On religious accommodation

Here's this week's OpEd from the Kingston Whig-Standard.

Quebec has done it again. Right after introducing legislation that effectively would permit assisted dying in the province, Quebec’s government is proposing a Charter of Quebec values. True to French form, these values are secular values.

The most controversial policy proposed is that public servants would be prohibited from wearing religious symbols conspicuously while on the job. I will get back to that “conspicuous” in a moment. Opinion polls suggest that this policy – just as the assisted dying legislation - has majority support both among the Quebecers but also among the wider Canadian public.

My liberal-minded fellow academics across Canada have issued condemnatory declarations, the loudest opposition coming from academics writing in French from Quebec. It seems it is all about accommodating the expression of religious views in the workplace. Being an atheist, I thought about staying clear of this debate lest I lose valuable friends in the academy. My gut feeling was, “They had it coming for a long time, these religious fanatics,” and “Why should they be permitted to confront me with their religious beliefs while I am trying to get professional services out of them?”

After all, most of those affected by the proposed policies would be followers of monotheistic ideologies. It is not unfair to suggest that the ideologies they are adhering to have oppressed most of humanity for much of our history. They have dictated to us what we can and cannot do in the privacy of our homes and they have used their political influence to dictate to governments what they can and cannot do. This is why it took such a long time to achieve reproductive rights for women, marriage equality, and that is why we are still bothering about assisted dying, among other policy issues

But other than me liking the feeling of finally being able to finally stick it to these ideologies, I cannot help but wonder whether the proposed policy is actually defensible in a liberal democracy. Are we any better today in our treatment of them, than they were in their treatment of us? My honest impression is that there are good arguments on both sides of the political divide.

The issue, of course, should not be about religious symbols. It is a non-starter. Why should my red “A” badge, as in “A” for Atheist, not be covered by this prohibition? Or the local devil worshippers’ symbol? What about folks wearing trade union paraphernalia? A cross possibly tattooed on an employee’s arm would have to be covered, no matter how hot it is in the office? Surely the issue should be exclusively about a public-sector employee doing his or her job professionally, not about the cloth on his or her head, right? If I receive professional services from religious employees, why should it matter what religious symbols they wear?

Well, a possible answer to this could be that we often end up talking to these employees as the weaker participant in the conversation. More often than not the public-sector employee is in a position of relative power compared to us. Is it really necessary for that person to be also permitted to wear religious accoutrements that tells me that they likely think I’m going to rot in hell anyway, because I am an atheist, or because I belong to a competing religion with its own invisible friend in the sky?

Looking at it from the standpoint of an impartial observer, I come to see these employees in their professional capacity. I don’t even have much of a choice, because unlike with private businesses, I cannot avoid public-sector employees due to the role they occupy. It is not clear why they should be permitted to drag their private ideas about the universe into our professional interaction.

Typically they hold ideas that may have been reasonable around the 14th century, but that does not hold quite true any longer in the 21st century. So, while they clearly are entitled to hold these views in their private lives, it is unclear indeed what powerful reasons there are for permitting them to drag those views into our professional interactions.

Powerful reasons: How about this one? Religion forms, for many people, part of their identity. Incidentally, the same holds true for other ideological commitments for other people. These ideological commitments could require of them to wear particular outfits. Is it not unreasonable to expect them not to wear that dress simply because they have to interact with folks not sharing their ideological commitments?

As a society enforcing such strictures, would we be any better than the totalitarian monotheistic religions that we successfully fought over time? I think not. At the end of the day, as a society we should not force citizens working for the state to check their convictions at the entrance to their office, provided they do their jobs impartially and professionally.

If they refuse to do the job they were hired to do because of their ideological commitments, we should fire them. No ifs, no buts. However, if they do their job as they promised to do when they were hired, surely their preference for particular cloth covering their hair, or a cross around their neck, should not disqualify them from becoming public servants.

Now, of course, the Parti Quebecois is what it is: is a divisive party with a separatist agenda. Both the end-of-life legislation as well as the Quebec charter proposal are driven, to some extent, by their need to separate Quebec culturally from the rest of Canada.

It is worth noting that both policies seem to have majority support. Assisted dying is overwhelmingly supported by Quebecers, the Quebec values charter commands barely majority support, but it does command majority support.

The PQ is, not unexpectedly, hypocritical in its proposed execution of the secular policies. It turns out inconspicuous religious symbols may be worn. So, if you’re a Christian wearing a smaller cross around your neck and you would be fine. This option is not available to Muslim women or to Sikhs, for instance. For lack of a better word, their headgear cannot be replaced by some miniature version.

Funny coincidence, is it not? That this proposed legislation is driven by rank hypocrisy is best shown by the exclusions the PQ has in mind. The crosses hanging in the National Assembly and elsewhere are there to stay, supposedly for historical reasons. This is complete nonsense, obviously. Why should history provide any stronger ethical reason for keeping massive religious symbols in the public domain than the fundamental needs of Quebecers whose religious identity commands them to wear particular religious garb, even to work?

The only reason to prevent a public-sector – or other – employee from wearing religious garb in the workplace would be that it would prevent them from discharging their work obligations professionally. If that is not the case, I can see no good reason for the prohibition. Any government seriously concerned about the separation of state and church should take a serious look at public funding for religious schools and hospitals, as well as the myriad tax exemptions heaped upon religious organisations as opposed to targeting citizens wearing religious paraphernalia at work.

Udo Schuklenk works at Queen’s. His new book, 50 Great Myths About Atheism (Wiley 2013), is out this month. He tweets @schuklenk

Why we don't have a good argument to 'punish' Syria now -sadly

My piece from the Kingston Whig-Standard.

U.S. President Barack Obama and his French counterpart, President Francois Hollande, have decided that it is time to “punish” the Syrian dictator Bashar al-Assad for the alleged use of chemical weapons against civilian and non-civilian Syrians alike. Mr. Obama declared many months ago that his “red line” in this civil war would be the use of chemical weapons.

Since then, chemical weapons have been used on a smaller scale on a number of occasions. Mr. Obama’s bluff was called, he blinked, the red line was crossed, and nothing happened, until a few weeks ago. Then chemical weapons were seemingly used on a larger scale, and around 1,500 people, including children, reportedly died.

Put in context, the civil war in Syria has cost already in excess of 100,000 lives, millions of people have been displaced, the country’s economy is in tatters, thousands and thousands of buildings and other infrastructure, including hospitals, have been destroyed. None of these were seemingly sensible red lines, so it does appear to be the case that if 100,000 people get killed in a civil war by means other than chemical weapons, that is quite all right as far as Mr. Obama and other world leaders are concerned. Fifteen hundred people murdered by chemical weapons - to them, that is another issue altogether.

To be fair, the world community has decided that the use of chemical weapons is a more serious issue than the use of other means to kill people in times of war. A UN convention signed by 165 countries prohibits the use of chemical weapons. Incidentally, Syria and North Korea are among the pariah states that have chosen not to sign this document.

Surely the use of chemical weapons against civilians is nothing that ought to be celebrated. It is unjust to use weapons of mass destruction indiscriminately against defenceless civilian populations. While it may seem obvious, let us pause for a moment and ask: Why is it unfair?

Well, civilians are by definition not parties to military conflict. For that reason it is irrelevant whether one agrees that the rebel army in Syria pursues a just cause or whether one supports the Syrian government. Neither would be justified in attacking civilians because they simply have nothing to do with the conflict in question. They must not be victimized by weapons of mass destruction. Weapons of mass destruction are not morally different from other weapons that kill and maim innocent bystanders. They do matter practically more simply because of their capacity to kill and maim more civilians.

This shows why the chemical weapons “red line” President Obama drew in the sand is unjustifiable. If any red line should have been drawn it should have been the “weapons-of-mass-destruction-used-against-civilians” red line. This, in turn, would have been a red line that should have triggered international intervention a long time ago. Just think of the Syrian air force’s bombing of Syrian cities and towns. Why should the Syrian civilians killed during those air raids count somehow morally less than those killed by chemical weapons?

The objective of the bombings Mr. Obama proposes is to keep the civil war in Syria going while discouraging Mr. al-Assad at the same time from using chemical weapons again. The main reason for this stance is probably that the U.S. government has – quite rightly – come to conclude that a takeover of Syria by rebel forces would likely result in a tak-over by not exactly democratically minded Islamic fundamentalists. Replacing a more or less secular dictator with a religious dictatorship does not appear to be on the agenda of the United States and their allies.

This means that the United States is not actually concerned about stopping the murder of Syrian civilians by non-chemical weapons of mass destruction. However, it is doubtful that if you bleed to death as a result of an air raid instead of suffocating as a result of the use of chemical weapons you are somehow better off, or you are somehow less worthy of international support. Yet that is what the current argument on limited military intervention suggests.

If this sounds implausible to you, and you wonder whether I did reconstruct the argument in support of military intervention correctly, let me give you another example that shows that it really is not actually about civilian lives lost, but about an arbitrarily chosen kind of weapon used in the process.

Think about North Korea. Over the last few decades, reportedly several hundred thousand North Koreans have starved to death as a result of the failed economic policies of the dictatorship in that country. In fact, more people have died there than in the current war in Syria. Has the international community done anything at all about this crime against humanity? Have their been threats of impending military action against the North Korean military targets? Not to my knowledge.

Surely the lives of North Koreans that have been lost in this man-made disaster do not count for less than the lives of those who have lost their lives in Syria. If numbers are anything to go by, the international community would have a stronger case for military intervention in North Korea than it has in Syria today.

Surely there can be a moral case for military intervention in the internal affairs of countries, the governments of which slaughter large parts of their own populations. Just think of the Holocaust in Germany. A concerted military effort by the international community could almost certainly have preserved many of the lives that were lost in German concentration camps at the time. It is not that Western governments did not know what was going on; they chose for far too long to stay clear of conflict.

It seems to me that known principles of “just war” should be applied to the situation in Syria - that a case for intervention might be made simply because of the large-scale murder of innocent civilians by the regime. However, that alone is insufficient to justify an intervention. If it was the case, for instance, that an intervention would result in even more civilian lives lost, we would have good reasons not to proceed.

Basically what we should be aiming at would be an intervention that with a high likelihood would degrade the regime’s ability to murder innocent civilians on a large scale while keeping the number of civilian lives lost in that operation to the possible minimum. Our action would be successful if it resulted in more civilian lives preserved than non-action would have preserved.

The uncertainties with regard to this overarching objective suggest that the case for military intervention has not been made.

Udo Schuklenk teaches bioethics at Queen’s University. He tweets @Schuklenk

My doctoral dissertation at a 'bargain' price

Yes, not a joke, the long out-of-print monograph sets you back now only 1,195.92 US$ if you buy it from an amazon.com dealer. The good news is, a second-hand copy on the same site is only 1 cent plus postage.

On ethical tourism

My latest OpEd in the Kingston Whig-Standard

 

Clearly the time has already come for some of the snowbirds among us to organize our trips down south during the coming winter months. Holiday resorts across the Caribbean are busily advertising their latest, best deals to us. And aren’t they nice, these ads? Lush rain forests, carefree, friendly locals, drinks on the beach, romance, the lot. You can’t help but think you’re heading to paradise. The reality, in at least some of these countries, is quite different.

Take Jamaica as just one example. I don’t know whether you have missed the easy-to-overlook news about the nearly weekly occurrences of anti-gay violence in Jamaica. A transgender teenager was hacked to pieces by a local lynch mob very recently. During the next few weeks there were several other reported incidents of mobs attacking other gay individuals, prompting the local police to mount rescue missions.

The Jamaican government does precious little to improve the situation of gay people in the country. Male homosexuality is illegal courtesy of an unholy coalition of colonial laws kept alive by the influence of fundamentalist preachers and the sub-standard level of education of the general population. It’s a dreadful situation, no matter how you look at it.

Gay and lesbian Jamaican ex-pats have quietly begun to organize a tourism boycott campaign. Their analysis suggests that, given Jamaica’s dependence on tourism, the government would begin to listen to their concerns if more and more tourists stayed away in disgust at the human rights situation in the country. Of course, one would want to ensure that the Jamaican High Commission in Ottawa hears about our decision. After learning about these issues I wrote to Her Excellency this week that Jamaica, with regret, was off my list of holiday destinations until things change.

But ethical tourism? Really? Should we make choices about our holiday destinations on issues other than location, time, price and quality of the resort? Believe it or not, despite being an ethics teacher, I’m not a fanatic on these or any other matters of ethics. There is little point in asking others to make sacrifices they consider unreasonable, even if I might be prepared to make those sacrifices.

But is it unreasonable to switch from, say, Jamaica to Costa Rica or to a Mexican state that supports marriage equality? How should we decide where to go? Surely Costa Rica or Mexico are also going to have some ethical issue or another! And how long would this whole thing take, anyway, given that all I want is to book a carefree vacation? Fair enough questions to ask.

How should we decide? My suggestion would be to use fairly uncontroversial criteria such as a country’s human rights record, its environmental protection efforts and possibly issues such as educational attainment, health care and other human welfare indicators.

So, with all that, you say, we might not go on vacation at all, because realistically we would spend the next few years figuring out how particular holiday destinations are doing instead of actually going there.

Not quite. It turns out that the Internet, as so often is the case, offers a whole host of websites that actually have done the work on our behalf already. To give you just one example, the site ethicaltraveller.org evaluates every country based on the criteria I have proposed. It makes no bones about the fact that there is no perfect holiday destination, but some clearly are way better than others. For this year it has the following top 10 ranking: Barbados, Cape Verde, Costa Rica, Ghana, Latvia, Lithuania, Mauritius, Palau, Samoa and Uruguay.

You could, if you really cared enough, do the legwork yourself. Amnesty International provides excellent country-based reviews of the human rights situations in particular countries that you might consider visiting as a tourist. This would matter to you if you thought human rights should take priority over environmental issues. Environmental organizations provide similar rankings, and the United Nations Development Program (UNDP) produces annually a freely accessible Human Development Report. The latter gives you a good indication on whether a particular country government does well by its people.

Are there good reasons against tourism boycotts? Of course there are. For starters, for a tourism boycott on ethical grounds to be useful it should target countries that rely heavily on tourism. It would be foolish to target China with a tourism boycott, because whether or not tourists come or stay at home makes little to no difference to China’s continuing rise.

All you would do is harm businesses and their employees without effecting any policy change at all. That would be a pointless boycott to begin with. So there you have a good argument against a particular tourism boycott.

Another argument goes that if you go as a tourist to places that violate human rights you have a chance to influence what’s happening locally by supporting those oppressed by the country’s majority culture or government. That is somewhat doubtful, isn’t it? In the case of Jamaica you would likely be holed up in a holiday resort and your interactions with “the locals” would be pretty limited.

Also, in all honesty, when we are on vacation we are not usually on a crusade to fix a country’s social ills by organizing demonstrations in the wake of another senseless mob attack, even if we were not prevented by the country’s laws from doing so in the first place. When I’m on vacation I want a break!

But why should we care at all? My view is that we should assist others in attaining better lives, or even just lives worth living, as long as we don’t pay an unreasonably high price for doing so. Even if it does sound a tad bit bombastic, the world really would be a better place if more of us followed this rule. In the particular case of choosing a holiday destination it seems that we would pay a fairly small price by deliberately choosing one Caribbean holiday destination over another based on the country’s treatment of all of its people, its environmental record or any other issues that matter to us.

Udo Schuklenk teaches bioethics at Queen’s and tweets @schuklenk

First reader reviews for 50 Great Myths About Atheism are in

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

4.0 out of 5 star Ambitious, and mostly very satisfying Aug 25 2013

By J.A. Rousseau - Published on Amazon.com

Format:Kindle Edition|Amazon Verified Purchase

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

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

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

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

(Disclosure: I am personally acquainted with both of the authors, and one is a colleague of mine. I do not however regard that as having influenced my comments unduly.)

5.0 out of 5 stars As good as the editorial reviews said Aug 24 2013

By peter veitch - Published on Amazon.com

Format:Kindle Edition|Amazon Verified Purchase

Excellent thinking about this important topic. Some good ideas that are new to me. I have changed some views after reading this.

A long overdue Open Letter to the Jamaican High Commissioner

Dear High Commissioner:

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

Sincerely,
Udo Schuklenk

time to decriminalise assisted dying in canada

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

This last week doctors organized under the Canadian Medical Association met for their policy convention in Calgary. A whole bunch of sensible policy recommendations came out of this meeting, including the suggestion that our kids should no longer be able to purchase energy drinks.

But commentators writing for national news organizations concluded, in typical handwringing style, that the CMA failed us terribly by not issuing a recommendation on the issue of the decriminalization of assisted dying.

I don’t think that was much of a failing. In fact, I don’t quite understand why it should matter more what doctors think than what you or I think about our own death. Why should they have a bigger say or stake in the manner of our own dying? I guess it could matter if they were to be forced to participate in assisted dying if it were to be decriminalized. The thing is, that would not be the case, anyway, so why get overly excited about our doctors’ views on the matter?

Where are we in the assisted dying stakes, anyway? Quebec has decided that assisted dying is no more than part of continuing medical care, and so, by its lights, it is its decision alone how it regulates this matter since health care is one of those powers entrusted to the provinces through the Constitution. The provincial government is intent on making assisted dying a possibility.

Quebecers overwhelmingly support this. There is even cross-party support in the province for the proposed legislation. The National Assembly is currently debating it. You can be sure that the federal government – currently controlled by conservative Christians – will try to have this provincial law set aside by the courts, and to be fair, there is a serious constitutional issue at stake here! The constitutional issue isn’t – as you might expect – about assisted dying, but about the question of whether our provinces should be able to set aside the parts of the federal Criminal Code that prohibit assisted dying by redefining it as a provincial health matter. If they were able to do so, what parts of the Criminal Code might be next?

Independent of the goings-on in Quebec, the Supreme Court of British Columbia declared in a 2012 ruling those parts of the Criminal Code that criminalize assisted dying unconstitutional. The federal government has appealed this decision and we should hear within the next few months how that went. However the Court of Appeals decides, the losing party will undoubtedly try to get this matter heard by the Supreme Court of Canada.

It is always tricky to predict how court judgements, especially Supreme Court of Canada judgements, will pan out. The latter, protests from legal eagles notwithstanding, has plenty of leeway to determine the course of assisted dying in this country.

I’m optimistic that decriminalization in some form or shape will eventually occur. The reason for this is essentially that our Charter of Rights and Freedoms places a very high value on respect for the autonomous choices we make for ourselves. That explains why suicide is legal in Canada. That also explains why we have the legal right to stop life-extending medical care at any time. Short of having us declared incompetent, doctors cannot treat us against our wishes.

Given this context, it doesn’t seem to be a great stretch for a court to determine that we also have the right to assistance in dying. Respect for our individual freedom will win out. It has on the abortion fronts, it has on the marriage equality front, and it will win on the assisted dying issue, too. As a species we seem bent on placing individual rights and freedoms, as far as self-regarding actions are concerned, above conservative values that have others determine what’s best for us.

The countervailing arguments against decriminalization are pretty thin - and that is putting it mildly. In the old days the same anti-euthanasia campaigners who busily contribute to public debate today were pretty clear that assisted dying would violate their religious rules, and so none of us should have access to it, regardless of our own worldviews. They have since realized that this kind of arguments doesn’t exactly help their cause among the wider Canadian public. Accordingly, they switched their campaigning to concerns about possible abuses of never-clearly defined “vulnerable” people.

Given that pro-choice campaigners are concerned about individual free choice and also our quality of life, the strategic shift in the anti-choice rhetoric to testable claims about worrying slippery slopes is actually to be welcomed. It is a fair enough question to ask whether disabled people, the poor and others you could reasonably describe as more vulnerable than some other classes of patients would be put at risk if we decriminalized assisted dying. No doubt the courts will look at this issue in great depth and detail.

The reason for my optimism on this front is that we know from jurisdictions that have decriminalized that there is no evidence that vulnerable people are disproportionately represented among those who receive assistance in dying. From some jurisdictions we even have firm data demonstrating that abuse has actually decreased since decriminalization. Even if there were a limited number of clear, uncontroversial cases of abuse in societies that have decriminalized, we would still need to establish that that abuse was a result of decriminalization.

The anti-choice campaigners have a habit of carefully fudging the issues here. Their claim that decriminalization has led to reductions in the quality and availability of palliative care also turns out to be without any basis in fact. None of the actual evidence we have fits the anti-choice campaigners’ scaremongering tactics, hence their ever-more-hysterical-sounding claims on that front.

With the exception of Quebec, I think it is fair to say that this country has been let down disgracefully by its elected representatives. Opinion poll after opinion poll - and this includes polling undertaken by anti-choice campaigners, too - concludes that an overwhelming majority of Canadians support the decriminalization of assisted dying. That, combined with the lack of evidence of a slippery slope to unwanted killings as a result of decriminalization in societies that have legalized assisted dying in some form or shape, makes a pretty powerful case for the decriminalization agenda.

Not so in the eyes of our elected representatives. They have caved in to the religious right’s lobbying and scaremongering on this issue, instead of showing the leadership we can rightfully expect of them. For what it’s worth, this failing cuts across party lines. Even the so-called Liberal Party of Canada, whose very name suggests that it should proudly support decriminalization, is to be found on the wrong side of history on this issue. The good news for us is that the courts will not be susceptible to pressure from religious and other campaigners.

Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen's University. He has chaired a panel of international experts drafting a landmark report on end-of-life issues on behalf of the Royal Society of Canada. He tweets @schuklenk

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

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

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

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

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

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

Research ethics scandal in Canada

So there we have our own research ethics scandal, and as is the habit with scandals, they tend to widen. Initially we learned that aboriginal children in the residential school system were subjected to research with nutritional supplements. Now we learn about even more exploitative clinical research. And the Truth and Reconciliation Commission is still digging.

Quite possibly this research was undertaken with the best of intentions, namely to improve the lot of malnourished aboriginal people. To some extent there seem to be parallels to research that is undertaken even today in some developing countries, where cheaper medicines are tested on impoverished trial populations because they are unable to afford the patented mainstream medicines that we take for granted.

There is an argument to be had that such research could be ethically acceptable if reasonable measures are taken to ensure that the trial populations will ultimately benefit from the research findings. After all, it is not the researchers’ fault that pharmaceutical companies price many life-preserving medicines out of the reach of the world’s poor. To blame them for trying to develop cheaper drugs to address genuine health issues seems unfair.

The intellectual property rights system leads to this unfortunate situation, and it should probably change, but it’s not something individual clinical researchers have any chance to influence one way or another.

Quite possibly similar motivations drove the researchers at the time in Canada. There they had a population that was severely malnourished. It was beyond their means to implement policies that would have ensured a supply of foods capable of ensuring a balanced diet for aboriginal Canadians living in remote areas of the country.

That the situation aboriginal people found themselves in was unacceptable is obvious, and the government of the day should be condemned for failing Canada’s aboriginal peoples. Where it gets trickier is to understand what exactly it was that made this research unethical. After all, quite possibly the motives were actually noble.

If it had turned out to be the case that nutritional supplements could have been a substitute for more expensive-to-provide regular food products, it might have been possible to improve the well-being of aboriginal Canadians. In all fairness, I am guessing here. I don’t know whether this is what motivated the researchers of the day. Even if it didn’t, this could have been a possible outcome. Unfortunately, the research (remember, it occurred during the 1940s and 1950s) wasn’t terribly methodologically sound, so it turned out to be time well wasted, even on that front.

A crucial issue in any kind of clinical research is the need for first-person informed consent, or consent given by a properly authorized legal guardian acting in the best interest of the potential trial participant who is unable to consent on her or his own behalf. A good example of the latter are underage people.

So, with regard to the research involving nutritional supplements, what exactly went wrong? For starters, consent was not sought and was not given. A clear no-go, certainly not only today, but also at the time. International standards at the time rightly declared clinical research with human participants in the absence of voluntary first-person informed consent unethical.

What else was unethical, even at the time? Withholding food (e.g. milk) from the involuntary trial participants to establish a particular clinical baseline for comparison was unethical. Not providing dental care to the involuntary participants in order to see clearer what impact the nutritional supplements or their absence would have was unethical.

Why was it unethical? It was unethical because the involuntary trial participants did not agree to the risk to their health. In addition to that: one principle of research ethics has always been that any worsening of a trial participant’s baseline needs to be well justified and is usually subject to some kind of compensation. For instance, today trial participants in sub-Saharan Africa who become HIV-infected in HIV vaccine trials typically receive a life-time supply of AIDS medication to compensate them for the harm they incurred as a trial participant.

The aboriginal Canadians received nothing to make up for the harm they incurred while they were reduced to the status of involuntary lab rats by government researchers.

Since the nutritional research was unearthed it has been reported that other research was also undertaken. This time it’s not just about nutritional supplements. It turns out clinical research was undertaken in aboriginal communities and residential schools. Again, informed consent was neither sought nor given. Incredibly, the drugs that were investigated were – insofar as they were successful – provided to the general population but not to the aboriginal communities without whose involuntary sacrifices they were made possible in the first place.

This kind of exploitation increases the ethics failures of those involved at the time quite significantly. Whereas in the initially reported nutritional supplement research we could have given the investigators the benefit of the doubt at least as far as their motives were concerned, we cannot reasonably do the same with regard to the now-reported clinical research.

What I find most disturbing about this widening scandal is that these events occurred right during the Nuremberg trials. Admittedly, there was no Internet at the time, but still, the crimes of the Nazi doctors in the German concentration camps were front-page news the world over. And yet, in Canada, at about the same time, a vulnerable, arguably captive population of aboriginal Canadians was essentially coerced into clinical research as if the reports about what happened during Nazi researcher Josef Mengele’s reign didn’t happen.

The 1947 Nuremberg Code established that first-person informed consent is essential for any clinical research involving human participants to be ethical. It is clear now that Canadian clinicians continued their research as if the worldwide outcry about the Nazi research never occurred. Nazi research happened in Nazi Germany; clearly that had nothing to do with their activities here in Canada, or so they must have thought.

There is a court order in place asking our government to turn over all related documents to these events to the Truth and Reconciliation Commission. This court order was issued in January. The Commission is still waiting for the relevant documents to be forwarded to its staff. Given that the Commission’s mandate expires in less than a year’s time, time is of the essence.

Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen’s University. Follow him on Twitter @schuklenk

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

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

Let’s face it - most of us spend a lot of time competing against each other. It might not be a terribly nice thing to do, but what choice do we really have in a world that has decided to shoot for progress through competition?

We try to look better, usually not just for ourselves, but also to look better than whomever we have chosen as our favourite competitor. If we have the financial means we send our kids to take extra lessons so they compete more successfully at school. It seems many professional athletes resort to doping in order to compete more successfully.

When I look at the other middle-aged blokes at the gym, it is clear to me that they do it not just to push death away by a year or two, but also to stay fit in the daily competition at their workplace. Anyone who has ever wondered why so many law and medical school students manage to pull 24- to 48-hour stints in the library close to exam time should be disabused of the idea that it was just coffee or the occasional energy drink that kept many of them going.

In the United States, drugs approved to assist children with Attention Deficit Hyperactivity Disorder, or ADHD, are prescribed by doctors to many children, as well as adults, who don’t actually suffer from that condition. Why? Well, despite the absence of conclusive clinical evidence, parents - as well as many students in high-pressure, high-stakes fields of study - have long voted with their feet and decided to move heaven and earth to upgrade their kids, or themselves, respectively, by means accessing these same ADHD drugs.

They believe these drugs increase our attention span as well as our knowledge retention capacity for significant periods of time. Studies suggest that about 5-10% of high school students and up to 35% of college students use these drugs for non-medically approved purposes.

A large number of society’s best-educated take a gamble on such drugs actually working. Clearly, after they try them once, many students continue to use them, because in their best judgment they do the trick.

Many doctors are opposed to the prescription of drugs for what they describe as non-medical purposes. Being able to focus better in college and to retain your knowledge for longer periods of time are such non-medical purposes. But what is a medical and what is a non-medical use of a particular medication?

This, of course, isn’t purely a clinical question. It’s inextricably linked to this question: what should the purpose of medicine be?

In my view, medicine should aim to achieve the twin objectives of keeping us alive as long as possible at as high a quality of life as is feasible. You can, of course, try to achieve that by fending off disease. Disease certainly impacts negatively on our lives, and all too often it cuts them short.

However, if there were drugs out there that could improve how our brains function, we would undoubtedly be able to improve the quality of the lives of many of those who choose to use them. Assuming that such drugs work – and it doesn’t matter whether the current drugs actually work for this purpose, because a future drug, inevitably, eventually will – our enhanced brain capacity would also mean that we would be more productive and more creative.

Yes, we could do more with our lives for a longer period of time. And this is one of the reasons why doctors who limit their professional activities to fighting disease as opposed to working toward the maximization of our biological and psychological well-being have a wrong understanding of what their job should be all about.

Today you can’t blame them, because the regulatory frameworks we have in place limit their professional activities, in quite conservative ways, to disease-fighting. A few attempts are made to prevent the occurrence of disease - for instance, by way of vaccinating us. The idea, though, that our health and well-being could also be improved from a status quo currently considered healthy is not something seriously considered by the medical profession. That is a profound mistake.

Worse, because of this conservative understanding of the nature of what it means to be a health care professional, no serious research is currently under way with a view toward upgrading our minds. Any such knowledge would be an accidental byproduct, likely of ADHD- or Alzheimer’s-related research.

There are obvious problem with the kind of change that I am proposing. For starters, we should be concerned that access to brain-capacity enhancers isn’t limited to those already well-off, because otherwise we would continue to increase the gap between society’s haves and the have-nots, with a nasty and harmful societal fallout eventually coming our way.

We should also be worried about fairness in the societal marketplace with regard to those who choose not to upgrade their mental capacities. They might do so because they could be, in principle, opposed to 21st-century medicine, or they might be worried about the long-term side-effects of the medication, or for any number of other reasons.

Given that we do compete on a global scale, these choices could well have ramifications for our national ability to compete against other nations. It will be a difficult regulatory balancing act, but I suspect that it is one we will eventually have to confront.

There is something of more immediate concern, and that is the current use of such drugs by students for non-medically approved purposes. Arguably, the playing field between students with access to such drugs and those who do not have access is not level any longer. It is a matter of fairness that we ensure that students with access do not gain a competitive advantage over those students who do not have access. I do think administrators of higher-education institutions should look carefully into the question of whether it is possible to test students for the use of such drugs in order to ensure that the playing field is level again.

No doubt privacy advocates will be up in arms against this proposal. I actually sympathize, but we do need to find a way to ensure that no competitive advantage is gained by those who access memory-enhancing drugs for not currently clinically approved purposes.

Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen’s University. Follow him on Twitter @schuklenk

Kingston's weekly mess

Like pretty much everyone else in Kingston I have my weekly garbage collection. I duly separate my stuff into garbage and green and blue or grey bins. I’m actually all in favour of this, even though the stench emanating during summer from the green bins is truly from another world.
These days I plan my way to the office strategically on collection days, aiming to avoid as many residential areas as is feasible, because that stuff just stinks to high heaven. Is there really no way to collect the organic waste without making large parts of town no-go areas during collection time?
I do also wonder about garbage collectors having to pick up the green-bin content during the summer months. It must be absolutely awful to collect the organic waste during this time of the year. Is this really the best system that we can think of at the beginning of the 21st century?
Well, leaving this fault in the existing system aside, there is also a remarkably large number of inconsiderate neighbours to report. And I don’t mean those who send you notes asking you to leave town in the name of their god. That deserves a commentary in its own right, but enough has been said during the last week already.
No, my rant isn’t about the obviously morally challenged neighbourly type. Given where I live, it’s fair to say that those I am concerned about enjoy an above-average education and should know better. So, it’s yet another rant about students in Kingston, you say? Yes and no.
Here is the problem: Kingston city hall confirmed that we currently have no bylaw in place requiring that our garbage be placed in a secure container on the curb for the early morning collection. As a result of that, students, but not just students, dump their rubbish in the evening before the collection in black plastic bags and leave them on the sidewalks.
I don’t know whether you noticed, but that also happens to be when our friendly other neighbours, namely our legions of racoons, start having street parties. They move from plastic bag to plastic bag, carefully untie the knots, check the content, eat what’s eatable and tie the bags back up, lest the rubbish be strewn all over the place.
Ok, fine, that’s not quite what’s happening. What’s happening is that the racoons rip open the bags and rifle through their contents, followed by squirrels, pigeons and any number of other non-human Kingston residents. By the time they’re done, a couple of properly piled-up black garbage bags have been transformed into an area akin to a war zone.
The wind oftentimes sends piles of rubbish straight into the lake, into adjacent properties’ driveways, and the list goes on. It is a complete and utter mess on a good day. The environmental impact of the rubbish being dumped into the lake week after week after week can’t be insignificant. I wouldn’t be too surprised if there were public health implications, too.
You would think that being reasonably well-educated would enable us to learn from such a bad experience, and that we would get ourselves a bin and next time place the plastic bag into the bin to avoid such a mess. You would also think that, once confronted with the mess our ripped-apart garbage bag has caused across our neighbourhood, we would pick up our rubbish and place it into our newly acquired bins.
Well, in my experience, that is not exactly what happens. It happens on some properties, but certainly not across the board. It is not unusual at all that the rubbish literally remains where it is, or where the wind happens to blow it. The idea behind this clearly is that “Our work is done after we place the garbage bag at the curb. Who cares what happens after that?”
In defence of tenants, though, I also wonder what’s wrong with many of the downtown core’s landlords. I do appreciate that ultimately you are in it for the money, but would it be that expensive to place a sufficient number of garbage bins in your properties to avoid this kind of situation? I’m sure that if you lived down here you would not find this weekly mess tolerable. One can’t really blame tenants for not buying these bins, given that their time in Kingston is limited and that they likely would not be able to use these bins wherever they are going next.
I understand that our city councillors have discussed this matter on more than one occasion. The thing is, though, discussions are cheap and they tend not to resolve the problem at hand unless they are followed up by action. What would be wrong with a bylaw requiring us to secure our garbage in containers that prevent our non-human neighbours from going through our rubbish?
It is common sense to do this anyway, but common sense clearly isn’t what propels everyone's actions, so a bit of a regulatory nudge might not be a terribly bad idea. What we currently have is an unacceptable mess by any stretch of the imagination! Surely it is not beyond city council’s capacity to address this issue once and for all. As an aside, given that the local tourist bus tends to drive tourists through our beautiful historic downtown, the picture that tourists will get of our town on garbage collection days isn’t one to celebrate either, I’m afraid.
Udo Schuklenk teaches bioethics at Queen’s University and made downtown Kingston his home some seven years ago. He’s on Twitter @schuklenk

Developing World Bioethics Special Issues on ARVs

Developing World Bioethics Volume 13, Issue 2 Pages ii - iii, 57 - 104, August 2013 Special Issue: Anti-retrovirals for treatment and prevention – new ethical challenges EDITORIAL Anti-retrovirals for treatment and prevention – time for new paradigms in our response to the HIV/AIDS epidemic? (pages ii–iii) Quarraisha Abdool Karim and Ronald Bayer Article first published online: 18 JUL 2013 | DOI: 10.1111/dewb.12033 ARTICLES Separate Goals, Converging Priorities: On the Ethics of Treatment as Prevention (pages 57–62) Florian Ostmann and Carla Saenz Article first published online: 25 JUN 2013 | DOI: 10.1111/dewb.12021 Ethics of ARV Based Prevention: Treatment-as-Prevention and PrEP (pages 63–69) Bridget Haire and John M. Kaldor Article first published online: 17 APR 2013 | DOI: 10.1111/dewb.12026 From modeling to morals: Imagining the future of HIV PREP in Lesotho (pages 70–78) Nora J. Kenworthy and Nicola Bulled Article first published online: 25 JUN 2013 | DOI: 10.1111/dewb.12029 Ethical Use of Antiretroviral Resources for HIV Prevention in Resource Poor Settings (pages 79–86) Stuart Rennie Article first published online: 31 MAY 2013 | DOI: 10.1111/dewb.12022 Ethical Considerations in Determining Standard of Prevention Packages for HIV Prevention Trials: Examining PrEP (pages 87–94) Bridget Haire, Morenike Oluwatoyin Folayan, Catherine Hankins, Jeremy Sugarman, Sheena McCormack, Gita Ramjee and Mitchell Warren Article first published online: 31 MAY 2013 | DOI: 10.1111/dewb.12032 Ethical Tradeoffs in Trial Design: Case Study of an HPV Vaccine Trial in HIV-Infected Adolescent Girls in Lower Income Settings (pages 95–104) J.C. Lindsey, S.K. Shah, G.K. Siberry, P. Jean-Philippe and M.J. Levin Article first published online: 31 MAY 2013 | DOI: 10.1111/dewb.12028