.jointcentreforbioethics.ca/people/upshur.shtml

5. Daniel Weinstock, PhD:

Canada Research Chair in Ethics and Philosophy, University of Montreal

Professeur titulaire, Département de Philosophie, and Directeur du Centre de recherche en éthique de l'Université de Montréal (CREUM)

http://www.philo.umontreal.ca/prof/daniel.marc.weinstock.html

End-of-Life Decision Making

Context and Preliminary Terms of Reference (June 18, 2009)

Introduction

The purpose of these preliminary terms of reference is to indicate some of the main boundaries of the project description. At its initial meetings the panel will do a careful review of this preliminary statement and will indicate more precisely the ultimate scope and focus of the project, which is expected to be more limited than what is presented here. The final terms of reference will be released by RSC at that time.

Objectives

This is one the most serious social and ethical issues facing all advanced countries. The many and varied perspectives relevant to the issue are rarely presented to the public in a balanced, thorough, and informed way. A RSC expert panel report could make a significant contribution to the public policy debate on this issue.

1. There is a large body of medical science evidence that, if summarized for the public, would be helpful to their consideration of the issue.

2. The public could also benefit from a presentation of evidence about actual experience from the various jurisdictions that permit physician-assisted death.

3. The public would also benefit greatly from having a careful, balanced review of various pros and cons of decriminalization of physician-assisted death from well-reasoned ethical and legal standpoints.

4. Many medical personnel would also benefit from having all the issues laid out in a comprehensive and sensitive way.

5. The panel should consider proposing policy recommendations for public consideration that are the results of its review.

Questions that may be considered by the panel

1. Is either physician-assisted suicide [PAS] or voluntary euthanasia [VE] ever morally justifiable and should either be decriminalized under certain carefully defined conditions? If so, under what conditions?

2. Is there a morally significant difference between withholding and withdrawing life-prolonging treatment, on the one hand, and hastening a patient’s death by VE or PAS, on the other?

3. Is “terminal sedation” (sometimes referred to as “palliative sedation”) a morally and legally preferable option to VE or PAS? Does the distinction between terminal sedation and life-shortening symptom relief make sense in practice? What is the situation with regard to the provision of potentially life-shortening symptom relief? It is a practice that is, to a certain extent, in the shadows. It has not been addressed explicitly and comprehensively in the law and leaves some wondering whether it is legal or not and therefore whether some people may not be getting adequate symptom management.

4. Is cessation of eating or drinking (or of artificial hydration and nutrition) a morally and legally preferable option to VE or PAS?

5. Is there evidence of abuse with respect to PAS and VE in jurisdictions in which PAS or VE have been decriminalized (particularly those with contexts comparable to Canada)? What types of data should be considered germane and persuasive to this question?

6. What, if any, safeguards could prevent abuse and exploitation of VE and PAS without erecting insuperable barriers for people who wish to access these forms of assisted dying?

7. Is the concept of human dignity a useful one for discussions of VE and PAS?

8. Is either VE or PAS consistent with traditional medical ethics? What has the Hippocratic Oath to say with regard to this? Would either be likely to undermine the bond of trust between doctor and patient? Would either be likely to enhance the bond of trust between doctor and patient?

9. Are Advance Directives reasonable, ethically and legally defensible instruments to express a formerly competent patient's wishes? What is the value (or lack thereof) of Advance Directives in this context? Is there a difference between positive and negative directives?

10. If it is determined that VE and PAS should be legally permitted, how should the issue of incompetent dying patients be approached?

11. What is the legal and ethical status of unilateral withholding and withdrawal of potentially life-sustaining treatment? (It is a hotly-contested area of end of life practice in Canada right now and is one that is causing significant moral distress for everyone involved.)

12. Why does consent (or refusal), which has the effect of legitimizing some behaviours, not seem to have the same effect in the case of PAS or VE?

13. How should we evaluate false positives and false negatives? Is it worse to have a system in place that allows for a lot of needless suffering and thwarting of individual autonomy, but never generates a single false positive, or is the converse true? (This makes a difference to how we calibrate the safeguards.)

Suggested approach to the topic

(a) Begin by asking: What is the state of current knowledge with respect to the following?

· What are the current states of practice with respect to end of life care in Canada (with respect to withholding and withdrawal, potentially life-shortening symptom relief, PAS, and VE)? What are the main variables in this area? Who are the main decision-makers? What are the default positions (what usually happens unless someone protests strongly)? What is the current state of the empirical evidence with regard to PAS and VE?

· How do families of patients, patients and health care providers feel about the current states of practice?

· What trajectory of development are we on in this area?

· How are providers, patients and families being educated?

· What is the law in this area in Canada? What are Canadians' beliefs about the law? What are Canadians' views about what the law should be like?

· What is driving current decision-making in this area – e. g., is it economics, shortages of providers, lack of training, normative stances, etc.?

(b) Then ask: What are the main value positions (normative stances) in play and to what extent are they actually motivating decisions?

(c) Then move on to the substantive normative questions in the light of the above. The panel's report should aim not to duplicate work already undertaken in other reports. Instead, the panel will undertake a review of such work prior to formulating its own analysis of the issues.

******************************************************

Bonjour,

Demain, la SRC : Les Académies des arts, des lettres et des sciences du Canada (la Société royale du Canada) annoncera un groupe d’experts commandé, de son propre chef, sur « La prise de décisions en fin de vie». Le communiqué suit.

Groupe d’experts de la SRC sur la prise de décisions en fin de vie

Le 26 octobre 2009

Parmi les nombreux rôles de service public que jouent les académies nationales dans le monde, l'un des plus importants est sans doute la production de rapports d'experts sur les enjeux importants de la politique gouvernementale. Les académies nationales des États-Unis sont les plus actives à cet égard, mais celles d'autres pays, notamment de l'Angleterre, de la France et d'autres nations européennes, sont aussi très actives sur ce front depuis de nombreuses années. Ces rapports doivent être équilibrés, exhaustifs, indépendants, libres de tout conflit d'intérêts et fondés sur une connaissance approfondie de la recherche publiée se rapportant aux questions qui ont été posées.

La Société royale du Canada (SRC) a également une longue feuille de route en matière de production de rapports définitifs de ce genre, qu'elle les produise de sa propre initiative ou en réponse à des demandes précises des gouvernements ou d'autres parties. Le projet annoncé aujourd'hui, « La prise de décisions en fin de vie » fait partie d'une nouvelle série de projets que la Société a commandés, de son propre chef, concernant des enjeux d'intérêt public d'une grande importance. Les autres projets seront annoncés au cours des prochains mois.

La Société se fie aux conseils d'un de ses principaux comités, le Comité sur les groupes d'experts, pour élaborer les nouveaux projets qu'elle met en œuvre de sa propre initiative ou en réponse à des demandes provenant de parties externes. Les membres de ce Comité sont également responsables de sélectionner les membres du groupe d'experts, y compris le président, de superviser les activités du groupe, de gérer l'examen par les pairs de la version préliminaire du rapport final et d'aider les membres du groupe d'experts si des difficultés surviennent durant leurs travaux.

Durant la dernière année, le Comité sur les groupes d'experts a suggéré au conseil d'administration de la Société une nouvelle série de rapports d'experts. Le conseil a approuvé un bon nombre des suggestions, y compris le projet sur les « La prise de décisions en fin de vie ». Les renseignements ci-dessous indiquent qui sont les membres du groupe d'experts, qui ont accepté de rédiger ce rapport, ainsi que le cadre de référence préliminaire de ce projet.

Les questions concernant ce projet peuvent être adressées à :

Professor Udo Schuklenk (panel chair), Queen’s University:

udo.schuklenk@gmail.com

Téléphone: 613-217-8659

Professor Daniel Weinstock, Université de Montréal:

daniel.marc.weinstock@umontreal.ca

Téléphone: 514-343-7345

Composition du groupe d'experts de la SRC

(six membres)

Président : Udo Schuklenk, Ph. D. :

· Professeur de philosophie et directeur de la chaire de recherche en bioéthique, Université Queen’s

· http://www.udo-schuklenk.org/

· Publications : http://www.udo-schuklenk.org/researchs.htm

Avant son arrivée au Canada, il a travaillé dans différentes universités en Australie, en Grande-Bretagne, en Allemagne et en Afrique du Sud, dont au Centre de bioéthique humaine de l’Université Monash et au Centre d’éthique professionnelle de l’Université du Central Lancashire. Il est actuellement corédacteur en chef de la revue Bioethics et rédacteur en chef fondateur de la revue Developing World Bioethics. Ces deux publications figurent dans les principaux index, y compris MedLine.

Membres :

1. Johannes J. M. van Delden, M.D., Ph. D. :

Centre Julius pour les soins de la santé, Centre médical universitaire, Université d’Utrecht, Pays‑Bas; chaire, commission d’éthique du Conseil médical de l’Académie royale des arts et des sciences néerlandaise (KNAW)

http://people.juliuscentrum.nl/profile.aspx?id=10959

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1331141

http://jme.bmj.com/cgi/content/extract/33/4/187

2. Jocelyn Downie, S.J.D. :

Chaire de recherche du Canada sur le droit et la politique de la santé

Professeure, facultés de droit et de médecine, Dalhousie University

http://law.dal.ca/Faculty/Full_Time_Faculty/Bios/Jocelyn_Downie/index.php

3. Sheila McLean, Ph. D., LL.D., FRSE, FRCGP, FRSA :

Première titulaire de la chaire de droit et d’éthique médicale de l’Association internationale du barreau et directrice de l’Institut de droit et d’éthique médicale, University of Glasgow

http://www.gla.ac.uk/departments/schooloflaw/staff/academic/mcleans/

4. Ross Upshur, M.D., M.SC. :

Chaire de recherche du Canada dans le domaine des soins primaires et professeur, départements de médecine familiale et communautaire et des sciences de la santé publique, University of Toronto; directeur, Centre conjoint de bioéthique du University of Toronto http://www.sunnybrook.ca/team/member.asp?t=13&page=1199&m=175

http://www.jointcentreforbioethics.ca/people/upshur.shtml

5. Daniel Weinstock, Ph. D. :

Chaire de recherche du Canada en éthique et en philosophie, Université de Montréal

Professeur titulaire, département de philosophie, et directeur du Centre de recherche en éthique de l'Université de Montréal (CREUM) http://www.philo.umontreal.ca/prof/daniel.marc.weinstock.html

Groupe d’experts de la SRC sur la prise de décisions en fin de vie

Principes généraux préliminaires (le 18 juin 2009)

Introduction

Ces principes généraux préliminaires ont pour but d’établir certaines balises essentielles en ce qui a trait à la description du projet. Au cours de ses premières réunions, le groupe d’experts examinera attentivement cette description préliminaire et précisera la portée et le but du projet, qui devraient être plus limités que ce que nous présentons ici. Les principes généraux finaux seront établis par la SRC à ce moment-là.

Objectifs

Cette question est celle qui, dans tous les pays avancés, pose les problèmes sociaux et éthiques les plus sérieux. Les très nombreux points de vue sur la question sont rarement présentés au grand public de façon objective, approfondie et éclairée. La publication d’un rapport par un groupe d’experts de la SRC pourrait contribuer de façon importante au débat public sur la question.

1. Il existe une volumineuse documentation médicale qui, résumée à l’intention du grand public, pourrait appuyer sa réflexion sur la question.

2. Le grand public pourrait également profiter de la présentation de documents sur l’expérience menée en différents endroits où l’euthanasie médicalement assistée est autorisée.

3. Le grand public pourrait aussi grandement profiter d’une revue approfondie et rigoureuse des pour et des contre de la décriminalisation de l’euthanasie médicalement assistée d’un point de vue éthique et juridique bien raisonné.

4. De nombreuses personnes exerçant dans le domaine médical auraient avantage à voir tous les enjeux exposés de façon claire et sensible.

5. À la suite de son étude, le groupe d’experts devrait envisager de soumettre des recommandations en matière de politique à l’intention du grand public.

Questions que le groupe d’experts pourrait examiner

1. Le suicide médicalement assisté et l’euthanasie volontaire sont-ils moralement justifiables et devraient-ils être décriminalisés dans certains cas bien définis? Si oui, quels seraient ces cas?

2. Y a-t-il une différence importante, sur le plan moral, entre le refus et le retrait d’un traitement de prolongation de la vie, d’une part, et l’accélération de la mort d’un patient par l’euthanasie volontaire ou le suicide médicalement assisté, d’autre part?

3. La « sédation terminale » (appelée parfois « sédation palliative ») est-elle préférable, sur le plan moral et juridique, à l’euthanasie volontaire ou au suicide médicalement assisté? Dans la pratique, y a-t-il une distinction entre sédation terminale et soulagement des symptômes susceptible d’abréger la vie? Où en est-on sur la question du soulagement des symptômes abrégeant la vie? C’est une pratique qui, dans une certaine mesure, se trouve dans une zone d’ombre. Elle n’a pas été examinée de façon explicite et exhaustive par les législateurs et l’on ignore encore si elle est conforme à la loi. Par ailleurs, dans le cas de certaines personnes, on peut se demander si la gestion des symptômes est adéquate.

4. Cesser d’alimenter le patient ou de lui donner à boire (ou cesser toute hydratation et alimentation artificielle) est-il préférable, sur le plan moral et juridique, à l’euthanasie volontaire ou au suicide médicalement assisté?

5. Y a-t-il des preuves d’abus en ce qui a trait au suicide médicalement assisté et à l’euthanasie volontaire là où ces pratiques ont été décriminalisées (particulièrement dans des contextes comparables à celui du Canada)? Sur quel type de données, pertinentes et convaincantes, pourrait-on s’appuyer pour répondre à la question?

6. Quelles mesures, le cas échéant, pourraient prévenir l’abus et l’exploitation de l’euthanasie volontaire et du suicide médicalement assisté sans ériger d’obstacles insurmontables pour les personnes qui souhaiteraient accéder à ces formes d’aide à la mort?

7. Le concept de dignité humaine est-il utile aux discussions sur l’euthanasie volontaire et le suicide médicalement assisté?

8. L’euthanasie volontaire et le suicide médicalement assisté sont-ils conformes à l’éthique médicale traditionnelle? Que dit le serment d’Hippocrate sur la question? Ces pratiques risquent-elles de compromettre le lien de confiance entre le médecin et le patient ou, au contraire, peuvent-elles le resserrer?

9. Les directives préalables sont-elles des outils raisonnables et justifiables sur le plan éthique et juridique pour formuler de façon adéquate les souhaits des patients qui avaient auparavant la capacité de décider? Quelle est la valeur (ou la non‑valeur) des directives préalables dans ce contexte? Y a-t-il une différence entre directives positives et directives négatives?

10. Si l’on établit que l’euthanasie volontaire et le suicide médicalement assisté devraient être légalement autorisés, comment doit-on approcher la question des patients mourants qui sont dans l'incapacité de décider?

11. Quel est le statut, du point de vue juridique et éthique, du refus ou du retrait unilatéraux d’un traitement susceptible de maintenir la personne en vie? (Cette question est vivement contestée au Canada et cause une grande détresse morale chez toutes les personnes concernées.)

12. Pourquoi le consentement (ou le refus), qui a pour effet de justifier certains comportements, n’a-t-il pas la même incidence dans le cas de l’euthanasie volontaire ou du suicide médicalement assisté?

13. Comment devrions-nous évaluer les faux positifs et les faux négatifs? Est-il plus grave d’avoir un système en place qui donne lieu à beaucoup de souffrance inutile et qui nie l’autonomie individuelle, mais ne génère jamais de faux positifs, que l’inverse? (Cela fait une différence sur la façon de calibrer les balises.)

Suggestion d’approche

(a) Demandez-vous d’abord : Quelle est l’état de nos connaissances en ce qui a trait à ce qui suit?

· Quelles sont les pratiques actuelles en matière de soins de fin de vie au Canada (relativement au refus ou au retrait des soins, au soulagement des symptômes susceptible d’abréger la vie, au suicide médicalement assisté et à l’euthanasie volontaire)? Quelles sont les principales variables dans ce domaine? Qui sont les principaux décideurs? Quelles sont les positions par défaut (ce qui se passe généralement, à moins que quelqu’un proteste fermement)? Quelles sont les connaissances empiriques actuelles en ce qui a trait au suicide médicalement assisté et à l’euthanasie volontaire?

· Que pensent les familles des patients, les patients et les fournisseurs de soins de santé des pratiques actuelles?

· Quelles sont les perspectives dans ce domaine?

· Comment les fournisseurs de soins de santé, les patients et les familles sont-ils informés?

· Quel est le contenu de la législation en la matière au Canada? Comment les Canadiens perçoivent-ils cette législation? Quel devrait être le contenu de la législation selon les Canadiens?

· Qu’est-ce qui sous-tend la prise de décisions dans ce domaine, p. ex., l’économie, l’insuffisance de fournisseurs, le manque de formation, les positions normatives, etc.?

(b) Demandez-vous ensuite : Quels sont les principaux énoncés de valeur (positions normatives) en jeu et dans quelle mesure influent-ils sur les décisions?

(c) Passez ensuite aux questions normatives essentielles, à la lumière de ce qui précède. Le groupe d’experts doit veiller à ne pas reproduire les travaux déjà effectués dans le cadre d’autres rapports. Il doit plutôt prendre connaissance de ces travaux avant d’entreprendre sa propre analyse de ces questions.

no answers to 'big questions'

Sunday morning in Britain ... and for those of us who have no life (your writer included) or nothing better to do, there's TV. The BBC offers religious fare under the cloak of a program called 'the big questions'. Today they're discussing issues such as whether there still is a moral duty to provide overseas aid, whether the body is 'sacrosanct' after death and other such genuinely important and interesting topics. It's a panel type program where experts give their take on the answers and an audience that agrees or disagrees.

Here's the weird bit: their 'experts' on moral questions are not ethicists (there isn't one on the program among the featured panelists), but representatives of major religions (ie there's a woman in red dress - the Anglican priest, a guy with a round cap on his head - the Jewish rabbi, and of course your Labour MP - last week they had a rabid, slightly nuttish Catholic woman raving against IVF, making up 'facts' on the run).

The thing is, often I find myself in agreement with their answers to the questions at hand (often I do not), BUT there is no moral argument, no moral analysis, it's people in funny cloth waving the magic God wand and voila there's (NO) answer. Plain bizarre.

fun

Tauriq Moosa interviews Russell Blackford and Udo Schuklenk

Interview With Russell Blackford and Udo Schüklenk


By Tauriq Moosa

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

First Reviews of Voices of Disbelief

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

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

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

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

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

Recent AIDS vaccine trial results - cause for celebration?

I am all in favour of AIDS vaccine trials. It's pretty much clear to me that safe sex (not to talk about abstinence) just isn't happen in sufficient numbers and consistency as to prevent the pandemic from happily continuing on its destructive way. During the last year or two there have been off-the-record discussions among AIDS activists and clinicians about whether HIV preventive vaccine trials should be abandoned altogether, seeing that until now all trials ended up in utter failure. Instead people played with the idea that we should simply get on with large-scale HIV testing and with putting infected people immediately on AIDS medication. The rationale behind this idea is that it turns out to be the case that infected people who are on AIDS medicines become after a short period of time non-infectious (their viral load undetectable). Mathematical modelling suggests that the pandemic could be brought to heel within a generation or two by using this strategy. It turns out to be the case that this test-and-treat strategy is also the most efficient means to keep infected people alive and kicking. On my reading of the literature AIDS would turn from a terminal illness into a serious chronic illness that can be efficiently dealt with by means of medical care. The later you go on treatment the higher your risk to die of AIDS.

Anyhow, this was the world of AIDS until today, at least if you believed the media. As part of the self-fulfilling prophecy (it's just a matter of time till vaccine research will yield results) we're told in today's newspapers and news programs that a vaccine trial conducted in Thailand resulted in a 31% reduction of likelihood of infection. Most people, of course, do not read beyond the headline, and that is unfortunate. The 'successful' vaccine is a combination of two vaccines that crashed and burned previously. There is no mechanism that would explain why a combination of two failed vaccines makes a successful vaccine. The numbers seem to be speaking for themselves - 31%!!! - but do they? I doubt it. Here's the baseline as reported toward the end of the Los Angeles Times article: 'New infections occurred in 51 of the 8,197 given vaccine and in 74 of the 8,198 who received dummy shots. That worked out to a 31 percent lower risk of infection for the vaccine group.' The 23 additional infections in the placebo arm - out of 16400 overall participants - doesn't seem seem to be a figure that's statistically significant by any stretch of the imagination, no matter how hard the study's spin doctors (it cost 105 mio US$ to conduct the study) try to make it look otherwise. There might be good reason to undertake the same study with a much larger number of participants across the world, but until then, I doubt we have anything to celebrate at all.

For starters the number of people infected in both arms is fairly small (roughly 125 out of >16400, 51 in the active agent arm, 74 in the placebo arm - I doubt that is statistically significant, might be just a fluke). Anyhow, the thing is that it could possibly be said that all other things being equal it might have prevented some people from becoming infected. The trouble is, of course, things are not being equal. There's all sorts of behavioural changes among trial participants, with some behaving like they would have anyhow, some increase their risk taking behaviour, others reduce it (overall there's likely a reduction in risk-taking behaviour, but some participants would almost certainly increased their risk-taking behaviour). So it is possible that among the infected people (in both arms) are people who increased their risk-taking behaviour as a result of trial participation.

The whole story is also yet another example of science by press release... the actual study will only be published in late October 2009...

'Passing as straight'

I thought, there we go again! I talked to a gay male friend the other night, you know, one of those all-over-the-place type chit-chats. Anyhow, at one point he tells me with some pride that one of his closest straight female friends complimented him the other day by saying that he'd 'pass as straight' easily. 'Passing as straight' is a primary preoccupation of many gay (I presume mostly male) folks. Goes also under 'straight acting', and stuff like that. The price is yours if you 'pass as straight', you lose if you fail and people can 'tell' that you're gay.

Now, what is it that makes gay men 'pass' as straight? Well, you guessed it, looking as if they're REAL men (I'm being half tongue in cheek here). What's a real man like? Well, you gotta have a deep voice naturally, you don't flap around too much with your hands, and, if at all possible, you make sexist jokes on the odd occasion (mind you, most drag queens are sadly excelling at that), it also helps to be dressed not too fashionably (mind you, metrosexuals are good at dressing properly these days, too). I suspect you also better have a pint instead of a glass of chardonnay, but I might be off on that one...

It's funny, I have had this 'compliment' more often than I can recall, both from straight and gay folks whom I know/knew. I always thought of it as seriously offensive to be honest. After all, I happen to be gay, and I'd much rather be identified as such if someone sees the need to identify me according to sexual orientation. What's the point of gay men mistaking me for a straight guy? Same is true for straight women... - defeats the purpose, doesn't it? What kind of compliment is it to tell someone who's gay that they don't 'look' gay. I mean, how often have you heard someone telling straight folks that they look 'soooo gay', and that one would have never thought that they might be heterosexual? And of the few who might have heard this 'compliment', how many would have taken pride in this in the same manner that very many gay folks take pride in 'passing' as straight?

What's even more puzzling is that this seemingly innocent 'compliment' also reveals a LOT about people's silly stereotypes. I mean, to be a gay man, does one really have to talk in a high-pitch voice and flap a lot around with one's hands? Isn't that at best a reflection of age-old stereotypical assumptions about gay men being some kind of stereotypical women? And that to be a 'proper' lesbian you got to be REALLY 'butch'. I could go on and on, but I'm sure you get the drift.

Much of this is based on the age-old assumption that gay folks really are the 'other' sex, and that they'd behave like that. I doubt that there's a biological hardwiring that ties this kind of behavior to sexual orientation. Certainly there's no good reason to take pride in 'passing' one way or another. Better to call people out on the prejudices that such 'compliments' reveal.

Stepping off my soap box now :).

Ps: It goes without saying, should you feel like acting it out camp or should you really feel like camp is you, it's REALLY fine, too. None of this matters one way or another!

We've got to PAY for news - but how?

You're reading this blog on the web (and no, it's not news!), so I suspect you might be reading much of your news on the web. There's excellent sites serving our insatiable need for news, from the BBC site in the UK to the M&G in South Africa to tbe BMJs health sites, and so on and so forth. This shift from print media to the web has resulted in the death of many venerable newspapers. Many have been household names for a century, and suddenly they were gone. Their sales figures plummeted because people bought paper copies of the newspapers in ever lower numbers, advertising revenue migrated to where people go today for news, a vicious cycle from a newspaper's perspective. Many websites run advertisements to pay for their content. It has become clear by now, however, that large news organisations such as the San Francisco Chronicle, or the Los Angeles Times cannot survive on the advertising revenue derived from their websites. Excellent newspapers tho they are, they're on the brink of extinction.

I have got to be honest, I rarely buy print copies of newspapers these days anymore. Living in Canada, I have difficulty justifying shelling out cash for the local papers, the quality of most of them is plain inferior to what is available free of charge on the web elsewhere. It's also unclear whether they contribute to national debate as much as they used to (after all, web based media are also capable of achieving this feast).

However, when I look carefully at how I interact with internet based news organisations' sites, I notice that, truth be told, essentially I am a free-rider. The superb (to my mind unique in terms of quality) BBC site, for instance is paid for by UK based TV license payers (ie tax payers) who have no choice but to pay their annual fee to support the BBC. While I am grateful to them, truth be told, I should probably pay towards maintaining that great source of high-quality news content that this site is. Equally, I doubt the South Africa based Mail& Guardian makes money from its fairly comprehensive site. There I am, a reasonably well-off developed world dweller, sucking up free news content produced in the developing world (fair enough, South Africa isn't as poor as its townships suggest, but still, you get the drift). Equally, the millions of Jamaican expatriates that read the Jamaican Gleaner newspaper to find out what's going on 'at home' do not pay the paper's proprietor anything for using the news content provided there free of charge to them via the internet. Mind you, the paper sucks so badly that it would probably never succeed if it decided to charge its internet based readers, but who knows...

I can't help but think that sadly Rupert Murdoch is right-on when he tries to get people to pay for news content on the News Corporation's website. As it happens, in my world News Corporation companies do not produce news, they generate reactionary propaganda, so I won't frequent their 'news' websites anymore in the future than I have done in the past. It's bad enough that I can't prevent Fox 'news' flooding into my home thru my cable provider's pre-packaged content delivery. However, if the BBC ever decided to charge a nominal fee for access to its internet news sites, I would almost certainly pay up.

The only disadvantage I see of this is that once the commercial access walls have gone up, there will be so much less news available, because the content will once again become proprietory in nature. Still, to assume that somehow large news sites could survive simply based on advertising revenue seems naive. When - if ever - have you clicked thru to one of the advertisers' sites? I think I may have done so 10 or 20 times over the last decade...

Any views on this anyone? My main concern is not that one would have to pay, as I said, I think we should begin paying for news content currently provided free of charge on the web. No, my main concern is that once we start paying we will ironically also receive access to much less information than we currently have. That surely is a regressive step.

Brief hiatus

Dear reader:

I haven taken up a Distinguished Visiting Fellowship at my good friend and colleague, Richard Ashcroft's University (Queen Mary, University of London). While I will be commuting forth and back between Canada and the UK (the environment, as usual, be damned ... do-gooders tend to travel at least as much as those who have no qualms about flying our environment into the ground), I have just arrived this week in Britain and I am trying to get my feet on the ground. Please be patient with me. I expect more frequent blog posts to resume this coming week.

Udo Schuklenk

Support Jewish Voice for Peace Campaign

Dear reader,

Defend academic freedom Defend the right to talk about boycott, divestment, and sanctions

On Thursday, August 20 the LA Times published an op-ed in which Ben Gurion University Professor Neve Gordon, a prominent political scientist and long-time peace activist, wrote that the question that kept him up at night, both as a parent and as an Israeli citizen, was how to ensure that his two children as well as the children of his Palestinian neighbors do not grow up in an apartheid regime. His pained conclusion is that the only strategy left is "massive international pressure" in the form of Boycott, Divestment and Sanctions (BDS). He therefore endorses the Palestinian BDS campaign proposed by a wide swath of Palestinian civil society.(1)

Following the publication of the article there has been a vehement and aggressive attack against Gordon in Israel that calls into serious question Israel's committment to academic freedom and the democratic right to free speech.

We now believe that "massive international pressure" will be needed to keep him from being fired from his job.

Tell Ben Gurion University and the Israeli Minister of Education to defend academic freedom.

Prof. Gordon's endorsement of economic pressure offers what Naomi Klein termed "the most effective tools in the nonviolent arsenal" to address the Israeli occupation (2).

And yet, Prof. Rivka Carmi, the President of Ben Gurion University, was quoted in the Jerusalem Post as saying that the "university may no longer be interested in his services." She added that "Academics who feel this way about their country, are welcome to search for a personal and professional home elsewhere." (3)

Is Prof. Carmi really calling on Prof. Gordon to leave his country?

Several Knesset members from the right called upon Carmi and the Minister of Education to sack Neve Gordon, while Education Minister Gideon Sa'ar called the article "repugnant and deplorable."(4) In the thousands of talkbacks generated by articles in Israel, hundreds of angry readers have called Gordon a traitor, a virus, cancerous, and have threatened to expel him from Israel and some have even called for his execution. Unsurprisingly Israeli rights-abusive policies, the occupation and how one might resolve the conflict are side-stepped, and the central issue becomes how to do away with the messenger.

In Prof. Gordon' words: "From the responses to the article it seems most people don't have the courage to discuss the main issues: Is Israel an apartheid state? How can the Israeli-Palestinian conflict be resolved? Is the settlement project good for Israel or will it cause the state's destruction? It's easy to criticize me while evading the tough and important questions." (5)

The dismaying response to Prof. Gordon's article is but the latest manifestation of attempts to silence dissent within Israel. In only the last six months, activists from New Profile have been arrested and investigated, Ezra Nawi is in danger of going to jail for non-violently defending the destruction of a Palestinian home, and just last week the Vice Prime Minister called Peace Now "a virus." Are these the actions of a democracy?

BDS is a legitimate non-violent strategy with a storied history, most famously in South Africa. It deserves honest, thoughtful appraisal, such as Dr. Gordon offered in his recent article. By supporting Professor Gordon, we are protecting the ability to talk openly about the Israeli occupation and about nonviolent options to address it, including boycott, divestment, and sanctions.

Write a letter to the President of Ben Gurion University and to the Ministry of Education in Israel to defend Dr. Neve Gordon's, and every Israeli's, ability to discuss political issues without fear of losing their jobs.

Sydney Levy
Jewish Voice for Peace

(1) http://www.latimes.com/news/opinion/commentary/la-oe-gordon20-2009aug20,0,1126906.story
(2) http://www.naomiklein.org/articles/2009/01/israel-boycott-divest-sanction
(3) http://www.jpost.com/servlet/Satellite?cid=1249418674692&pagename=JPost%2FJPArticle%2FShowFull
(4) http://www.haaretz.com/hasen/spages/1109492.html
(5) http://www.ynetnews.com/articles/0,7340,L-3765612,00.html

What is it with 'these' people?

I don't get it! There have been reports this week that 'illegal' refugees who tried to cross into Italy from Libya's coast were left to die when their little boat ran out of gas, food and importantly water three days into their journey. Only about 5 out of a total of 80 made it. The others died eventually because they drank sea water, starved etc. The survivors were picked up eventually by the Italian coast guard. They told journalists that several ships passed them by and ignored their pleading. One even dropped a bit of water to them and disappeared thereafter.

How can people call themselves civilized who choose to do nothing at all to prevent almost certain death of other human beings when their direct and immediate action could have prevented such a harm from occurring? Surely the cost of taking the refugees on-board would not have fallen into the category of overwhelming burden or serious risk to one's own life. They could have even radioed the Italian or Libyan coast guard to pick those dying folks off the seas, yet these seafarers chose to do nothing at all.

Boggles the mind!

ps: I'm not even going to comment on the US health care debacle. How daft can people be and still be taken seriously ...

Those HIV serodiscordant couples' studies...

There has been some evidence that if guys are circumcised they're less likely to pick up HIV (and possibly other STIs) from people they happen to have unsafe sex with. Some clever public health folks wanted to know whether that cuts also the other way round, ie whether HIV infected men are less likely to transmit the bug when they're circumcised. What better place to investigate such speculations than Africa.

The medical journal THE LANCET just published a piece testing just this hypothesis. The investigators recruited 922 uncircumcised HIV infected men whose female partners happened to be still HIV negative. They then circumcised half of the guys. The women were informed of the objective of the study, but - as far as I can see - it was left open whether the male partner was HIV infected or not. This was so, because in addition to the infected guys they also had non-infected guys in the study, but obviously they were not 'counted' as there was nothing these guys could have passed on to their partners anyhow. So the women had no certainty to assume that their partner was HIV infected (as opposed to the next woman's partner). Indeed, the study authors concede that 'Inclusion of only couples who agreed before enrolment to couples' counselling and result disclosure [sic!] might have resulted in lower HIV transmission rates in both trial groups.' (p.236)

The investigators jumped otherwise thru the usual ethics loops, there's informed consent, folks were counselled to use condoms and that safe sex is imperative. To give them credit where credit is due: anyone who seroconverted during the study (ie who became infected) will be supplied with life-preserving AIDS medication when that is clinically indicated. So, HIV negative women who seroconverted during the study will be offered chemotherapy.

I've got to be honest: I do not believe such studies ought to take place. For starters, there was truly no good reason to assume that circumcision would have any impact whatsoever on transmission rates - and, surprise, surprise, it had no impact. Still, epidemiologists do what epidemiologists do best, they watch and report. So, in our case we had medical professionals who knew that there were a large number of HIV infected men whose partners did not positively know of their infection - the study authors confirm this for a quarter of each group. They then stood idly by and watched what happened. Turns out that circumcision doesn't reduce HIV transmission rates.

I can't get my head around the idea that the medical researchers should have had no moral obligations to warn the women in this study of the HIV infection of their partner. Now, you'll object that that would defeat the purpose of this study. You are right, but it would reduce the incidence of HIV infection and premature death among the women in question. You'll say that that would also prevent the investigators from undertaking this study. Exactly, that is why I think such research should not take place.

We know already what prevents HIV transmission. Put infected people on AIDS medicines (HAART) and drop all the social science investigative nonsense. You'll say that for us to do that we need more cash and more people tested. You're right on both counts. A good start could have been not to waste money on such research then and use the cash where it demonstrably would do some good.

Your thoughts on the KINDLE are sought

I'm sure you have seen, heard of or tried Amazon's kindle reader. It's a device that permits you to download books to a portable reader and ... umm read them there. There's several advantages to this: One thing is that you can carry quite a few 'books' with you on the one device, so for those frequent travellers among us, that's a truly neat thing. There also seems to be a slightly less wasteful production process (no books are being printed, paper wasted, ink produced etc - on the other hand, you need to produce another digital product that's likely filling up the landfills in African and other developing countries within a few years).

What annoys me about this piece is that (at least until very recently) Amazon could remotely delete content from the device, that its format is proprietory (ie you have to download from amazon), that its readability is questionable (particularly when there's bright sunshine) and importantly that you save only pennies on the price of a printed volume. The latter is particularly odd, given that the cost of printing a book are much much more substantial than the cost of sending a file to someone.

What are your views on the kindle??

Stop Censorship

Beware the Spinal Trap

Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results – and can even be lethal, says Simon Singh.

Simon Singh

---

On 29th July a number of magazines and websites are going to be publishing Simon Singh’s Guardian article on chiropractic from April 2008, with the part the BCA sued him for removed.

They are reprinting it, following the lead of Wilson da Silva at COSMOS magazine, because they think the public should have access to the evidence and the arguments in it that were lost when the Guardian withdrew the article after the British Chiropractic Association sued for libel.

We want as many people as possible around the world to print it or put it live on the internet at the same time to make an interesting story and prove that threatening libel or bringing a libel case against a science writer won’t necessarily shut down the debate.

---

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.

If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

Racism affecting nurses

Boggles the mind... but I suppose I shouldn't be surprised anymore about findings such as these (reproducing a press release from York University, Toronto, Canada):

Nurses stung by racism on the job, York U research finds

Nurses in Ontario experience racism on the job from patients, doctors, nurse managers, and most often from other nurses, research by a York University professor has found.

“I would call it a new racism, a subtle but systemic form,” says professor Tania Das Gupta, Chair of the Department of Equity Studies in York’s Faculty of Liberal Arts and Professional Studies. “It doesn’t use the language of racism, but it ranges from comments about accents and physical attributes, to a failure to recognize the nurse’s skills and knowledge.”

Das Gupta surveyed nurses through the Ontario Nurses’ Association, receiving 593 responses from nurses across the province. She conducted 18 in-depth interviews and closely studied arbitration cases.

In the survey, 41 per cent responded that they had been made to feel uncomfortable because of their race, colour or ethnicity. Most Black/African Canadian nurses (82 per cent) and Asian Canadian nurses (80 per cent) said they had experienced this, as well as 50 per cent of South Asian Canadian nurses and 57 per cent of Central/South American Canadian nurses. Even 25 per cent of the white/European Canadian nurses said they had been made to feel uncomfortable because of their ethnicity or religion, said Das Gupta.

The results of the survey, which was conducted a few years ago, are analyzed in Das Gupta’s recent book, Real Nurses & Others: Racism in Nursing (Fernwood, 2009). The title for the book came from the experience of one black nurse who was asked often if she was a “real” nurse.

Das Gupta decided to study racism in nursing closely because she had often been called as an expert witness in racial discrimination cases involving nurses. She expected that most of the racism toward nurses would come from their patients or managers, but the greatest proportion – 27.3 per cent – was from co-workers. Patients were the next most likely group to express racism (23.8 per cent), followed by doctors (14.3 per cent) and nursing managers (12.8 per cent).

Systemic racism in institutions arises from conscious or unconscious policies, procedures and practices that adversely affect people of colour, including their exclusion, marginalization and infantilization, says Das Gupta. Her research examines how fear, lack of support, management collaboration, co-worker harassment and ineffective institutional responses make it difficult for victims of racism to fight back.

Surprisingly, most nurses who experience racism don’t take the issue to their union, but try to handle it on their own, says Das Gupta. This is significant because 58.1 per cent of black/African nurses and 48.3 per cent of Asian nurses perceived that their race, ethnicity or colour affected their relationship with their colleagues, while 54.8 per cent of black/African nurses, 46.7 per cent of Asian and 44.4 per cent of South Asian nurses said it affected their relationship with their manager.

“Both those relationships can affect job promotion and there’s a pattern of differential treatment,” said Das Gupta. ”I think there’s a role for government to play to address this kind of systemic racism, as well as unions, employers, educators and even community groups.”

Thank you BMW

Not that I like BMW (the brand and most of its cars), but I am delighted about the company's decision to withdraw its Formula 1 sponsorship (and team, I hope). Seriously, in an age where everyone's going on about reducing energy wastage, we got guys driving around in circles in overpowered racing cars. I wonder how many people watch this stuff hoping to see the next big accident. Anyhow, another major team down... few to go :0).

mr or mrs blessing youg and me

Read from top :-). enjoy the excellent command of the English language. Note that it's all blessed by God (end of blurb), too, so there's no need to worry that this just might be another scam :). Uneducated as these folks are, they don't even seem to know that prime in most places these days is below 3%, so their supposed offer wouldn't even be competitive if it was serious :0). Oh well...

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Mr Blessing after gender operation ...

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Militant theists

I owe this cartoon to Darragh Hare and obviously its creator (some things are being created after all :).

Canadian doctors move on Right-to-Die issue

Interesting stuff. Doctors in the French speaking Canadian province of Quebec are bound to issue a discussion document this coming fall proposing that voluntary euthanasia be legalised under certain circumstances, namely in case of terminally ill patients suffering severe pain.

The Montreal Gazette points out that the Quebecoise electorate has been more progressive than voters in other Canadian provinces, with about 80% favouring the legalisation of voluntary euthanasia. Conservative religious people are naturally not bemused, and their lobbyists dragged out flawed stuff like the doctrine of the double-effect and the intention-foresight distinction.

Simply put: these people believe that if someone dies as a foreseeable side-effect of having received large quantities of pain killers that is not euthanasia provided the doctor's decision was to relief pain and not to kill the patient. Of course, the effect is the same: the patient dies as a foreseeable consequence of her doctor's intervention. To say that I don't mean to do X when I know that X is the inevitable result of my actions is probably intelligible (after all, I might accept X as an unwanted but inevitable thing, in order to achieve something else, say the alleviation of pain). And yet, it seems deeply dishonest to go on about this distinction when it is clear that I will kill a given patient if I intervene in a particular way (even if my intention is otherwise). Seems like camomile for the tortured guilty conscience. Perhaps it is time to consider whether it would be better to permit people legal access to this option to avoid endless probes into doctors' intentions. It would appear to be more sensible to focus on the outcomes of actions and decide whether or not they are desirable. The double-effect doctrine and the intention-foresight distinction are not particularly helpful, when looked at from this perspective.

Canada at this point in time outlaws voluntary euthanasia, as well as physician assisted suicide (in this case the doctor would not administer the drug to terminate your life, she would only make them available to you so that you can commit suicide yourself if you so wish).

JAMA follow-up

You might recall my criticism of more or less unprofessional conduct by the Journal of the American Medical Association's current editors. It's a story that began here, continued here, with the last post being this one. Apparently the WALL STREET JOURNAL's health blog (kindly citing my blog) asked JAMA for a reply to the criticism I raised both on this blog as well as on a mailing list of the World Association of Medical Editors. According to the Wall Street Journal's health writers the JAMA editors refused to comment. This is much in line with what I have experienced with re to my open questions on the World Association of Medical Editors' listserv. There has been deafening silence, too. It seems to be the case that JAMA's editors are not accountable to anyone with regard to their conduct. They even get away with rewriting the publishing history of the journal they edit.

As a by-product of their shenanigans they flagged (again) the serious problems the scientific publishing community faces with the dawn of the age of on-line only 'publishing'. With the push of a button, scientific publications that once were can simply be made to disappear (and probably also be changed retrospectively). Scientists who criticise an original paper (as was the case with the JAMA on-line editorial that disappeared into thin air) will look a tad bit daft because the article they commented on has disappeared (presumably a result of the egg-on-editors'-face syndrome...). None of this would be possible with print copy publications!

Natalia from Russia likes me - YAY

Hey! You should be so lucky. I got this amazing email from Natalia, completely out of the blue, or, more to the point, out of Russia. I have never heard of her before, but look at her gorgeous face... and she wants to meet me next month. Wow. Anyhow, enjoy her letter ... possible replies to her email are entertained in the comment section. I really would have preferred Dimitri to write, but hey, can't have it all... Udo

----------------------------

Hello my dear friend !!!
How are you doing?
My name is Natalya. I am 28 years old. My birthday is July,25th. I live in Russia.

Really it is very interesting to me to learn you more and to study you.

I as would like to tell to you about that that I really lonely woman and I very much would like to have acquaintance to the man for serious relations. For this purpose I to address in agency of acquaintances and to give them my letter. To me to tell that I can really find the man through their agency and they to allow me a little e-mail. I to choose yours and very pleasant for me if you answer my letter. I hope that we can study more about each other.

I very much want to have acquaintance with good the man. I as to have some questions for you.
How there is your life? What city you live? What you to think about our meeting? You wanted that I could arrive to you in next month?
I wish you good day and success.
I wait for your letter.
Your friend Natalya.

JAMA shenanigans continue

You might recall that I posted various blogposts (the last one being this) about the ongoing shenanigans between JAMA and Jonathan Leo.

Here's how the story continues. I copy below a message I just posted to fellow medical editors of the World Association of Medical Editors via our listserv. It's pretty self-explanatory. This truly boggles the mind!

I will keep you posted in case I get a reply.


Colleagues,

you will recall probably the ongoing forth and back between the JAMA editors and Jonathan Leo.

I want to draw to your attention these two documents:
www.udo-schuklenk.org/files/jamamarch.pdf
www.udo-schuklenk.org/files/jamajuly.pdf

The first document is an on-line publication (incl doi number and all) from March by the JAMA editors. It has been very widely criticized in various fora and condemned pretty much uniformly by everyone with some knowledge of publishing ethics, no least bioethics outlets. What is significant is

a) JAMA has excised its first publication from its website as well as biomedical data-bases (I have no idea how the latter feast was achieved). No retraction notice was published, no erratum of any kind. As one of my colleagues pointed out: what does this mean for the substantial commentary (overhelmingly critical in nature) that was published in various fora on this now non-existent article?

b) My own publisher (Wiley-Blackwell) told me that anything published with a doi number online must not be changed in any print version or on-line without proper errata, withdrawal notes etc.; basically an on-line paper with a doi number ought to be treated just like one would treat a print article. So, one question I have is whether this is simply part of the lex JAMA (continuously revised by the paper's current editors, including seemingly the journal's publication history itself), or whether my publisher has given me false information with regard to the status of on-line publication with doi numbers.