Posts tagged medicine

The flip side of conscientious objection

Lisa Harris, M.D., wrote an interesting article for the September issue of the New England Journal of Medicine in which she flips the usual discusssion on conscientious objection and abortion. Harris argues that focusing on conscientious objections to performing abortions ignores the fact that many medical providers perform abortion services precisely because they feel compelled by their conscience:

Whether or not abortion provision is “conscientious” depends on what conscience is. Most ideas of conscience involve a special subset of an agent’s ethical or religious beliefs — one’s “core” moral beliefs. The conclusion that abortion provision is indeed “conscientious” by this standard is best supported by sociologist Carole Joffe, who showed in Doctors of Conscience that skilled “mainstream” doctors offered safe, compassionate abortion care before Roe. They did so with little to gain and much to lose, facing fines, imprisonment, and loss of medical license. They did so because the beliefs that mattered most to them compelled them to. They saw women die from self-induced abortions and abortions performed by unskilled providers. They understood safe abortion to be lifesaving. They believed their abortion provision honored “the dignity of humanity” and was the right — even righteous — thing to do. They performed abortions “for reasons of conscience.”

Though abortion providers now work within the law, they still have much to lose, facing stigma, marginalization within medicine, harassment, and threat of physical harm. However, doctors (and, in some states, advanced practice clinicians) continue to offer abortion care because deeply held, core ethical beliefs compel them to do so. They see women’s reproductive autonomy as the linchpin of full personhood and self-determination, or they believe that women themselves best understand the life contexts in which childbearing decisions are made, or they value the health of a woman more than the potential life of a fetus, among other reasons. Abortion providers continue to describe their work in moral terms, as “right and good and important,” and articulate their sense that the failure to offer abortion care generates a crisis of conscience.

Yet we continue to hear only of medical providers who conscientiously object to performing certain services —  which, as Harris points out, has negative consequences:

First, U.S. federal and state laws continue to protect only conscience-based refusals to perform or refer for abortion, offering minimal legal protection for conscience-based abortion provision. Second, the equation of conscience with nonprovision of abortion contributes to the stigmatization of abortion providers. Finally, bioethicists have focused on defining conditions under which conscientious refusals are acceptable but, with rare exceptions, have neglected to make the moral case for protecting the conscientious provision of care.

This is more than just an interesting philosophical argument. It is also tool that should be used by reproductive rights activists in debates over conscientious objection to providing health care. The next time you hear a person argue for the right to not perform certain services, ask them whether they would also argue for the right to perform certain services. The answer will likely indicate whether the person simply opposes whatever service is being discussed (i.e., abortion), or whether the person actually has a logically consistent argument concerning conscience rights.

What makes killing wrong?

That’s the subject of a controversial new paper in the Journal of Medical Ethics by Walter Sinnott-Armstrong, a philosopher at Duke University, and Franklin Miller, a bioethicist at the National Institutes of Health. Here is the abstract:

What makes an act of killing morally wrong is not that the act causes loss of life or consciousness but rather that the act causes loss of all remaining abilities. This account implies that it is not even … morally wrong to kill patients who are universally and irreversibly disabled, because they have no abilities to lose. Applied to vital organ transplantation, this account undermines the dead donor rule and shows how current practices are compatible with morality.

The Boston Globe has some analysis of the paper here.

EU targets immoral bank bonuses

The European Union (EU) might soon consider tougher measures on banker bonuses that go against “all reason, common sense and morality,” according to EU financial services commissioner Michel Barnier. From Bloomberg:

Barnier, who’s responsible for proposing laws that govern banks across the 27-nation EU, warned that he’ll seek extra legislation by the end of this year if lenders “carry on paying excessive bonuses.” Ideas being “worked on” include limiting the gap between minimum and maximum pay in a bank and also setting a ratio between fixed and variable pay, he said at a European Parliament hearing in Brussels today.

Most people on the right side of the political spectrum would call this socialism, but it’s interesting to see Barnier frame the issue not as one of political persuasion, but of decency. You can find previous postings on this subject here, here, and 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.

Would you swallow a morality pill?

Recent advances in cognitive science have allowed scientists to identify many of the brain structures and chemical substances that regulate our moral beliefs and behaviors — which has some scientists thinking we’re close to developing drugs that can control our morality.

Whether or not this is close to happening, Guy Kahane at the University of Oxford thinks the mere possibility raises a couple interesting questions:

We don’t yet know, of course, what’s possible. But it’s better to begin the ethical discussion too early than too late. And even if “moral” pills are just science fiction, they raise deep questions. Will we want to take them if they ever become available? And what does it say about us if we won’t?

Jack Kevorkian is dead

Jack Kevorkian, who helped more than 100 terminally people kill themselves and fought for the legal right to assisted suicide, has died at 83. Keith Schneider of the New York Times has penned an obituary worthy of the controversial figure that deserves your attention no matter your position on the issue.

From June 1990, when he assisted in the first suicide, until March 1999, when he was sentenced to serve 10 to 25 years in a maximum security prison, Dr. Kevorkian was a controversial figure. But his critics and supporters generally agree on this: As a result of his stubborn and often intemperate advocacy for the right of the terminally ill to choose how they die, hospice care has boomed in the United States, and physicians have become more sympathetic to their pain and more willing to prescribe medication to relieve it.

I think this quote, from journalist Jack Lessenberry, nicely sums up Kevorkian:

“Jack Kevorkian, faults and all, was a major force for good in this society. He forced us to pay attention to one of the biggest elephants in society’s living room: the fact that today vast numbers of people are alive who would rather be dead, who have lives not worth living.”