Posts tagged health

Study finds no correlation between legalized assisted suicide and patients’ desire to die

One of the arguments used by those who oppose physician-assisted suicide is that legalizing the procedure would result in terminally ill patients rushing to end their lives. Common sense tells us this isn’t likely: very few people willingly run to their deathbeds. Of course, common sense isn’t always correct or reliable. That’s why we have science.

Yet, in this case, it appears science has confirmed what many people already think is true: a new study published in Frontiers in Psychology for Clinical Settings, found that “a liberal legal setting does not necessarily promote the wish for assisted suicide.”

The results of a series of interviews with the 33 patients … suffering from the motor neurone disease amyotrophic lateral sclerosis (ALS) … revealed that 94 percent did not have any desire for assisted suicide, but 57 percent could imagine a time when doctors administer the drug (currently, Swiss law insists that the lethal dose be self-administered). In addition, 54 percent said they could imagine a time when they would ask their doctor for a lethal drug prescription, to be taken at a later date of their choosing. The findings reveal that patients have a strong desire to take their own healthcare, treatment and fate in their own hands — which is essentially why assisted suicide exists in the first place, to allow those who feel they are losing control of their minds or bodies to regain power and see their own will take shape again.

In fact, according to the president of an assisted suicide center in Switzerland (who is quoted in the article), most terminally ill people do not actually go through with it, but still receive comfort from knowing that they could legally discuss assisted suicide with their doctor — just another benefit of allowing people the legal option to fully control their health care decisions, you might say.

"A good death"

That’s all some people are asking for:

Dr. Richard Wesley has amyotrophic lateral sclerosis, the incurable disease that lays waste to muscles while leaving the mind intact. He lives with the knowledge that an untimely death is chasing him down, but takes solace in knowing that he can decide exactly when, where and how he will die.

Under Washington State’s Death With Dignity Act, his physician has given him a prescription for a lethal dose of barbiturates. He would prefer to die naturally, but if dying becomes protracted and difficult, he plans to take the drugs and die peacefully within minutes.

“It’s like the definition of pornography,” Dr. Wesley, 67, said at his home here in Seattle, with Mount Rainier in the distance. “I’ll know it’s time to go when I see it.”

Dr. Steven Kirtland, who has been Dr. Wesley’s pulmonologist for three years, said he had little hesitation about agreeing to Dr. Wesley’s request, the only prescription for the drugs that Dr. Kirtland has written.

“I’ve seen a lot of bad deaths,” Dr. Kirtland said. “Part of our job as physicians is to help people have a good death, and, frankly, we need to do more of that.”

Why is this so difficult for many Americans to understand?

How should we break society’s bad habits?

You might have heard last week that New York City Mayor Michael Bloomberg announced a plan to ban the sale of large sodas and other sugary drinks at restaurants, movie theaters and street carts throughout the city.

Bloomberg’s proposal raises a number of questions, including one posed in the New York Times' latest edition of Room for Debate: should the government work to change people's behavior for the better, or is that job best left to society?

You can read the six entries here.

Also, you can read some of my thoughts on these sorts of laws here.

The ethics of having children

Are there circumstances under which it is immoral to have children? If so, why? Those are the questions Elizabeth Kolbert takes up in a wonderful new essay in the New Yorker called “The Case Against Kids”:

Barring infertility or other complications—and despite the best efforts of Rush Limbaugh and Senate Republicans—couples today, at least in the U.S. and the rest of the developed world, can determine how many children they will have—five, four, three, two, one, or zero. Several recent books look at this decision from different vantage points, and come to surprising—some might say even alarming—conclusions.

In “Why Have Children?: The Ethical Debate” (M.I.T. Press), Christine Overall tries to subject that decision to morally rigorous analysis. Overall, who teaches philosophy at Queen’s University, in Ontario, dismisses the notion that childbearing is “natural” and therefore needs no justification. “There are many urges apparently arising from our biological nature that we nonetheless should choose not to act upon,” she observes. If we’re going to keep having kids, we ought to be able to come up with a reason.

Keep reading here.

Cost, not sloth, causes obesity

Many people believe that obesity is caused by a lack of moral fiber. That is, those who are overweight are in their situation because they lack the willpower necessary to keep in shape. If only they had a stronger backbone, they’d be fit.

But this is simply not the case, says Zoe Williams in the Guardian.

There is a widespread underestimation, or blank refusal to admit, how much cheaper cheap food really is. It became a mantra of the mainstream, as obesity started to define the pathology of this century, that the problem was not poverty, it was education. This was based on two facts. The first was that everybody, except affluent women, was getting fatter. So it couldn’t be related to poverty, since it was hitting upper-middle class men.

The second was that an organic vegetable box would always be cheaper than a pack of Findus Crispy pancakes; therefore the more healthily you ate, the less you would spend. And I saw plenty of counter-arguments to that, identifying poor eating habits as a result of deprivation. One was that people with kids and very little money can’t afford to waste food, so have to buy things that children are likely to eat, which more or less means food with too much salt and not enough fresh vegetation. Another was that people battling food scarcity tend to overeat when food is available, and depending on what they’re overeating, a missed meal the next day won’t compensate for that.

Both of those propositions make sense, but I rarely heard people say, just look at the phenomenal value for money, calories-per-penny in a McDonald’s. It blows your mind how cheap a £1 cheeseburger is; crisps are even cheaper. Cheap foods are fatty, and the whole point of fat is satiety. If you look at fresh vegetables in the old-fashioned way, as fuel, rather than the modern way, as an embodiment of morality and self-governance, they are terrible value, especially the organic ones.

So, why do people make sloth argument? And what are the implications of thinking about obesity differently?

I think there’s an element of projection here, where people who can afford to eat well – and do – still secretly yearn for a Big Mac, and it’s their own yearning rather than political deliberation that makes them think they’re looking at a lack of willpower from the McDonald’s classes. But this has nothing to do with willpower.

I understand this strenuous avoidance of reality. Once you accept that crap food is an economic, not a moral choice, you have to accept a whole raft of unpleasant outcomes as a function of deprivation, not an illustration of a lack of backbone. You have to accept that 24,000 “lifestyle-related” yearly deaths from diabetes are related not to sloth but to poverty. Sure, it’s still a lifestyle, but it’s not a choice. You have to accept that the education agenda against obesity – vegetables and regular exercise – will never work (that should be obvious, just by looking at the data or, failing that, just by looking around).

Why skeptics should embrace political advocacy — and how they can do it

By Michael De Dora

In my nearly three years working in the skeptic community, I have learned many important things. I’ve been taught how science works, and how to spot pseudoscience. I’ve discovered how we fool ourselves into believing we’ve seen ghosts, aliens, and other scary monsters that likely don’t exist. And I’ve found out how psychics, mediums and others prey upon other humans for monetary gain. I’ve also realized that skeptics, like most human beings, love their community. Conferences, pub meetings, blogs, and podcasts: these represent comfortable places where most members are relatively sane and rational, and inquiry into almost any subject is welcomed.

Yet, often ignored or forgotten in the fray of social discussion on science denialism and hucksterism, and community building, is that skepticism also deserves a voice in public policy debates. Secularists have recognized this, and founded organizations like Americans United for Separation of Church and State, the Freedom from Religion Foundation, and the Secular Coalition in order to pair with more socially focused groups. So far, skeptics have not.

In my view, skepticism, like secular thinking, should not be limited to the social. It should also be engaged in the political. This essay will attempt to outline why I believe this, and propose both issues and methods that would help skeptics get more involved in the political process.

There are several reasons why many skeptics are not as engaged in political advocacy as much as I think they ought to be. Here are three of the most common:

1. Politics concerns values, which are not amenable to empirical inquiry or rational discussion.

2. Politics demands political party affiliation.

3. Politics is irrational and messy. The system is broken.

As a result of these objections — and, to be sure, skimpy funding — there are few dedicated skeptical lobby groups, or skeptic organizations that lobby on traditionally skeptic issues.
And, without an organized skeptical-political movement, there are few skeptics who get involved in the political process.

I think the three objections above are mistaken, and that they have negative consequences. Here are my brief rebuttals:

1. Skepticism might mostly be about applying science to problems concerning, say, pseudoscience and health, but science itself does rely upon values. These values include, at the least: methodological naturalism, evidence and testability, and logical coherence.

Furthermore, while values might not be amenable to empirical study, they are and should be subject to another thing skeptics value: rational examination. This is not to say reason is all-powerful. But reason can help us evaluate our values and help us assess whether we have properly thought them out. It is also not to say that skepticism should critically examine all values. Rather, my point is that skeptics should not avoid debates just because in some way they include talk of values.

2. Admittedly, much of politics is battles between political parties and factions, such as Republicans, Democrats, Greens, and independents. Yet one need not fit into, or adopt, any of the aforementioned parties to be engaged in the political process.

Indeed, I believe skepticism is by definition non-partisan, and therefore it is unnecessary to consider which political party to lean toward. This is because skepticism is a method, not a position. As such, I think skeptics will be most successful politically if they can manage to focus on applying the method to specific political problems within the domain of skepticism, several of which I will propose below.

3. Politics is certainly often irrational and messy, but it is not necessarily irrational and messy. There are always chances to inject a sliver of rationality into an irrational system. The question is whether you think this is worthwhile.

Moreover, while our political system might appear to be broken, one of the few ways to actually effect change — and perhaps even fix the system — is to work within it. I value conversations on how to make change outside of the current system, or to create a better one. But while having that conversation, we should realize change is being made within the current system. We can either let it happen without resistance, or we can put our chips on the table and work to defend our worldview.

Two questions now remain: which political issues should skeptics concern themselves with? And how should they get involved?

A couple of issues immediately come to mind: evolution in public schools and climate change. Leaving these important but well-worn issues aside for a moment, I propose there are at least three other topics that skeptics could readily concern themselves with:

— Defunding and/or dismantling the National Center for Complementary and Alternative Medicine (NCCAM). Since 1992, NCCAM (previously the Office of Alternative Medicine) has been awarded $2 billion for research, and currently has an annual budget of $134 million. Yet nearly twenty years of study have shown that most alternative medicine “cures” work no better than placebos. As David Gorski writes on Science-Based Medicine, NCCAM should be defunded or abolished, and any valuable parts should be folded into the National Institutes for Health (NIH).

— Health coverage for alternative medicine practices that have been proven ineffective. Again, most well-known alternative medicine practices have been shown to be unsuccessful as medical cures. Yet lawmakers continue to push for their coverage under health care plans. From Derek Araujo last year:

“Congressional allies of the so-called ‘complementary and alternative medicine’ industry successfully introduced language in health care reform legislation requiring insurers to cover any state-licensed health care providers — including, of course, complementary and alternative medicine practitioners. Language prohibiting ‘discrimination’ against any state-licensed practitioners survived in the Affordable Care Act President Obama signed into law on March 23, 2010.”

— Government-mandated vaccines and religious exemptions.
In all 50 U.S. states, children are required to be properly immunized before attending school. However, in addition to medical exemptions offered in each state, 48 states allow for religious exemptions, while 20 states allow for personal belief exemptions for daycare and school (source). Unfortunately, this has recently become a more popular trend, leading to greater danger of a serious outbreaks.

These three issues all: stem from historically skeptical subjects; concern some talk of values, but mostly are about science; do not demand party affiliation; and might actually be winnable.

How can skeptics go about getting involved in these issues?

The first step is to merely pay attention and get informed. Take a second and click over to any number of web sites and blogs that carry position papers, reports, and news analysis. Some suggestions: the Center for Inquiry’s (CFI) Office of Public Policy, National Center for Science Education (NCSE), the Union of Concerned Scientists (UCS), the National Council Against Health Fraud, Science-Based Medicine, QuackWatch, and even SkepChick.

The second, and perhaps more important step, is to actually make your voice heard. Even without dedicated skeptic lobby organizations, armed with information, you can and should write and call your lawmakers. Sign up to receive action alerts from organizations such as CFI-OPP, NCSE, and USC, and you’ll soon start receiving emails that will allow you to easily message your representatives on issues relating to science and skepticism. It takes only a couple of minutes for you to fill out an action alert and send it along to a lawmaker, who is — contra to what many think — almost certainly paying attention (perhaps not to the unique content in each message, but certainly to the number of messages they receive). Or, if you feel so compelled, write a letter to your representative (though be aware that due to restrictive security measures, there’s a good chance your letter will be delayed several months, or might never even reach its intended audience). Or pick up a phone and let your representative know you care about a certain issue and are paying attention to his or her actions.

More broadly, attend local hearings and public forums and voice your opinion. Share action alerts and other links to Facebook, Twitter, Google Plus, and whatever other social networks you use. Write letters to the editor. Comment on blog posts and online news articles. Do whatever you can to spread the message.

You might think that all of this is relatively inconsequential, but that is not true. Politicians essentially care about two things: money and votes. We might not have the money, but we do represent votes. The more that elected officials hear from us — whether by action alert, letter, phone call, or other means — the more they will have to consider our points of view. And the more that others see that you are engaged, the more likely they will be to get involved and engaged as well. Which means that politicians might have to consider our viewpoints sooner than they thought.

Perhaps more importantly, writing a letter, placing a phone call, sharing a link, or penning a letter to the editor takes very little of your time, and there is no guarantee your fellow skeptics will take up the cause. If you don’t do it, no one else might do it either. And that would be a shame, because a moment of your time could make a difference.

——

Note: this essay is adapted from a talk I gave at SkeptiCamp NYC on Saturday, Dec. 3. I will let you know if video surfaces.

Further note: I think the word “skeptic” could be replaced with many other labels. We could all probably be more engaged in the political process anyway. But this talk was tailored specifically for SkeptiCamp, so there you have it.

Birth control should be free

Last week I linked to an article in The Economist that rejected religious objections to the Institute of Medicine’s recent recommendation that health insurance plans provide free coverage for birth control, breast-pump rentals, counseling for domestic violence, and annual wellness exams and HIV tests.

Writing on the blog Talking Philosophy, Mike Labossiere has expanded on The Economist's discussion, focusing specifically on several objections to covering birth control. Here's his conclusion, though the entire post is worth reading:

As a final point, it seems sensible and morally correct to have birth control covered. This coverage might help reduce the number of unwanted pregnancies and thus result in less costs (monetary and social). If so, covering birth control could turn out to be financially a good idea-even if premiums are increased, the overall costs might be lower. There is also the moral argument that reducing the number of unwanted pregnancies would create more happiness than unhappiness-and also perhaps reduce the number of abortions. Then again, maybe the coverage will have no impact-it all depends on how many women forgo birth control on the basis of cost.

Secular liberalism with a conscience

Susan Jacoby is thinking what I’m thinking (or am I thinking what she’s thinking?). Last week I wrote an essay in which I argued that moral considerations should play a larger role in economic policy debates. On the same day, Susan wrote an essay arguing for something very similar. Take a look:

Secular liberals, however, have had very little to say about the moral aspects of economic issues-and that is a great weakness of the secular movement. Where are the forthright, persistent secular voices of those who ought to be making a case, based on reason, that it is not only immoral but economically foolish to balance the budget on the backs of those least able to fend for themselves? If one’s heart does not bleed for a young man with no hands, then let the brain consider what that man will cost taxpayers if he remains a beggar for years-even the rest of his life.

For secular Americans, this is a time to decide whether we will turn back toward the dreary 19th-century secular conservative philosopher Herbert Spencer, who perverted Darwin’s theory of evolution by means of natural selection in a state of nature into what he called “social selection” and opposition to all state aid to the poor, public education, and health laws. Of the poor, he declared, “If they are sufficiently complete to live, they do live, and it is well that they should live. If they are not sufficiently complete to live, they die, and it is best that they should die.” Best for whom?

Or will we heed the voice of Darwin himself, who stated clearly in The Descent of Man that the tooth-and-claw laws of nature become subordinate to environmental factors-and man’s own moral evolution-in a state of civilization. “If we were intentionally to neglect the weak and helpless,” he wrote, “it could only be for a contingent benefit, with an overwhelming present evil.”

Two views on San Fransico’s proposed ban on circumcisions

As you might have already heard, San Francisco residents will vote on a proposal this November to make it a criminal offense to perform a circumcision on a male under the age of 18. This has sparked debate between secularists over whether they should support or reject the measure. Here are two views on the issue:

- Ron Lindsay, CEO and president of the Center for Inquiry, says secularists should not support the ban.

- Tom Flynn, executive director of the Council for Secular Humanism, says secularists should support the ban.