ToC Bioethics 2013; 27(3)

Volume 27, Issue 3 Pages ii - ii, 117 - 174, March 2013 The latest issue of Bioethics is available on Wiley Online Library EDITORIAL BEING A GOOD ACADEMIC CITIZEN (page ii) UDO SCHÜKLENK ARTICLES THE NEW MILITARY MEDICAL ETHICS: LEGACIES OF THE GULF WARS AND THE WAR ON TERROR(pages 117–123) STEVEN H. MILES GETTING MORAL ENHANCEMENT RIGHT: THE DESIRABILITY OF MORAL BIOENHANCEMENT(pages 124–131) INGMAR PERSSON and JULIAN SAVULESCU BRAIN DEATH IN ISLAMIC ETHICO-LEGAL DELIBERATION: CHALLENGES FOR APPLIED ISLAMIC BIOETHICS (pages 132–139) AASIM I. PADELA, AHSAN AROZULLAH and EBRAHIM MOOSA ONTOLOGY OR PHENOMENOLOGY? HOW THE LVAD CHALLENGES THE EUTHANASIA DEBATE(pages 140–150) FELICITAS KRAEMER REFOCUSING THE RESPONSIVENESS REQUIREMENT (pages 151–159) SEEMA SHAH, REBECCA WOLITZ and EZEKIEL EMANUEL DEBATE MORAL ENHANCEMENT VIA DIRECT EMOTION MODULATION: A REPLY TO JOHN HARRIS (pages 160–168) THOMAS DOUGLAS ‘ETHICS IS FOR BAD GUYS!’ PUTTING THE ‘MORAL’ INTO MORAL ENHANCEMENT (pages 169–173) JOHN HARRIS LETTER TO THE EDITORS THERE'S NO METHOD IN THE BADNESS (page 174) DAVID BENATAR

50 Great Myths About Atheism

Ha, and there it is, in all its glory, the cover of our upcoming 50 Great Myths About Atheism! You can't say that folks could easily overlook it in their local bookstore (where they still exist)!

The publisher is currently producing the page pdf's, so it'll be a few more months before it'll actually be out!

Lancet background series on NCD and human development

For those interested in global and/or public health issues, you might want to check out the The Lancet. The journal has published two days ago (on-line early) a series of excellent background papers on non-communicable diseases (NCDs) and their threat to human development in low- and middle-income countries. This is a very important issue, because for decades political activism and much of bioethical scholarship) has been focusing on issues of infectious disease control (think about HIV/AIDS, drug resistant TB etc) and/or the brain drain. More or less completely neglected by bioethics scholars (yes, there are a few exceptions) have been NCD. This background series is looking among other issues at the producers of food products (if you want to call cigarettes, soft drinks, and other such goodies food products). Noteworthy is the conclusion found in one of these review papers. It should give the current UK government and its calls for self-regulation and public-private partnerships pause for thought:  'Despite the common reliance on industry self-regulation and public—private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.' Other papers look at strategies developed by STI activists to get essential medicines to those in need and apply them to the NCD issue.

The papers mentioned are available at the time of writing as Open Access documents, but you might have to register with The Lancet.

Wow! 9 Volume Ethics Encyclopedia finally out!

You can't but help think 'wow' when you actually hold the 9 beautiful volumes comprising the Wiley-Blackwell International Encyclopedia of Ethics in your hands. It simply is an amazing feat accomplished by an experienced hand at producing top-quality edited works, Hugh LaFollette. So, to get the disclaimers out of the way, I have three entries in this encyclopedia. I also edit journals for this publisher and I am contracted to produce a couple of books for Wiley-Blackwell.

Conflict of interest or no, you can't help but feel in awe of this reference work. The list of authors truly reads like a list of the Who is Who in academic ethics, ranging from David Archard, Marcia Baron, Roger Crisp, Norman Daniels over Dale Jamieson, Margaret Moore and Rosalind Hoursthouse to the likes of Philip Pettit, C. L. Ten, Rosemarie Tong and Michael Tooley and hundreds of others. It is not the case, by the way, that authors could just send their stuff in and after a cursory review they'd be accepted. I truly battled it out over one entry with Hugh and kind of lost, at last any consequentialist would see it that way. When I refused to add particular content that Hugh wanted referenced and that I genuinely thought wasn't worth citing, we found a way out of this impasse (classic stand-off between editor and author, I've been there on both sides more often than I care to remember).  A co-author was added, said co-author added the content Hugh was keen on, and everyone moved on with their lives. As I said, consequentialists would rightly note that I 'lost' this one.

As you would expect of such a work, it provides a comprehensive index both organized in alphabetical order as well as broader subject areas, as well as further readings following each entry. There is even a limited number of entries on 'Non-Western Ethics', the emphasis here being on limited. I was a bit surprised that no dedicated entries were to be found on secular approaches to ethics and their relationship to religious approaches to ethics. I should not pretend, of course, that I read all or even most of the entries, but at least the available indices didn't point me to anything dedicated to this complicated issue. There are a few entries on religion, but nothing on atheism, secularism or indeed humanism. To be fair, many entirely secular approaches to ethics (eg utilitarianism) are featuring prominently in the encyclopedia, so perhaps this isn't such a big deal after all. In any case, it's all too easy, with a work of this scope, to squibble over 'missing' content, or individual authors' take on a particular issue. Only small-minded reviewers would ponder for too long on such omissions or individual authors' takes on particular subject matters.

Researchers and students in my own field of specialization, Bioethics, will find as contributors the names of many leading academics as well as those of many junior scholars. Hugh LaFollette and his team deserve the highest praise for this astounding product. I have no doubt that this encyclopedia will serve as the reference work both for established researchers as well as for students trying to get a quick overview of particular subjects for many years to come.

Of course, this is the 21st century, so the first hint that this project had come to fruition and that my entries were 'around' came with a google scholar alert telling me that something with my name on it had been published. The link embedded in said alert sent me straight to Wiley's website where an on-line version of the entry was available for download. That's a wonderful thing, of course, and something other encyclopedias offer, too. Wiley plans to up-date the individual on-line entries more frequently than it plans to publish future editions of the print copy. I must say that I am a tad bit puzzled about this. To me this seems to suggest that there could (well, that there will) be distinctly different entries on the same subject matter in the same encyclopedia, except that one will be in the print version, and another in the on-line version. In some ways this won't matter, because you can still choose which one to cite for your purposes. On the other hand, once the first set of revisions is filtering thru into the on-line version, there will be different products out there, under the same name. I'm not too keen on this, but I cannot see how this can be avoided. On the bright sight, as authors we will be able to boycott revisions of our on-line content if the publisher behaves sufficiently badly as to draw the wrath of the academic community on itself (just ask Elsevier). I, for instance, have not updated various entries in two Elsevier owned encyclopedias since the academic boycott of Elsevier got off the ground. It goes without saying that at that point in time things would get even more confusing as the print edition would have an entry from one author, while the on-line edition could well have an entry on the same topic from someone different. It'll be fun to watch how Wiley and its team of editors will deal with such an eventuality.

Korean edition of 50 Voices of Disbelief

And here it is, the cover page of the Korean edition of 50 Voices of Disbelief, it's coming in at a whopping 550 pages, no less. After the Polish edition of the volume, this is the second foreign language edition, it'll soon be followed by a Spanish translation. I am pleased to report that the Polish rights for our up-coming 50 Great Myths about Atheism (Wiley-Blackwell 2013) have been sold already. Fingers crossed there will be more international editions of that work!

Enhancement Horror in Germany? Not Quite.

Pharmacology reports in its current issue the results of a survey of about 2600 German university students. The study's objective was to find out to what extent German students use cognitive-enhancing drugs. Turns out, German students find themselves in good company. A survey [doi:10.1038/452674a] of readers of Nature reported that about 20% of readers of that journal take performance enhancing drugs. German students come in at roughly that level. Compare that to office workers (5%). Makes you wonder whether the scientist readers of Nature know something that the rest of us don't know - after all, one reason for people arguing against the use of cognitive-enhancing drugs is that 'we dunno whether they actually work.' It seems those in the know are voting with their feet on this little detail. 

The survey (anonymous as it was) was cristal clear with regard to what it was that they were after. Here's their definition of brain doping, as they call it, 'Substances for brain doping are pharmaceuticals or illegal drugs that you cannot buy in a drugstore and that were not prescribed to you to treat a disease. The only reason why you use this substance is to improve cognitive performance, such as attention, alertness, and mood. Examples are stimulant drugs (amphetamines), caffeine tablets, cocaine, methylphenidate, and mephedrone.' That excluded then academia's traditional brain doping means, caffeine from the coffee maker, those revolting energy drinks and other above-the-counter stuff like that. It also excluded students who would be taking ADHD medication because of a clinical condition they were suffering from. One oddity perhaps, caffeine tables were included in their list, because they're only available in limited quantities in pharmacies in Germany, while here in Northamerica we can, of course, get em at the local 7/11. Of course, the articles also offers standard ruminations about caffein tablets being 'may be' gateway drugs. Bit like the good ol marijuana wars. Oh, did I mention that this research was partially funded by the World Anti-Doping Agency? So, naturally it's all really terrible. Really!

The survey team had a very high response rate (German students, ha!), 2834 surveys were distributed, 2569 were returned. That's a >90% rate of return. The sex distribution was roughly 60% female to 40% male. Here's what the survey unearthed with regard to illicit drug taking for the purpose of cognition enhancement. Of all students about 23% took such drugs. By field of study it looks like this:

• Economics or law  25.0%
• Languages or education 17.6%
• Culture sciences 27.8%
• Sports science 31.6%
• Medicine, psychology,
• or natural sciences 23.9%

By sex it looks like this:

• Female 20.4%
• Male 27.9%

In terms of semester distribution, it seems first semester students are the most likely takers. 

First 28.6%
Other 20.0% 

The main conclusion of the study: 'Drug prevention models need to be established.' Amen to that! - Just kidding. Presumably the same drug prevention models that have been such overwhelming failures on all other fronts are being recycled here. 

Like many other bioethicists I am - in principle - in favour of permitting students (and others) to take cognition enhancing drugs, provided certain conditions of voluntariness are met, and provided the students are informed about the known risks and benefits. However, there are drugs and drugs, of course. Some cognition enhancing medicines are addictive, others are not. I would be worried about folks taking addictive enhancing drugs, because I have some doubts about the cost-benefit ratio here. However, in case of cognition enhancing drugs that have no significant harmful side-effects and that are not addictive, it is arguably time to change regulations prohibiting the use of such drugs. Just going by the numbers cited above, it is clear that draconian measures are bound to fail, just like any drugs related prohibition has failed. It is equally clear that many medical professionals are happily prescribing cognition enhancing drugs to their 'patients', given that this is currently the only legal way of obtaining them. Assuming that their 'patients' quality of life improves as a result of their willingness to prescribe these drugs, all the - ethical - power to them. Universities also need to decide how to handle this. One would really want to see research testing whether those students who take such drugs actually perform better (I suspect they would), and whether that is a result of their drug taking. If it turned out to be the case that they had an advantage over students not taking such drugs, there would have to be institutional responses ensuring a kind of a level playing field in terms of exams, grades and such matters. 

Ps: cannot vouch for the veracity of the image used in the top left-hand corner... :).

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

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

Open Access a threat to academic freedom?

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

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

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

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

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

Taxing junk food?

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

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

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

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

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

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

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

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

'Discrimination' - always a wrong?

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

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

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

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

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

Simple enough, isn't it?

Quebec at the forefront of assisted dying effort in Canada

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

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

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

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

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

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

Table of Contents Bioethics 2013; 27(2)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My truly favorite line is this, 

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

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

2013 here we come

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

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

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

Being a good academic citizen

A lot of ink has been spilt about the pro’s and con’s of academic peer review. I am not going to add to the existing literature on this matter in this blogpost. Suffice it to say that I subscribe to the view that anonymous peer review is still the least deficient of the available mechanisms to determine the quality of a given article submission. As an editor of two international journals I am painfully aware of the fact that occasionally the quality of peer review is not as good as it should be. Usually enraged or not so enraged emails from authors give us editors an indication that one or another of the reviewers we invited to review a particular manuscript might not have been as diligent as would have been desirable.  In some of those cases we tend to embark on a second round of reviews. Either way, we depend on volunteers, also commonly known as good academic citizens, to review articles submitted to the journal. Our Editorial Board members have graciously agreed to review a minimum of four submitted articles for us in any given year, many review quite a few more submissions.

Without dependable reviewers Bioethics and Developing World Bioethics could not function and deliver high-quality outputs. One problem we encounter frequently is that it often is very difficult to find reviewers for submitted manuscripts. We know from conversation with fellow editors at other bioethics and medical ethics journals that we are not alone in this. The ‘very difficult’ refers to a number of different problems, the accumulated effects of which have a deleterious effect on our operations. For starters, too many academics are very happy to submit their manuscripts for review but they think little of returning the professional courtesy of their reviewers by responding positively to invitations to review manuscripts for the journal. As a result, some of those good academic citizens, who review diligently for us, get arguably overburdened with review requests, while those who prefer not to review content get a free ride. I wonder whether the Golden Rule might actually be more frequently written about by academic ethicists than it is actually followed by us. It is notable that junior academics tend to be more generous with their time while many (but by no means all) of the more established scholars are among the more frequent non-responders. The former also tend to provide longer, more in-depth and more constructive reviews. This, of course, is very much appreciated by authors keen to improve their papers prior to submitting their final draft for publication.

Other problems that typically delay – sometimes very significantly – decisions on submitted manuscripts have to do with invited reviewers not responding to our invitations, lagging significantly behind agreed-upon deadlines for the delivery of the reviews, not delivering promised reviews at all, but also producing reviews so devoid of critical substance that they are useless for all intent and purposes.

Part of the problem is undoubtedly that many academic institutions encourage free-riders by not giving serious credits for undertaking per reviews for academic journals, funding agencies and the like. If annual performance reviews, or tenure reviews do not include credits for such work it is understandable why academics turn down such work. This is very unfortunate indeed.  As academics we should flag this issue within our institutions with a view toward establishing formal institutional recognition of demonstrable, quantifiable services to the academic community. 

Margaret Somerville in secular garb - in the Catholic Register

Good fun, Margaret Somerville, a McGill law professor is interviewed in the Catholic Register. The main objective of the article is to figure out her 'secular stance' on assisted dying. For good measure, and presumably to ascribe expertise to her in matters bioethics, the Catholic Register describes her as a bioethics professor, yet McGill only notes her law school and her medical school professorial appointments. I was not able to find any evidence of her holding currently a formal appointment as a bioethics professor at that university. 

Evidence has never been MsSomerville's strongest point. So, without any evidence to back up her claims she declares on the Catholic website, 'One of the things that's wrong with respect to Justice (Lynn) Smith's judgment (in Carter v. Attorney General of B.C.) is that she purports to review the use of euthanasia and physician-assisted suicide in the jurisdictions that have legalized it. She said there is no problem, there is no slippery slope. Well, that's simply not right factually.' 

It turns out, in our Report on end of life decision-making in Canada we reviewed the empirical evidence on the slippery slope matter and concluded that there is no evidence that assisted dying leads us down slippery slopes to unwanted killings. Of course, we reviewed evidence, Ms Somerville is in full preaching mode. 

Ms Somerville also declares that 'The biggest group who are against euthanasia are doctors, and certainly by far not all of them are Church people.' Things are more complicated. For instance, a survey of medical specialists in Quebec reported a strong majority of medical specialists in that province coming out in favour of decriminalizing assisted dying. 

Ms Somerville is also up to her old magic tricks when framing the issue at hand: 'The pro-euthanasia people are very keen on saying there's a societal consensus, that everyone wants this. Well yes, but you've got to make sure those surveys are properly done. If you say to somebody that someone is in terrible pain and they want euthanasia, should they be able to have it? You've got to choose between saying yes to euthanasia and saying no to pain and suffering relief. What you have to do is ask people, does someone have absolute rights to all possible pain management? And the answer is yes, absolutely.' [emphasis added]

This is a true Somerville classic. The choice is, of course, not between either pain relief or euthanasia. You want good palliative care and access to assisted dying for those who do not consider their lives worth living. It's not either euthanasia or palliative care. 

She is also against equal marriage rights, because 'of its impact on kids' rights.' It goes without saying that there is no evidence that kids brought up in same sex families are in any way worse off than those who are brought up in heterosexual families, or that their 'rights' are violated in any appreciable sense. But hey, Ms Somerville is concerned. Right. How about reading up on the evidence?  I understood this to be an important concept in law, but I might be mistaken. She also notes, incredibly, that as far as she knows, homosexuality is natural 'for some people'. You just got to love her! - It is not terribly surprising, perhaps, that Ms Somerville's views, these days, are not even accepted as expert advice by the courts. As far as I can tell (her McGill website, her Wikipedia entry), this 'bioethics professor' has no formal qualifications in either ethics or bioethics.