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“There are good reasons to think that some AIs today have wellbeing.”
In this guest post, Simon Goldstein (Dianoia Institute, Australian Catholic University) and Cameron Domenico Kirk-Giannini (Rutgers University – Newark, Center for AI Safety) argue that some existing artificial intelligences have a kind of moral significance because they’re beings for whom things can go well or badly.
This is the sixth in a series of weekly guest posts by different authors at Daily Nous this summer.
[Posts in the summer guest series will remain pinned to the top of the page for the week in which they’re published.]
We recognize one another as beings for whom things can go well or badly, beings whose lives may be better or worse according to the balance they strike between goods and ills, pleasures and pains, desires satisfied and frustrated. In our more broad-minded moments, we are willing to extend the concept of wellbeing also to nonhuman animals, treating them as independent bearers of value whose interests we must consider in moral deliberation. But most people, and perhaps even most philosophers, would reject the idea that fully artificial systems, designed by human engineers and realized on computer hardware, may similarly demand our moral consideration. Even many who accept the possibility that humanoid androids in the distant future will have wellbeing would resist the idea that the same could be true of today’s AI.
Perhaps because the creation of artificial systems with wellbeing is assumed to be so far off, little philosophical attention has been devoted to the question of what such systems would have to be like. In this post, we suggest a surprising answer to this question: when one integrates leading theories of mental states like belief, desire, and pleasure with leading theories of wellbeing, one is confronted with the possibility that the technology already exists to create AI systems with wellbeing. We argue that a new type of AI—the artificial language agent—has wellbeing. Artificial language agents augment large language models with the capacity to observe, remember, and form plans. We also argue that the possession of wellbeing by language agents does not depend on them being phenomenally conscious. Far from a topic for speculative fiction or future generations of philosophers, then, AI wellbeing is a pressing issue. This post is a condensed version of our argument. To read the full version, click here.
Artificial language agents (or simply language agents) are our focus because they support the strongest case for wellbeing among existing AIs. Language agents are built by wrapping a large language model (LLM) in an architecture that supports long-term planning. An LLM is an artificial neural network designed to generate coherent text responses to text inputs (ChatGPT is the most famous example). The LLM at the center of a language agent is its cerebral cortex: it performs most of the agent’s cognitive processing tasks. In addition to the LLM, however, a language agent has files that record its beliefs, desires, plans, and observations as sentences of natural language. The language agent uses the LLM to form a plan of action based on its beliefs and desires. In this way, the cognitive architecture of language agents is familiar from folk psychology.
For concreteness, consider the language agents built this year by a team of researchers at Stanford and Google. Like video game characters, these agents live in a simulated world called ‘Smallville’, which they can observe and interact with via natural-language descriptions of what they see and how they act. Each agent is given a text backstory that defines their occupation, relationships, and goals. As they navigate the world of Smallville, their experiences are added to a “memory stream” in the form of natural language statements. Because each agent’s memory stream is long, agents use their LLM to assign importance scores to their memories and to determine which memories are relevant to their situation. Then the agents reflect: they query the LLM to make important generalizations about their values, relationships, and other higher-level representations. Finally, they plan: They feed important memories from each day into the LLM, which generates a plan for the next day. Plans determine how an agent acts, but can be revised on the fly on the basis of events that occur during the day. In this way, language agents engage in practical reasoning, deciding how to promote their goals given their beliefs.
The conclusion that language agents have beliefs and desires follows from many of the most popular theories of belief and desire, including versions of dispositionalism, interpretationism, and representationalism.
According to the dispositionalist, to believe or desire that something is the case is to possess a suitable suite of dispositions. According to ‘narrow’ dispositionalism, the relevant dispositions are behavioral and cognitive; ‘wide’ dispositionalism also includes dispositions to have phenomenal experiences. While wide dispositionalism is coherent, we set it aside here because it has been defended less frequently than narrow dispositionalism.
Consider belief. In the case of language agents, the best candidate for the state of believing a proposition is the state of having a sentence expressing that proposition written in the memory stream. This state is accompanied by the right kinds of verbal and nonverbal behavioral dispositions to count as a belief, and, given the functional architecture of the system, also the right kinds of cognitive dispositions. Similar remarks apply to desire.
According to the interpretationist, what it is to have beliefs and desires is for one’s behavior (verbal and nonverbal) to be interpretable as rational given those beliefs and desires. There is no in-principle problem with applying the methods of radical interpretation to the linguistic and nonlinguistic behavior of a language agent to determine what it believes and desires.
According to the representationalist, to believe or desire something is to have a mental representation with the appropriate causal powers and content. Representationalism deserves special emphasis because “probably the majority of contemporary philosophers of mind adhere to some form of representationalism about belief” (Schwitzgebel).
It is hard to resist the conclusion that language agents have beliefs and desires in the representationalist sense. The Stanford language agents, for example, have memories which consist of text files containing natural language sentences specifying what they have observed and what they want. Natural language sentences clearly have content, and the fact that a given sentence is in a given agent’s memory plays a direct causal role in shaping its behavior.
Many representationalists have argued that human cognition should be explained by positing a “language of thought.” Language agents also have a language of thought: their language of thought is English!
An example may help to show the force of our arguments. One of Stanford’s language agents had an initial description that included the goal of planning a Valentine’s Day party. This goal was entered into the agent’s planning module. The result was a complex pattern of behavior. The agent met with every resident of Smallville, inviting them to the party and asking them what kinds of activities they would like to include. The feedback was incorporated into the party planning.
To us, this kind of complex behavior clearly manifests a disposition to act in ways that would tend to bring about a successful Valentine’s Day party given the agent’s observations about the world around it. Moreover, the agent is ripe for interpretationist analysis. Their behavior would be very difficult to explain without referencing the goal of organizing a Valentine’s Day party. And, of course, the agent’s initial description contained a sentence with the content that its goal was to plan a Valentine’s Day party. So, whether one is attracted to narrow dispositionalism, interpretationism, or representationalism, we believe the kind of complex behavior exhibited by language agents is best explained by crediting them with beliefs and desires.
What makes someone’s life go better or worse for them? There are three main theories of wellbeing: hedonism, desire satisfactionism, and objective list theories. According to hedonism, an individual’s wellbeing is determined by the balance of pleasure and pain in their life. According to desire satisfactionism, an individual’s wellbeing is determined by the extent to which their desires are satisfied. According to objective list theories, an individual’s wellbeing is determined by their possession of objectively valuable things, including knowledge, reasoning, and achievements.
On hedonism, to determine whether language agents have wellbeing, we must determine whether they feel pleasure and pain. This in turn depends on the nature of pleasure and pain.
There are two main theories of pleasure and pain. According to phenomenal theories, pleasures are phenomenal states. For example, one phenomenal theory of pleasure is the distinctive feeling theory. The distinctive feeling theory says that there is a particular phenomenal experience of pleasure that is common to all pleasant activities. We see little reason why language agents would have representations with this kind of structure. So if this theory of pleasure were correct, then hedonism would predict that language agents do not have wellbeing.
The main alternative to phenomenal theories of pleasure is attitudinal theories. In fact, most philosophers of wellbeing favor attitudinal over phenomenal theories of pleasure (Bramble). One attitudinal theory is the desire-based theory: experiences are pleasant when they are desired. This kind of theory is motivated by the heterogeneity of pleasure: a wide range of disparate experiences are pleasant, including the warm relaxation of soaking in a hot tub, the taste of chocolate cake, and the challenge of completing a crossword. While differing in intrinsic character, all of these experiences are pleasant when desired.
If pleasures are desired experiences and AIs can have desires, it follows that AIs can have pleasure if they can have experiences. In this context, we are attracted to a proposal defended by Schroeder: an agent has a pleasurable experience when they perceive the world being a certain way, and they desire the world to be that way. Even if language agents don’t presently have such representations, it would be possible to modify their architecture to incorporate them. So some versions of hedonism are compatible with the idea that language agents could have wellbeing.
We turn now from hedonism to desire satisfaction theories. According to desire satisfaction theories, your life goes well to the extent that your desires are satisfied. We’ve already argued that language agents have desires. If that argument is right, then desire satisfaction theories seem to imply that language agents can have wellbeing.
According to objective list theories of wellbeing, a person’s life is good for them to the extent that it instantiates objective goods. Common components of objective list theories include friendship, art, reasoning, knowledge, and achievements. For reasons of space, we won’t address these theories in detail here. But the general moral is that once you admit that language agents possess beliefs and desires, it is hard not to grant them access to a wide range of activities that make for an objectively good life. Achievements, knowledge, artistic practices, and friendship are all caught up in the process of making plans on the basis of beliefs and desires.
Generalizing, if language agents have beliefs and desires, then most leading theories of wellbeing suggest that their desires matter morally.
We’ve argued that language agents have wellbeing. But there is a simple challenge to this proposal. First, language agents may not be phenomenally conscious — there may be nothing it feels like to be a language agent. Second, some philosophers accept:
The Consciousness Requirement. Phenomenal consciousness is necessary for having wellbeing.
The Consciousness Requirement might be motivated in either of two ways: First, it might be held that every welfare good itself requires phenomenal consciousness (this view is known as experientialism). Second, it might be held that though some welfare goods can be possessed by beings that lack phenomenal consciousness, such beings are nevertheless precluded from having wellbeing because phenomenal consciousness is necessary to have wellbeing.
We are not convinced. First, we consider it a live question whether language agents are or are not phenomenally conscious (see Chalmers for recent discussion). Much depends on what phenomenal consciousness is. Some theories of consciousness appeal to higher-order representations: you are conscious if you have appropriately structured mental states that represent other mental states. Sufficiently sophisticated language agents, and potentially many other artificial systems, will satisfy this condition. Other theories of consciousness appeal to a ‘global workspace’: an agent’s mental state is conscious when it is broadcast to a range of that agent’s cognitive systems. According to this theory, language agents will be conscious once their architecture includes representations that are broadcast widely. The memory stream of Stanford’s language agents may already satisfy this condition. If language agents are conscious, then the Consciousness Requirement does not pose a problem for our claim that they have wellbeing.
Second, we are not convinced of the Consciousness Requirement itself. We deny that consciousness is required for possessing every welfare good, and we deny that consciousness is required in order to have wellbeing.
With respect to the first issue, we build on a recent argument by Bradford, who notes that experientialism about welfare is rejected by the majority of philosophers of welfare. Cases of deception and hallucination suggest that your life can be very bad even when your experiences are very good. This has motivated desire satisfaction and objective list theories of wellbeing, which often allow that some welfare goods can be possessed independently of one’s experience. For example, desires can be satisfied, beliefs can be knowledge, and achievements can be achieved, all independently of experience.
Rejecting experientialism puts pressure on the Consciousness Requirement. If wellbeing can increase or decrease without conscious experience, why would consciousness be required for having wellbeing? After all, it seems natural to hold that the theory of wellbeing and the theory of welfare goods should fit together in a straightforward way:
Simple Connection. An individual can have wellbeing just in case it is capable of possessing one or more welfare goods.
Rejecting experientialism but maintaining Simple Connection yields a view incompatible with the Consciousness Requirement: the falsity of experientialism entails that some welfare goods can be possessed by non-conscious beings, and Simple Connection guarantees that such non-conscious beings will have wellbeing.
Advocates of the Consciousness Requirement who are not experientialists must reject Simple Connection and hold that consciousness is required to have wellbeing even if it is not required to possess particular welfare goods. We offer two arguments against this view.
First, leading theories of the nature of consciousness are implausible candidates for necessary conditions on wellbeing. For example, it is implausible that higher-order representations are required for wellbeing. Imagine an agent who has first order beliefs and desires, but does not have higher order representations. Why should this kind of agent not have wellbeing? Suppose that desire satisfaction contributes to wellbeing. Granted, since they don’t represent their beliefs and desires, they won’t themselves have opinions about whether their desires are satisfied. But the desires still are satisfied. Or consider global workspace theories of consciousness. Why should an agent’s degree of cognitive integration be relevant to whether their life can go better or worse?
Second, we think we can construct chains of cases where adding the relevant bit of consciousness would make no difference to wellbeing. Imagine an agent with the body and dispositional profile of an ordinary human being, but who is a ‘phenomenal zombie’ without any phenomenal experiences. Whether or not its desires are satisfied or its life instantiates various objective goods, defenders of the Consciousness Requirement must deny that this agent has wellbeing. But now imagine that this agent has a single persistent phenomenal experience of a homogenous white visual field. Adding consciousness to the phenomenal zombie has no intuitive effect on wellbeing: if its satisfied desires, achievements, and so forth did not contribute to its wellbeing before, the homogenous white field should make no difference. Nor is it enough for the consciousness to itself be something valuable: imagine that the phenomenal zombie always has a persistent phenomenal experience of mild pleasure. To our judgment, this should equally have no effect on whether the agent’s satisfied desires or possession of objective goods contribute to its wellbeing. Sprinkling pleasure on top of the functional profile of a human does not make the crucial difference. These observations suggest that whatever consciousness adds to wellbeing must be connected to individual welfare goods, rather than some extra condition required for wellbeing: rejecting Simple Connection is not well motivated. Thus the friend of the Consciousness Requirement cannot easily avoid the problems with experientialism by falling back on the idea that consciousness is a necessary condition for having wellbeing.
We’ve argued that there are good reasons to think that some AIs today have wellbeing. But our arguments are not conclusive. Still, we think that in the face of these arguments, it is reasonable to assign significant probability to the thesis that some AIs have wellbeing.
In the face of this moral uncertainty, how should we act? We propose extreme caution. Wellbeing is one of the core concepts of ethical theory. If AIs can have wellbeing, then they can be harmed, and this harm matters morally. Even if the probability that AIs have wellbeing is relatively low, we must think carefully before lowering the wellbeing of an AI without producing an offsetting benefit.
[Image made with DALL-E]
Some related posts:
“Philosophers on GPT-3”
“Philosophers on Next-Generation Large Language Models”
“GPT-4 and the Question of Intelligence”
“We’re Not Ready for the AI on the Horizon, But People Are Trying”
“Researchers Call for More Work on Consciousness”
“Dennett on AI: We Must Protect Ourselves Against ‘Counterfeit People’”
“Philosophy, AI, and Society Listserv”
“Talking Philosophy with Chat-GPT“
The post A Case for AI Wellbeing (guest post) first appeared on Daily Nous.
The-Promise-Walker-Henry-Scott-Tuke-Oil-Painting
nathannobis
Henry Scott Tuke's painting "The Promise" (1888).
An AI door, according to a generative AI
Written by David Lyreskog
In what is quite possibly my last entry for the Practical Ethics blog, as I’m sadly leaving the Uehiro Centre in July, I would like to reflect on some things that have been stirring my mind the last year or so.
In particular, I have been thinking about thinking with machines, with people, and what the difference is.
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The Uehiro Centre for Practical Ethics is located in an old carpet warehouse on an ordinary side street in Oxford. Facing the building, there is a gym to your left, and a pub to your right, mocking the researchers residing within the centre walls with a daily dilemma.
As you are granted access to the building – be it via buzzer or key card – a dry, somewhat sad, voice states “stay clear of the door” before the door slowly swings open.
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The other day a colleague of mine shared a YouTube video of the presentation The AI Dilemma, by Tristan Harris and Aza Raskin. In it, they share with the audience their concerns about the rapid and somewhat wild development of artificial intelligence (AI) in the hands of a few tech giants. I highly recommend it. (The video, that is. Not the rapid and somewhat wild development of AI in the hands of a few tech giants).
Much like the thousands of signatories of the March open call to “pause giant AI experiments”, and recently the “Godfather of AI” Geoffrey Hinton, Harris and Raskin warn us that we are on the brink of major (negative, dangerous) social disruption due to the power of new AI technologies.
Indeed, there’s a bit of a public buzz about “AI ethics” in recent months.
While it is good that there is a general awareness and a public discussion about AI – or any majorly disruptive phenomenon for that matter – there’s a potential problem with the abstraction: AI is portrayed as this big, emerging, technological, behemoth which we cannot or will not control. But it has been almost three decades since humans were able to beat an AI at a game of chess. We have been using AI for many things, from medical diagnosis to climate prediction, with little to no concern about it besting us and/or stripping us of agency in these domains. In other domains, such as driving cars, and military applications of drones, there has been significantly more controversy.
All this is just to say that AI ethics is not for hedgehogs – it’s not “one big thing”[i] – and I believe that we need to actively avoid a narrative and a line of thinking which paints it to be. In examining the ethical dimensions of a multitude of AI inventions, then, we ought to take care to limit the scope of our inquiry to the domain in question at the very least.
So let us, for argument’s sake, return to that door at the Uehiro Centre, and the voice cautioning visitors to stay clear. Now, as far as I’m aware, the voice and the door are not part of an AI system. I also believe that there is no person who is tasked with waiting around for visitors asking for access, warning them of the impending door swing, and then manually opening the door. I believe it is a quite simple contraption, with a voice recording programmed to be played as the door opens. But does it make a difference to me, or other visitors, which of these possibilities is true?
We can call these possibilities:
Condition one (C1): AI door, created by humans.
Condition two (C2): Human speaker & door operator.
Condition three (C3): Automatic door & speaker, programmed by humans.
In C3, it seems that the outcome of the visitor’s action will always be the same after the buzzer is pushed or the key card is blipped: the voice will automatically say ‘stay clear of the door’, and the door will open. In C1 and C2, the same could be the case. But it could also be the case that the AI/human has been instructed to assess the risk for visitors on a case-to-case basis, and to only advise caution if there is imminent risk of collision or such (was this the case, I am consistently standing too close to the door when visiting, but that is beside the point).
On the surface, I think there are some key differences between these conditions which could have an ethical or moral impact, where some differences are more interesting than others. In C1 and C2, the door opener makes a real-time assessment, rather than following a predetermined cause of action in the way C3’s door opener does. More importantly, C2 is presumed to make this assessment from a place of concern, in a way which is impossible in C1 and C3 because the latter two are not moral agents, and therefore cannot be concerned. They simply do not have the capacity. And our inquiry could perhaps end here.
But it seems it would be a mistake.
What if something was to go wrong? Say the door swings open, but no voice warns me to stay clear, and so the door whacks me in the face[ii]. In C2, it seems the human who’s job it is to warn me of the imminent danger might have done something morally wrong, assuming they knew what to expect from opening the door without warning me, but failed in doing so due to negligence[iii]. In C1 and C3, on the other hand, while we may be upset with the door opener(s), we don’t believe that they did anything morally wrong – they just malfunctioned.
My colleague Alberto Giubilini highlighted the tensions in the morality of this landscape in what I thought was an excellent piece arguing that “It is not about AI, it is about humans”: we cannot trust AI, because trust is a relationship between moral agents, and AI does not (yet) have the capacity for moral agency and responsibility. We can, however, rely on AI to behave in a certain way (whether we should is a separate issue).
Similarly, while we may believe that a human should show concern for their fellow person, we should not expect the same from AIs, because they cannot be concerned.
Yet, if the automatic doors continue to whack visitors in the face, we may start feeling that someone should be responsible for this – not only legally, but morally: someone has a moral duty to ensure these doors are safe to pass through, right?
In doing so, we expand the field of inquiry, from the door opener to the programmer/constructor of the door opener, and perhaps to someone in charge of maintenance.
A couple of things pop to mind here.
First, when we find no immediate moral agent to hold responsible for a harmful event, we may expand the search field until we find one. That search seems to me to follow a systematic structure: if the door is automatic, we turn to call the support line, and if the support fails to fix the problem, but turns out to be an AI, we turn to whoever is in charge of support, and so on, until we find a moral agent.
Second, it seems to me that, if the door keeps slamming into visitors’ faces in condition in C2, we will not only morally blame the door operator, but also whoever left them in charge of that door. So perhaps the systems-thinking does not only apply when there is a lack of moral agents, but also applies on a more general level when we are de facto dealing with complicated and/or complex systems of agents.
Third, let us conjure a condition four (C4) like so: the door is automatic, but in charge of maintenance support is an AI system that is usually very reliable, and in charge of the AI support system, in turn, is a (human) person.
If the person in charge of an AI support system that failed to provide adequate service to a faulty automatic door is to blame for anything, it is plausibly for not adequately maintaining the AI support system – but not for whacking people in the face with a door (because they didn’t do that). Yet, perhaps there is some form of moral responsibility for the face-whacking to be found within the system as a whole. I.e. the compound of door-AI-human etc., has a moral duty to avoid face-whacking, regardless of any individual moral agents’ ability to whack faces.
If this is correct, it seems to me that we again[iv] find that our traditional means of ascribing moral responsibility fails to capture key aspects of moral life: it is not the case that any agent is individually morally responsible for the face-whacking door, nor are there multiple agents who are individually or collectively responsible for the face-whacking door. Yet, there seems to be moral responsibility for face-whacking doors in the system. Where does it come from, and what is its nature and structure (if it has one)?
In this way, not only cognitive processes such as thinking and computing seem to be able to be distributed throughout systems, but perhaps also moral capacities such as concern, accountability, and responsibility.
And in the end, I do not know to what extent it actually matters, at least in this specific domain. Because at the end of the day, I do not care much whether the door opener is human, an AI, or automatic.
I just need to know whether or not I need to stay clear of the door.
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Notes & References.
[i] Berlin, I. (2013). The hedgehog and the fox: An essay on Tolstoy’s view of history. Princeton University Press.
[ii] I would like to emphasize that this is a completely hypothetical case, and that I take it to be safe to enter the Uehiro centre. The risk of face-whacking is, in my experience, minimal.
[iii] Let’s give them the benefit of the doubt here, and assume it wasn’t maleficence.
[iv] Together with Hazem Zohny, Julian Savulescu, and Ilina Singh, I have previously argued this to be the case in the domain of emerging technologies for collective thinking and decision-making, such as brain-to-brain interfaces. See the Open Access paper Merging Minds for more on this argument.
I’m going to begin by quoting a very long passage from Bleak House, one involving a suitor in the court of Chancery, generally known as “the man from Shropshire,” an oddity who in every session cries out “My Lord!” – hoping to get the attention of the Lord Chancellor; hoping always in vain. His name is Mr. Gridley and Esther Summerson relates an encounter with him:
“Mr. Jarndyce,” he said, “consider my case. As true as there is a heaven above us, this is my case. I am one of two brothers. My father (a farmer) made a will and left his farm and stock and so forth to my mother for her life. After my mother’s death, all was to come to me except a legacy of three hundred pounds that I was then to pay my brother. My mother died. My brother some time afterwards claimed his legacy. I and some of my relations said that he had had a part of it already in board and lodging and some other things. Now mind! That was the question, and nothing else. No one disputed the will; no one disputed anything but whether part of that three hundred pounds had been already paid or not. To settle that question, my brother filing a bill, I was obliged to go into this accursed Chancery; I was forced there because the law forced me and would let me go nowhere else. Seventeen people were made defendants to that simple suit! It first came on after two years. It was then stopped for another two years while the master (may his head rot off!) inquired whether I was my father’s son, about which there was no dispute at all with any mortal creature. He then found out that there were not defendants enough—remember, there were only seventeen as yet!—but that we must have another who had been left out and must begin all over again. The costs at that time — before the thing was begun! — were three times the legacy. My brother would have given up the legacy, and joyful, to escape more costs. My whole estate, left to me in that will of my father’s, has gone in costs. The suit, still undecided, has fallen into rack, and ruin, and despair, with everything else — and here I stand, this day! Now, Mr. Jarndyce, in your suit there are thousands and thousands involved, where in mine there are hundreds. Is mine less hard to bear or is it harder to bear, when my whole living was in it and has been thus shamefully sucked away?”
Mr. Jarndyce said that he condoled with him with all his heart and that he set up no monopoly himself in being unjustly treated by this monstrous system.
“There again!” said Mr. Gridley with no diminution of his rage. “The system! I am told on all hands, it’s the system. I mustn’t look to individuals. It’s the system. I mustn’t go into court and say, ‘My Lord, I beg to know this from you — is this right or wrong? Have you the face to tell me I have received justice and therefore am dismissed?’ My Lord knows nothing of it. He sits there to administer the system. I mustn’t go to Mr. Tulkinghorn, the solicitor in Lincoln’s Inn Fields, and say to him when he makes me furious by being so cool and satisfied — as they all do, for I know they gain by it while I lose, don’t I? — I mustn’t say to him, ‘I will have something out of some one for my ruin, by fair means or foul!’ HE is not responsible. It’s the system. But, if I do no violence to any of them, here — I may! I don’t know what may happen if I am carried beyond myself at last! I will accuse the individual workers of that system against me, face to face, before the great eternal bar!”
His passion was fearful. I could not have believed in such rage without seeing it.
Now, please bear Mr. Gridley, and his rage, in mind as I turn to George Orwell’s great essay on Dickens. It’s possibly the finest thing ever written about Dickens – even though it’s often wrong – and is a wonderful illustration of Orwell’s power of inquiring into his own readerly responses. (A topic for another post.)
The first point I want to call attention to is this: Orwell was of course a socialist, a person who believed that British society required radical change; and there were people who saw Dickens as a kind of proto-socialist. This, Orwell points out, is nonsense on stilts. If you want to know what Dickens thinks about revolutionary political movements, just read A Tale of Two Cities. He’s horrified by them.
Orwell then goes on to note that Dickens’s early experiences as a reporter on Parliament seem to have been important for shaping his attitude towards government as a whole: “at the back of his mind there is usually a half-belief that the whole apparatus of government is unnecessary. Parliament is simply Lord Coodle and Sir Thomas Doodle, the Empire is simply Major Bagstock and his Indian servant, the Army is simply Colonel Chowser and Doctor Slammer, the public services are simply Bumble and the Circumlocution Office — and so on and so forth.”
Such a man could never be a socialist. And yet, “Dickens attacked English institutions with a ferocity that has never since been approached.” So what is the nature of this attack?
The truth is that Dickens’s criticism of society is almost exclusively moral. Hence the utter lack of any constructive suggestion anywhere in his work. He attacks the law, parliamentary government, the educational system and so forth, without ever clearly suggesting what he would put in their places. Of course it is not necessarily the business of a novelist, or a satirist, to make constructive suggestions, but the point is that Dickens’s attitude is at bottom not even destructive. There is no clear sign that he wants the existing order to be overthrown, or that he believes it would make very much difference if it were overthrown. For in reality his target is not so much society as ‘human nature’. It would be difficult to point anywhere in his books to a passage suggesting that the economic system is wrong as a system. Nowhere, for instance, does he make any attack on private enterprise or private property. Even in a book like Our Mutual Friend, which turns on the power of corpses to interfere with living people by means of idiotic wills, it does not occur to him to suggest that individuals ought not to have this irresponsible power. Of course one can draw this inference for oneself, and one can draw it again from the remarks about Bounderby’s will at the end of Hard Times, and indeed from the whole of Dickens’s work one can infer the evil of laissez-faire capitalism; but Dickens makes no such inference himself. It is said that Macaulay refused to review Hard Times because he disapproved of its ‘sullen Socialism’. Obviously Macaulay is here using the word ‘Socialism’ in the same sense in which, twenty years ago, a vegetarian meal or a Cubist picture used to be referred to as ‘Bolshevism’. There is not a line in the book that can properly be called Socialistic; indeed, its tendency if anything is pro-capitalist, because its whole moral is that capitalists ought to be kind, not that workers ought to be rebellious. Bounder by is a bullying windbag and Gradgrind has been morally blinded, but if they were better men, the system would work well enough that, all through, is the implication. And so far as social criticism goes, one can never extract much more from Dickens than this, unless one deliberately reads meanings into him. His whole ‘message’ is one that at first glance looks like an enormous platitude: If men would behave decently the world would be decent.
And here’s what I love about Orwell: he says that Dickens’s position “at first glance looks like an enormous platitude” – but he is not content with a first glance. He continues to think about it, and as he does he realizes that Dickens, after all, has a point. This I think is the most extraordinary moment in the essay:
His radicalism is of the vaguest kind, and yet one always knows that it is there. That is the difference between being a moralist and a politician. He has no constructive suggestions, not even a clear grasp of the nature of the society he is attacking, only an emotional perception that something is wrong, all he can finally say is, ‘Behave decently’, which, as I suggested earlier, is not necessarily so shallow as it sounds. Most revolutionaries are potential Tories, because they imagine that everything can be put right by altering the shape of society; once that change is effected, as it sometimes is, they see no need for any other. Dickens has not this kind of mental coarseness. The vagueness of his discontent is the mark of its permanence.
Most revolutionaries are potential Tories – that is, their revolutionary sensibility would erase itself if they could just get Their Boys into power. Once they and people like them are in charge, then they will do anything they can to thwart change. But what that means is: Meet the new boss, same as the old boss. (As I note in this essay, following Ursula K. LeGuin, even an anarchist society would have its petty tyrants.) Most would-be revolutionaries ignore this problem, but “Dickens has not this kind of mental coarseness.” And that’s why he’s vital.
This point takes us back to the man from Shropshire, Mr. Gridley. He will not be calmed by invocations of “the system,” the broken system in which everyone is trapped. The Lord Chancellor is not trapped as he is trapped. The Lord Chancellor is not a victim as he is a victim. The people who enable the system, and profit from it, must be held accountable – or nothing important will change. The salon of politics will only be redecorated. So: “I will accuse the individual workers of that system against me, face to face, before the great eternal bar!”
And this, Orwell suggests, is what the novelist can do, what the novelist can bring before our minds and lay upon our hearts. Some political systems are clearly superior to others; but Dickens understands that whatever political system we build, its chief material will be what Kant called “the crooked timber of humanity,” of which “no straight thing was ever made.” To force us to look at that truth — which, properly understood, will result not in political quietism but a genuine and healthy realism — is what the novelist can do for us. “That is the difference between being a moralist and a politician.” The novelist-as-moralist has the power to drag the individual workers of the system, any system, “before the great eternal bar” — but not God’s bar as such, which is what Mr. Gridley means, but rather, the bar of our readerly witness, our readerly judgment, whoever and whenever we are.
Will artificial intelligence fatally undermine the integrity of scholarly publishing? A formal debate from the annual meeting of the Society for Scholarly Publishing.
The post SSP Conference Debate: AI and the Integrity of Scholarly Publishing appeared first on The Scholarly Kitchen.
In our newest "how can we help you?" thread,
My employer uses turnitin and asks us to investigate every single case where turnitin shows any percentage of assignments being generated by AI. I think this has gotten a bit out of hand despite constantly warning my students about the policy. (Student who have something detected also tend to conclude their assignments with “some experts say X some experts say Y and this is an important issue so we need to investigate further and have more discussions.”)
I think this has substantially increased my workload and that of the casual staff who works with me. Is this getting more common? How have others dealt with the increased workload and potential unpaid work of casual staff?
Good questions. I haven't had a major surge in investigations or made any major changes to how I teach yet yet, but I spoke to friend recently who has who told me that they are now simply having students do all of their work by hand in class.
What about the rest of you? Have you experienced a big surge in academic misconduct cases because of AI? If so, how are you dealing with it? And either way, if you have experienced a surge or not, have you adopted any teaching strategies to prevent AI-based misconduct?
Is a 15-week limit on abortion an acceptable compromise?
A recent opinion piece by George F. Will, “Ambivalent about abortion, the American middle begins to find its voice” in the Washington Post made the startling claim that the overturning of Roe v. Wade (Dobbs v. Jackson Women’s Health Organization, 2022) has resulted in “a partial healing of the nation’s civic culture.” One might think exactly the reverse. The Dobbs decision energized voters, especially women and young people, resulting in numerous Republican electoral defeats across the country. However, Will argues that the return of abortion policy to the states gives voters the opportunity of choosing moderate restrictions on abortion. Since most Americans support early abortion while opposing late-gestation abortion, Will thinks that a 15-week ban on abortion would be an acceptable compromise.
Why 15 weeks? Two reasons can be given. Almost all abortions in the US—93%—occur within the first 15 weeks of pregnancy. For this reason, making abortion illegal after 15 weeks would not, it would seem, impose serious burdens on most people seeking abortions.
Another reason is that several European countries limit abortion on request to the first trimester, leading some US lawmakers to suggest that a 15-week ban would bring our abortion law in line with theirs. This is disingenuous, to say the least. While elective abortion is limited in some European countries, it is not banned afterwards, but is allowed on other grounds, including economic or social reasons, or a threat to the woman’s physical or mental health. Moreover, in most European countries, patients do not have to pay for abortion; it is covered under universal health coverage. The fact is that the trend in Europe has not been to limit abortion, but to expand access to it. Countries in Europe “… have removed bans, increased abortion’s legality and taken steps to ensure laws and policies on abortion are guided by public health evidence and clinical best practices.”
Were states to guarantee access to abortion prior to 15 weeks, a 15-week ban might be acceptable. However, even before Dobbs, many women in the US lacked access to abortion, due to a dearth of providers, especially in rural areas. They often had to travel many miles to find an abortion clinic, which meant that they had to arrange childcare if they have other children or take time off work. Delay is also caused by the need to raise money for an abortion, which is not paid for by Medicaid in most states, except in cases of rape, incest, or a life-threatening condition. To be sure, even if there were none of these roadblocks, some women would still not be able to have early abortions because they do not know that they are pregnant, due to youth, being menopausal, chronic obesity, or a lack of pregnancy symptoms. Any time limits will pose hardships for some people. But if access to early abortions were guaranteed, a compromise on a 15-week limit might be worth it.
I suspect that time-limit advocates are not particularly interested in making sure that women who have abortions get them early in pregnancy. They want to place roadblocks in the way of getting abortions, full stop. That these roadblocks increase the numbers of late abortions is of little concern to them, however much they wring their hands over late abortions. Abortion can be reduced by reducing the number of unwanted pregnancies, something that has been shown to be achieved by access to contraceptives and science-based sex education in the schools. Remember when pro-lifers emphasized those methods? Me neither.
“Some US lawmakers suggest that a 15-week ban would bring our abortion law in line with European countries. This is disingenuous, to say the least.”
My second concern is with abortions sought after 15 weeks. The reason for a late abortion may be that the woman has a medical condition that has not developed, or has not been detected, until later in pregnancy. In such cases, the pregnancy is almost always a wanted pregnancy, and the decision to terminate imposes a tragic choice.
It may be responded that all states allow abortions to be performed when this is necessary to save the pregnant woman’s life, and many allow for abortions to protect her from a serious health risk. The problem is that these exceptions conflict with standard medical care, especially in the case of miscarriage. Once the woman has begun to miscarry, the failure to remove the fetus is likely to cause her sepsis, which can be life-threatening. However, in states with restrictive abortion laws, doctors cannot perform an immediate abortion, which is the standard of care in such situations. They have to wait until her death is imminent and, in some states, they cannot remove the fetus until its heart stops.
Ireland’s restrictive abortion law was repealed after a woman who was denied an abortion during a miscarriage died from septicemia. To the best of my knowledge, no woman in the US has died as a result of restrictive abortion laws, but some have come close. An OB-GYN in San Antonio had to wait until the fetal heartbeat stopped to treat a miscarrying patient who developed a dangerous womb infection. The delay caused complications which required her to have surgery, lose multiple liters of blood, and be put on a breathing machine. Texas law essentially requires doctors to commit malpractice.
Conservatives often portray those in the pro-choice camp as advocating abortion until the day of delivery, for trivial reasons. This is deeply unfair. If they want us to compromise on time limits, they should be willing to guarantee access to abortion before 15 weeks. They should be willing to compromise on pregnancy prevention through contraception and sex education. And they should agree to drop all restrictions on late-term abortions that make legislators, rather than doctors, in charge of deciding what is appropriate medical care for their patients.
Featured image: Gayatri Malhotra via Unsplash (public domain)
An interview with Prof Antonio Diéguez Lucena, professor of Logic and Philosophy of Science at the University of Málaga, Spain. Here he speaks of his research into the philosophy of biology and technology.
In our newest "how can we help you?" thread, a reader asks:
What are the norms (in the US) for expressing gratitude to your dissertation advisor/dissertation committee upon completing your dissertation? A handwritten card seems appropriate. Should you give a small gift as well?
Good questions. Another reader submitted the following reply:
The important thing is to keep the relationship professional. Where I worked before (in the USA), we had an awkward situation where students from some countries would give professors expensive gifts as they left an exam 8in the Business School) - quite expensive bottles of wine, etc. This is wholly inappropriate in the USA, especially at a public university, even if it would be expected in tehir home country. The greatest gift you can give a supportive professor is to have a great career yourself - if you publish a book in 10 years, and your feelings are still really warm, then send them a copy of the book.
Do any other readers have any helpful tips?
Starting with letter 20 in On the Aesthetic Education of Man (1795), we tell more of the story of how art is supposed to get us from sensation to thinking.
Aesthetic perception ends up being essential to any conceptualization (thinking) whatsoever!
Sponsor: Check out the Skeptoid podcast at skeptoid.com.
The post Ep. 319: Schiller on Experiencing Beauty (Part Two) first appeared on The Partially Examined Life Philosophy Podcast.The new documentary “No Way Back: The Reality of Gender-Affirming Care” criticizes transgender ideology from a self-described “liberal, west coast Democrat” perspective. Despite facing significant resistance from trans activists, it has been making an impact.
The film will be showing in select theaters across the country during a one-day AMC Theatres Special Event on Wednesday, June 21st at 4:30 and 7:30 pm. It will be available online and on DVD starting July 2nd.
Below, Joshua Pauling interviews producer Vera Lindner.
Joshua Pauling (JP): Thanks for taking the time to discuss your new documentary. It really is a powerful depiction of what is happening to people when transgender ideology takes over. I especially found the detransitioners’ stories compelling. The story you tell throughout is decidedly reasonable and anchored to reality. Kudos to you all for producing such a thorough and moving documentary on such an important and controversial topic. And much respect for being willing to say hard but true things in the documentary.
How has the response been to the film thus far?
Vera Lindner (VL): We’ve received tons of gratitude, tears, and donations. The most humbling has been the resonance the film created in suffering parents. I wept many times reading grateful, heartbreaking messages from parents. People are hungry, culturally speaking, and are embracing our film as truth and facts, and a “nuanced, compassionate, deeply researched” project.
JP: That is great to hear, and interesting that there has been an overwhelming response from parents. Parents are frequently the forgotten victims of this ideology.
How has the film been doing when it comes to numbers of views and reach?
VL: Since February 18th, the film has been viewed 40,000 times on Vimeo, after it was shut down in its first week and then reinstated due to publicity and pressure from concerned citizens. Many bootlegged copies have proliferated on Odysee, Rumble, and such, so probably 30,000 more views there as well. After we put it on Vimeo on Demand in mid-April, it’s getting purchased about 50 times a day. Our objective is the widest possible reach.
Since February 18th, the film has been viewed 40,000 times on Vimeo, after it was shut down in its first week and then reinstated due to publicity and pressure from concerned citizens.
JP: Sad to say, I’m not surprised that it was shut down within a few days. Can you explain more about how such a thing happens? In what ways has it been blocked or throttled?
VL: Vimeo blocked it on the third day due to activists’ doing a “blitz” pressure campaign on Vimeo. Then they reinstated it, after news articles and public pressure. Our private screening event in Austin was canceled due to “blitz” pressure on the venue (300 phone calls by activists in two days). These experiences help us refine our marketing strategy.
JP: I guess that shows the power of public pressure, from either side. You know you’ve touched a nerve when the response has been both so positive as to receive countless heartfelt letters from people, and so harsh that activists want it canceled.
What do you see as next steps in turning the tide on this topic as a society? What comes after raising awareness through a documentary like this?
VL: Our objective was to focus on the medical harm and regret of experimental treatments. All studies point to the fact that regret peaks around eight to eleven years later. Yet the message of the activists toward the detransitioners is, “It didn’t work for you, you freak, but other people are happy with their medicalization.”
Our expectation is that conversations about the long-term ramifications of this medical protocol will start. We need to talk not only about how individuals are affected, but the society as a whole. Wrong-sex hormone treatment and puberty blockers lead to serious health complications that could lead to lifelong disability, chronic pain, osteoporosis, cardiac events, worsening mental health. SRSs (sex-reassignment surgeries) cost hundreds of thousands of dollars. These are not just one individual’s personal issues.
The economics of our health insurance will be impacted. The ability of these people to be contributing members of society will be impacted profoundly. The Reuters investigation from November 2022 stated that there are 18,000 U.S. children currently on puberty blockers and 122,000 kids diagnosed with gender dysphoria (and this is only via public insurance data, so likely an undercount). These all are future patients with musculoskeletal, cardiovascular, and mental illnesses for a lifetime. A hysterectomy at twenty-one can lead to early dementia, early menopause, and collapse of the pelvic floor organs.
The economics of our health insurance will be impacted. The ability of these people to be contributing members of society will be impacted profoundly.
I don’t yet see conversations about the long-term health implications of “gender-affirming care,” particularly in relation to how insurance, the labor force, interpersonal relationships, and future offspring will be affected. Everyone wants to be affirmed now and medicalized now. But there are lifelong implications to experimental medicine: autoimmune illnesses, cancers, etc. Sexual dysfunction and anorgasmia have real implications on dating, romantic life, and partnering up. A few people are talking about this on NSFW posts on Reddit.
JP: It’s interesting how speaking out against trans ideology and gender-affirming care creates some unlikely alliances across the political and religious spectrum. What do you see as the potentials and pitfalls of such alliances?
VL: We align with people who are pro-reality, who respect core community values such as truth and honesty, and who see the human being as a whole: body and soul. There is no metaphysical “gendered soul” separate from the body. Teaching body dissociation to kids (“born in the wrong body”) has led to a tidal wave of self-hatred, body dysmorphia, depression, anxiety, and self-harm. We are our bodies, and we are part of the biosphere. We respect nature and the body’s own intricate biochemical mechanism for self-regulation, the endocrine system. We believe that humans cannot and should not try to “play God.” We are students of history and know that radical attempts to re-engineer human society according to someone’s outrageous vision (read Martine Rothblatt’s The Apartheid of Sex) have led to enormous human cataclysms (communism, Chinese cultural revolution).
We are our bodies, and we are part of the biosphere. We respect nature and the body’s own intricate biochemical mechanism for self-regulation, the endocrine system.
JP: Well, then count me a realist, too! Funny you use the term pro-reality. I’ve written similarly about the possibility of realist alliances. While this makes for some improbable pairings, there can be agreement on the importance of fact-based objective reality and the givenness of the human body.
Realists can agree that the world is an objective reality with inherent meaning, in which humans are situated as embodied, contingent beings. Such realists, whether conservative, moderate, or progressive, might have more in common with each other on understanding reality and humanity than some on their “own side” whom I call constructivists: those who see the world as a conglomeration of relative meanings, subjectively experienced by autonomous, self-determining beings, who construct their own truth and identity based on internal feelings.
But I do have a related question on this point—a bit of respectful pushback, if I may.
Your pro-reality position seems to have implications beyond just the transgender question. Can one consistently oppose the extremes of gender-affirming care while upholding the rest of the LGB revolution? If our male and female bodies matter, and their inherent design and ordering toward each other mean something, then doesn’t that raise some questions about the sexual revolution more broadly?
As we see the continued deleterious effects on human flourishing unfold as thousands of years of wisdom and common sense regarding sex and sexuality are jettisoned, there are both religious and non-religious thinkers raising this question, though some go farther than others. I think, for example, of Louise Perry’s The Case Against the Sexual Revolution, Christine Emba’s Rethinking Sex, Mary Harrington’s Feminism Against Progress, and Erika Bachiochi’s “Sex-Realist Feminism.” An enlightening panel discussion with many of these thinkers was co-hosted by Public Discourse earlier this year. When the real human body is considered, its holistic structure as male or female is clearly ordered and designed to unite with its complement.
If our male and female bodies matter, and their inherent design and ordering towards each other mean something, then doesn’t that raise some questions about the sexual revolution more broadly?
How does this reality relate to the rest of the sexual revolution? If one argues that individuals should be able to express themselves sexually and fulfill their desires with no external limits beyond human desire or will, how does one justify saying that transgenderism is off-limits?
VL: I will answer the question, but I need to say that this is my personal opinion. I’m fifty-five and have worked in entertainment for more than thirty years, and in Hollywood for twenty-five years. The entertainment industry attracts LGBT people, so I’ve hired, mentored, befriended, and promoted LGBT and gender-non-conforming people every day of my career. I believe that being gay or lesbian is how these people were born. Some were affected by their circumstances, as well, but in general I believe that homosexuality is innate, inborn, and has existed for millennia. There were a handful of “classic” transsexual women as well. I have three close friends who transitioned in their late forties.
But the explosion we are seeing now is different. A 4,000-percent increase of teenage girls identifying as trans? This is unprecedented. Mostly these are autistic, traumatized, mentally ill teens who seek to belong, who wish to escape their traumatized brains and bodies, who have been bullied relentlessly (“dyke,” “fag,” “freak”) and now seek a “mark of distinction” that will elevate their social status. Instead of being offered therapy, deep understanding, and compassion for their actual traumas, they are being ushered toward testosterone, mastectomies, and hysterectomies. This is not health care. The tidal wave of regret is coming, because these adolescents were never transsexual to begin with. Many of them are lesbians or gay boys who have internalized so much homophobia and bullying that they would rather escape all of it and become someone different than deal with it.
This is what we want to address. Kids explore identities. This is a natural process of discovering who they are. Medicalizing this exploration cements this exploration they were doing when they were teens. Life is long, and one goes through many phases and many “identities.” To be “cemented” for a lifetime in the decision you made as a distressed sixteen-year-old to amputate healthy sex organs does not make sense.
JP: The rise in the rate of transgender identification is indeed stunning, as is the stark increase in the percentage of Gen-Zers who identify as LGBT. What those trends portend is a live question, as are the varied possible causes. And as you say, there is a tidal wave of regret building, from those who have been pushed toward gender transition. We will all need to make special effort to love and care for them.
You’ve been so gracious with your time. As we conclude, are there any other comments you’d like to share with our readers?
VL: Find a theater near you to attend the theatrical one-day premier on June 21st. Then the movie will become available online and via DVD on July 2nd. Watch the documentary and pass it on to all in your circles!
And ask commonsense humanistic questions:
– Can adults make decisions on behalf of kids that will forever change the path of the kids’ lives?
– Is it worth it to ruin one’s health in the name of a belief system?
– Is what you are reading in academic medical research based on evidence, or pseudo-science?
– If humans have been going through puberty for millennia, who are we to mess with that now?
– Is puberty a disease?
JP: Thank you for your work on this vital issue. I hope this documentary continues to make an impact. And realists unite!
By Borgar Jølstad and Erik Gustavsson.
Health care priority setting should be based on morally relevant factors such as need, severity, and maximizing health outcomes. But sometimes we must choose between health care allocations where these primary considerations are tied. It is sometimes suggested, and implemented in practice, that in these situations other, perhaps more controversial, factors can play the role of tiebreakers. For example, age, healthcare worker status, and first come, first serve, have been suggested as tiebreakers for ventilator guidelines in many U.S. states. This may seem an elegant solution, but tiebreakers are deeply problematic.
First, there is the issue of the value of the tiebreaker. If it is important enough to make a difference in ties, why is it not important enough to make a difference in other cases? That is, why are these factors only valuable in ties? Since any difference among the primary considerations in the priority setting system will offset the tiebreaker, any value ascribed to the tiebreaker will be miniscule. This is particularly strange in priority setting systems where ties are frequent, and the tiebreaker plays a major role in the end. The result is a minimal value making a big difference.
For example, in the Australian pandemic priority setting guidelines people are allocated to “high” and “low” priority groups based on likelihood of recovery and benefiting from treatment. Ties are to be broken by previous disadvantage and health care worker status. Presumably, the reason why these factors are ascribed the role of tiebreakers is that they are not important enough to decide whether someone is “high” or “low” priority. But strangely, they tip the scale in many cases. If a factor is important enough to make such a big difference, relegating it to the status of tiebreaker or secondary consideration seems strange.
Secondly, it is doubtful whether our reasons for implementing a tiebreaker can overcome our reasons for preferring a lottery. In Against Tiebreaking Arguments in Priority Setting we argue that lotteries are the reasonable way to break ties. Lotteries can be justified by referring to impartiality, respect for the separateness of persons, fairness, and the moral value of chances. Our reasons for preferring a lottery are particularly strong in ties, where people’s claims are, presumably, equally strong. If tiebreakers are only valuable enough to make a difference in ties, how can they overcome these reasons for preferring a lottery? Both fairness and impartiality are preserved by lotteries, whereas deciding using a tiebreaker involves allowing a professedly minimally important factor to be decisive for the outcome.
Tiebreakers are puzzling and seem notoriously difficult to justify for priority setting. If a factor is truly important, it should simply be part of our primary considerations, while ties should be decided by lottery.
Paper title: Against Tiebreaking Arguments in Priority Setting
Authors: Borgar Jølstad and Erik Gustavsson
Affiliations:
(A) The Health Services Research Unit—HØKH, Akershus University Hospital (Ahus), Lørenskog, Norway.
(B) Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
(A) Centre for Applied Ethics, Department of Culture and Society, Linköping University, Sweden.
(B) National Centre for Priorities in Health, Department of Health, Medicine and Caring sciences, Linköping University, Sweden.
Competing interests: None
Social media accounts of post authors: @Borgar_Jolstad
The post “We could use that as a tiebreaker” – Yes, but why should we? appeared first on Journal of Medical Ethics blog.
I find the term “medical aid in dying” (MAID) deeply pernicious. It is not only an assault on human dignity (which it implicitly claims to defend), but it also employs a rhetorical sleight of hand. The term conjures up an image of someone who is already dying of a painful and terrible disease, and the aid they receive seems good and possibly even heroic. So I will switch from the misleading term “medical aid in dying” and now speak of “physician-assisted killing,” or PAK.
These misleading ideas associated with MAID have taken a firm hold of the Canadian imagination. According to a poll from Research Co., a representative sample of Canadians were asked the following question: “At this point, only an adult with a grievous and irremediable medical condition can seek medical assistance in dying in Canada. Do you agree or disagree with allowing adults in Canada to seek medical assistance in dying because of the following reasons?”
When asked about “Disability,” a full 50 percent of Canadians agreed that someone should be able to seek PAK. When breaking down the results by age groups, one might expect to find that younger folks, more attuned as they are to the nefarious effects of structural coercion, would be less likely to support PAK in the case of disability. But the opposite turned out to be the case: for 18- to 34-year-olds, support actually jumped ten points to 60 percent. In other words, 6 in 10 of young Canadians support PAK as a response to disability.
What about poverty? A lower number of Canadians—27 percent—think of it as a reason someone should be able to pursue PAK. But once again the numbers for young people are remarkable and disturbing: 41 percent of Canadians aged 18 to 34 believe it can be a legitimate reason to request PAK.
How did Canada get here? Is the United States headed down this same path? If so, how can Americans reverse course?
PAK in America vs. Canada
As families and local communities have frayed, we no longer have a ready-to-hand idea of what a good death might be apart from PAK. The dying process has been outsourced to massive, impersonal housing projects that build sterile nursing homes underwritten by vulture capitalists who discovered they can get rich on our inability to deal with death. So, to the extent that PAK gives both the dying and their families an alternative to the horror show of dying alone (except for maybe the company of a robot) in totally inadequate “care homes,” it becomes quite attractive, and pro-lifers face a serious challenge in resisting it.
Effective resistance to PAK in America has focused largely on slippery slope arguments that emphasize what happens after you open the door to this practice. If those with terminal illness can seek death, why not those with disabilities, or those suffering from severe mental illnesses? PAK opponents, in other words, are focusing on things that invoke discomfort and even anger. But will this be enough in the long run?
If those with terminal illness can seek death, why not those with disabilities, or those suffering from severe mental illnesses?
Nothing has bolstered this strategy for PAK opponents in the United States more than pointing to what is happening in Canada, whose program has expanded in ways that invoke less a slippery slope, and more a free fall accelerating at 9.8 meters per second squared. Consider that it was only five short years ago that Canada legalized PAK. And as we’ve seen, the law has recently enabled killing the poor and the disabled precisely because they are poor and disabled.
This gold-standard reporting from The New Atlantis earlier this year clearly demonstrates the extent of the horrors of Canada’s program. The program trains those who administer death to expect patients who “choose” PAK due to lacking the support they need. In a kicker that is difficult to get out of one’s mind, the article explains the message that Canada sends to its vulnerable populations:
Just a few years ago they would have been textbook candidates for what a just society would say: Your life has value. In Canada today they hear something else: Your death will be beautiful.
But what kinds of situations are we talking about? In what kinds of cases are the powers that be in Canada telling people that they might be better off dead? Well, how about a veteran who asked for PTSD treatment? Or another veteran who asked that a wheelchair ramp be built into her home? Though neither was dying, in both cases they were asked if PAK would be a better option for them.
In another case, a woman with very severe chemical sensitivities “chose” PAK after she was denied public housing that wouldn’t trigger those sensitivities. Or how about a 63-year-old man who had been waiting for spinal fusion surgery for eighteen years, and bearing terrible pain during that time, saying “I am fed opioids and left to kill myself.” He requested PAK and was approved. And then there was the 44-year-old woman with a degenerative disease who, after being denied home healthcare, decided to be as direct as she could about what actually killed her:
Ultimately it was not a genetic disease that took me out, it was a system. There is desperate need for change. That is the sickness that causes so much suffering. Vulnerable people need help to survive. I could have had more time if I had more help.
The Toronto Star, the largest and most progressive newspaper in Canada, described the move toward these practices as “Hunger Games style social Darwinism.”
PAK and Post-Christianity
Opponents of PAK in the United States have pointed to the dystopia to the north of us, and so far their strategy seems successful: even in many blue states (especially out east), PAK is not legal. Yet why has Canada gone so far with PAK? Returning to the polling figures cited at the beginning of this essay, what are we to make of these numbers in a progressive country that has adopted a position so antithetical to how Americans understand social justice?
In Canada, killing the most vulnerable human beings comports well with a society that values giving individuals what they ask for (autonomy), and a just distribution of resources (equity) in ways that allow the most people to derive the greatest benefit from them (utilitarianism).
One reason is that progressivism in the United States has retained aspects of its Christian inheritance—with its focus on nonviolence, inherent and inalienable human dignity, and preference for the most vulnerable. Progressivism in secular Canada, especially among young Canadians, is by now far removed from these commitments. Thus, in Canada, killing the most vulnerable human beings comports well with a society that values giving individuals what they ask for (autonomy), and a just distribution of resources (equity) in ways that allow the most people to derive the greatest benefit from them (utilitarianism).
It doesn’t take a genius to point out the tensions here: equity very often conflicts with utility calculations, and the poor and disabled are some of the least autonomous human beings in our communities. But that doesn’t stop the secular state, and even secular academic bioethicists in both Canada and the United States, from attempting to muddle their way through with these incoherent values in play.
The fact that increased cultural distance from Christianity may have helped pave the way for Canada’s PAK regime is further suggested by what’s happened—and what has not happened—in the much more religious United States. While Oregon and Washington (two of the least Christian states) have had legal PAK for decades, it has only recently become legal in states like California and New Jersey. And despite the best efforts of groups like Compassion and Choices (formerly the Hemlock Society), PAK is still illegal in most of the country—including in deep blue states like New York, Connecticut, and Massachusetts, as noted earlier.
The arguments that have won the day in deep blue USA are—you guessed it—about the slippery slope of such laws and the effect that they will have on the poor and disabled. Unsurprisingly, the most effective advocates against such laws are disability rights advocates (and especially disabled people themselves) who point to the disturbing data about why people seek PAK. When physical pain doesn’t even make the top five reasons people in Oregon request PAK—but fear of loss of autonomy, fear of loss of enjoyable activities, and fear of being a burden on others do make the top five—this sends a very clear message to the disabled: it’s reasonable that someone like you would want to kill yourself. And in Canada, they take the next step: we think someone like you might want to take advantage of the legal right to kill yourself.
Going on Offense
Happily, disability rights activists are still winning the day, again, even in deep blue places on the east coast. But playing a strictly defensive game of knocking down legalization attempts—especially as the United States secularizes and becomes more like Canada—seems like an untenable strategy for protecting the most vulnerable from this deadly violence. Locking in the dignity and radical equality of all human beings will require more. In short, it is time to go on offense.
A broad and diverse coalition of folks is doing exactly that: seeking to make PAK unconstitutional and therefore permanently off the books in this country. The Euthanasia Prevention Coalition in the United States recently reported on a lawsuit filed in the State of California by the United Spinal Association, Not Dead Yet, Institute for Patients’ Rights, Communities Actively Living Independent and Free, Lonnie VanHook, and Ingrid Tischer. These plaintiffs are all organizations with members who have disabilities, individual persons with disabilities, and/or organizations that advocate for persons with disabilities.
The lawsuit has the goal of reaching the Supreme Court and overturning California’s law protecting physician-assisted killing. They argue that this law is unconstitutional because it treats suicidal persons with disabilities (which according to the Americans with Disabilities Act includes those with a terminal disease) differently from other kinds of suicidal persons. If the suicidal person does not have a disability, then the state of California protects her and restricts her ability to kill herself. But if the person has a disability, then California has a special set of discriminatory rules that imply that her life is worth less and (like Canada) even refuses care and supportive services in favor of steering her toward her death. This, the plaintiffs argue, is a violation of the Fourteenth Amendment’s Equal Protection and Due Process clauses.
In my view, this a brilliant strategy on multiple levels, aligning “conservative” pro-life human dignity concerns with “progressive” disability rights concerns in a way (to this non-lawyer’s mind, at least) that makes a powerful legal, moral, and rhetorical case against legalized PAK. Again, it is long past time for us to go on offense in this battle. And the horror show we see unfolding with our secular neighbors to the north indicates just how much is at stake if we lose.
Elon Musk, Mars, and bioethics: is sending astronauts into space ethical?
The recent crash of the largest-ever space rocket, Starship, developed by Elon Musk’s SpaceX company, has certainly somewhat disrupted optimism about the human mission to Mars that is being prepared for the next few years. It is worth raising the issue of the safety of future participants in long-term space missions, especially missions to Mars, on the background of this disaster. And it is not just about safety from disasters like the one that happened to Musk. Protection from the negative effects of prolonged flight in zero gravity, protection from cosmic radiation, as well as guaranteeing sufficiently high crew productivity over the course of a multi-year mission also play an important role.
Fortunately, no one was killed in the aforementioned crash, as it was a test rocket alone without a crew. However, past disasters in which astronauts died, such as the Space Shuttle Challenger and Space Shuttle Columbia disasters, remind us that it is the seemingly very small details that determine life and death. So far, 15 astronauts and 4 cosmonauts have died in space flights. 11 more have died during testing and training on Earth. It is worth mentioning that space flights are peacekeeping missions, not military operations. They are carried out relatively infrequently and by a relatively small number of people.
It is also worth noting the upcoming longer and more complex human missions in the near future, such as the mission to Mars. The flight itself, which is expected to last several months, is quite a challenge, and disaster can happen both during takeoff on Earth, landing on Mars, and then on the way back to Earth. And then there are further risks that await astronauts in space.
The first is exposure to galactic cosmic radiation and solar energetic particles events, especially during interplanetary flight, when the crew is no longer protected by both Earth’s magnetic field and a possible shelter on Mars. Protection from cosmic radiation for travel to Mars is a major challenge, and 100% effective protective measures are still lacking. Another challenge remains being in long-term zero-gravity conditions during the flight, followed by altered gravity on Mars. Bone loss and muscle atrophy are the main, but not only, negative effects of being in these states. Finally, it is impossible to ignore the importance of psychological factors related to stress, isolation, being in an enclosed small space, distance from Earth.
A human mission to Mars, which could take about three years, brings with it a new type of danger not known from the previous history of human space exploration. In addition to the aforementioned amplified impact of factors already known—namely microgravity, cosmic radiation, and isolation—entirely new risk factors are emerging. One of them is the impossibility of evacuating astronauts in need back to Earth, which is possible in missions carried out at the International Space Station. It seems that even the best-equipped and trained crew may not be able to guarantee adequate assistance to an injured or ill astronaut, which could lead to her death—assuming that care on Earth would guarantee her survival and recovery. Another problem is the delay in communication, which will reach tens of minutes between Earth and Mars. This situation will affect the degree of autonomy of the crew, but also their responsibility. Wrong decisions, made under conditions of uncertainty, can have not only negative consequences for health and life, but also for the entire mission.
“It is worth raising the question of the ethicality of the decision to send humans into such a dangerous environment.”
Thus, we can see that a future human mission to Mars will be very dangerous, both as a result of factors already known but intensified, as well as new risk factors. It is worth raising the question of the ethicality of the decision to send humans into such a dangerous environment. The ethical assessment will depend both on the effectiveness of available countermeasures against harmful factors in space and also on the desirability and justification for the space missions themselves.
Military ethics and bioethics may provide some analogy here. In civilian ethics and bioethics, we do not accept a way of thinking and acting that would mandate the subordination of the welfare, rights, and health of the individual to the interests of the group. In military ethics, however, this way of thinking is accepted, formally in the name of the higher good. Thus, if the mission to Mars is a civilian mission, carried out on the basis of values inherent in civilian ethics and bioethics rather than military ethics, it may be difficult to justify exposing astronauts to serious risks of death, accident, and disease.
One alternative may be to significantly postpone the mission until breakthrough advances in space technology and medicine can eliminate or significantly reduce the aforementioned risk factors. Another alternative may be to try to improve astronauts through biomedical human enhancements. Just as in the army there are known methods of improving the performance of soldiers through pharmacological means, analogous methods could be applied to future participants in a mission to Mars. Perhaps more radical, and thus controversial, methods such as gene editing would be effective, assuming that gene editing of selected genes can enhance resistance to selected risk factors in space.
But the idea of genetically modifying astronauts, otherwise quite commonsensical, given also the cost of such a mission, as well as the fact that future astronauts sent to Mars would likely be considered representative of the great effort of all humanity, raises questions about the justification for such a mission. What do the organizers of a mission to Mars expect to achieve? Among the goals traditionally mentioned are the scientific merits of such a mission, followed by possible commercial applications for the future. Philosophers, as well as researchers of global and existential catastrophes, often discuss the concept of space refuge, in which the salvation of the human species in the event of a global catastrophe on Earth would be possible only by settling somewhere beyond Earth. However, it seems that the real goals in our non-ideal society will be political and military.
Written by Rebecca Brown
Breed Specific Legislation
The UK currently imposes what’s called ‘Breed Specific Legislation’ in an effort to limit serious injuries due to dog attacks. The legislation was introduced in 1991 and made it illegal to own, sell, abandon, give away or breed dogs deemed to belong to one of four banned breeds. These are the Pit Bull Terrier, Japanese Tosa, Dogo Argentino and Fila Brasileiro. These breeds, having been selectively bred for purposes such as fighting, hunting and guarding, and are considered to have physical and behavioural attributes that mean they pose an unacceptable risk to the public. Dogs that meet the criteria for being a banned breed can be seized and either destroyed or permitted to remain with their owner under restrictive conditions. Breed specific legislation has been recently criticised in a number of organisations.
I do not intend to defend Breed Specific Legislation. It’s plausible that there are alternative, more effective and less damaging ways of reducing harm from dog attacks. However, many of the critiques of Breed Specific Legislation made by prominent animal charities and veterinary bodies are flawed. In pursuing what they no doubt see as a worthwhile end (the scrapping of Breed Specific Legislation), those publicly lobbying for change have made numerous confused and misleading arguments. Below, I outline why these arguments are misleading, implausible or weak, and how they fail to show that Breed Specific Legislation should be revoked.
Any dog can bite
One common claim is that “All dogs, whatever their breed type or size, are capable of showing aggression” and that “All dogs have the potential to be dangerous”. I don’t want to quibble about whether or not a Chihuahua is technically capable of inflicting a serious injury, but the relevant question is surely a) how likely a given dog is to bite a person, coupled with b) how damaging that bite is likely to be.
The Royal Society for Prevention of Cruelty to Animals (RSPCA) point to the more relevant claim that “recent studies found no difference observed between legislated and non-legislated breeds in the medical treatment required following a bite, or in the severity of bite and the type of dog that bit.” Unfortunately they don’t provide any citation or link to this evidence so it’s impossible to evaluate it. So we are left with the frankly implausible claim that if you get bitten by a toy poodle puppy you’re as likely to be harmed as if you are bitten by a breed of dog that was selectively bred to be able to fight a bull to the death.
Elsewhere on the RSPCA website is a document about dog aggression. Here they seem to acknowledge – albeit carefully – the fairly obvious point that some dog breeds are more likely to show aggression, and are more dangerous when aggressive, than others:
Although it might seem that some dogs are born to be aggressive, it is more accurate to say that they are born with inherited tendencies that might, if not controlled, make aggressive behaviour more likely… There are inherited ways of behaving that are particular to some breeds or types of dogs that make it more likely for individuals to grow up to use aggression where others would not… Aggression is not a single characteristic, however there are breeds of dogs that have historically been used for specific purposes, such as for fighting dogs or other animals, or for guarding. Whilst these breeds may not be any more likely to show aggression, because of their physical and temperamental attributes if they do show aggression it is likely to have more serious consequences. Persistence in attack coupled with strong jaws can cause serious injuries.
Lack of evidence
Notwithstanding the above quote from the RSPCA, another common claim is that there’s no ‘robust scientific evidence’ that some dogs (and types of dog) are able to inflict more damaging injuries than others. Again, this seems to be a case of absence of evidence rather than evidence of absence. It may be worth recalling Yeh et al’s (2018) article ‘Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial’ which usefully highlights how direct RCT evidence might not be necessary in order to conclude that interventions such as parachutes are probably a good idea when jumping out of aeroplanes. Thinking again of the toy poodle versus pit bull example, we can probably draw some fairly reliable conclusions based upon ‘mechanistic reasoning’, without a need to inflict different kinds of dogs bites upon participants as part of a randomised trial.
Disconfirmatory evidence
It is also claimed that there is direct evidence that banned breeds are no more dangerous than other breeds, and that Breed Specific Legislation is completely ineffective at reducing (serious) injuries from dogs.
The RSPCA tells us that “Between 1989 and 2017, 48 people died in dog-related incidents. Of the 62 dogs involved, 53 were dog breeds not on the prohibited list.” And that “Only 8% of dangerously out of control dog cases involved banned breeds”. They also reference evidence that “in the past 20 years (1999-2019), the number of hospital admissions for the treatment of dog bites has increased by 154%, despite the prohibition of certain types of dogs”.
What can we make of this? First of all, the population data: dog bites requiring hospital treatment do not appear to have dropped as a result of the introduction of Breed Specific Legislation. This may well be the case, but it’s not possible to tell based on the information provided. We don’t know how dog ownership has changed over the time period studied – perhaps there were lots more dogs, and this resulted in more bites. It has certainly been speculated that the enthusiasm for pets during the covid lockdown (the number of dogs registered with the UK Kennel Club increased by nearly 40% between 2020 and 2021) might have contributed to more dog bite injuries in recent years. The population data might be suggestive, but it is far from conclusive evidence that Breed Specific Legislation doesn’t or hasn’t prevented any serious injuries from dogs since it was introduced.
Second, the breed-linked data, supposedly showing that banned breeds are responsible for only a small minority of serious injuries, including deaths. But wait: banned breeds, of which there are only four (amongst hundreds of other dog breeds) were involved in 1/7 (14%) of the fatal attacks on people during the period mentioned; they were implicated in 8% of cases of ‘dangerously out of control’ dogs. We don’t know how many dogs belonging to banned breeds exist in the UK, but surely it’s less than 14%, meaning they’re at least overrepresented in these samples.
And surely we can go further than that. I’m pretty keen on dogs and had a childhood of obsessively recording and watching all the annual coverage of Crufts repeatedly. I can reliably tell the difference between an Italian Greyhound, a Whippet and a Greyhound, or describe to you what a Wirehaired Vizsla looks like. But I have never heard of three of the breeds on the banned list and possibly never seen them.
This Wikipedia article lists fatal dog attacks in the UK, including breed information where known. The breeds responsible for fatal attacks on humans since 1980 are largely unsurprising. In the below table I’ve summarised the data from the Wikipedia article. (Note that I’ve grouped some breeds / breed types together [Mastiffs; Bulldogs other than American Bulldogs]).
| Breed | Number of fatalities involved in since 1980 (including as part of cross-breed) |
| Staffordshire Bull Terrier | 12 |
| American Bulldog | 9 |
| American Bully XL | 7 |
| Mastiff / Bull Mastiff / Neapolitan Mastiff / Italian Mastiff | 7 |
| Alsatian / German Shepherd | 6 |
| American Pit Bull Terrier / Pit Bull type | 6 |
| Rottweiler | 6 |
| Bordeaux Bulldog / Bulldog type / Aylestone Bulldog / British Bulldog | 4 |
| Jack Russell Terrier | 3 |
| Bull Terrier | 2 |
| Cane Corso | 2 |
| Husky | 2 |
| Doberman | 1 |
| Alaskan Malamute | 1 |
| Lakeland Terrier | 1 |
| Presa Canario | 1 |
| Chow Chow | 1 |
Again, without baseline information about how common these breeds are, one must be cautious about extrapolating from this list to draw conclusions about the dangers of specific breeds. Yet what is clear is that, with the exception of Jack Russell Terriers and a single Lakeland Terrier (responsible for killing three newborn infants), small dogs do not tend to kill people. Dogs that end up inflicting injuries sufficient to kill people tend to be powerful types, which have been selectively bred for guarding, fighting or hunting.
These dogs don’t deserve to die
One unfortunate refrain used by critics including the RSPCA and British Veterinary Association is that dogs deemed to belong to a banned breed and which do not qualify for an exemption, despite showing no previous signs of aggressive or dangerous behaviour, do not deserve to die. Yet this seems to mischaracterise what the Breed Specific Legislation is intended to do. It is clearly not intended to hand out punishment to ‘bad’ dogs, but instead to act as a preventative measure, to stop injuries in the first place. Indeed, since dogs are not moral agents it is entirely inappropriate to punish them on the basis that they ‘deserve’ it. We should of course treat dogs kindly and not cause them unnecessary suffering. But to suggest that Breed Specific Legislation is a form of undeserved punishment of ‘innocent’ dogs is misleading. Even the destruction of dogs that have seriously injured or killed people should not be construed as punishment: the justification for such actions is to protect people from future attacks from a dog proven to be dangerous.
Banning breeds implies that all other dogs are safe
Commentators suggest that, by banning certain breeds, the government sends the message that only these breeds are dangerous, that dogs belonging to other breeds are never dangerous, and that it is breed alone (rather than circumstances, handling, training, etc.) that makes a dog dangerous. Yet I wonder if this is really the case. It hadn’t crossed my mind that only those banned breeds were (potentially) dangerous, and I would be surprised if other people concluded this from the legislation. Indeed, it seems equally plausible that banning specific breeds would raise awareness of general dangers posed by all dogs.
A vet writing for the British Veterinary Association states “there has never been an onus on anyone, young or old, to behave sensibly and respectfully around dogs.” The problem is that many serious bites – particularly those resulting in fatalities – happen to children. 31 of the 64 fatalities in the UK since 1980 listed on the Wikipedia page were in children under 12. They include a number of babies, one of whom was 5 days old when she died. Children are particularly vulnerable to dog attacks: they are small (and thus injuries may be more severe and they are less able to escape or protect themselves if attacked); they are more likely to provoke dogs through excitement or rough treatment; they are more likely to miss the signs that a dog feels threatened and may attack. But there is a limit to what small children can be taught or the extent to which parents can control their behaviour, and we inevitably place them at risk by putting them in shared spaces with dogs. Of course there is an onus on people to treat dogs carefully and kindly, and to ensure those without the capacity to do this are protected. Yet focusing on whether or not children or their parents could (or should) have behaved differently once again seems to attend to questions of blame and desert, rather than the core matter: how best to prevent injuries in the first place.
Whilst it may well be a good idea to provide training and support to people regarding how to safely handle and act around dogs, this is not incompatible with Breed Specific Legislation. We need not accept the supposition that people are too stupid to simultaneously appreciate that poor training, irresponsible handling, stressful circumstances and the inherited predispositions and physical characteristics of a dog can all contribute to how likely it is to bite and injure someone.
Don’t judge a book by its cover
An interesting argument presented in criticism of Breed Specific Legislation is that the law is implemented based on the extent to which a dog fits the breed standard of a banned breed. This raises complaints from the RSPCA and British Veterinary Association for failing to use, for instance, genetic testing to determine whether or not a dog belongs to a particular (banned) breed.
But isn’t this disingenuous? First of all, if it is physical attributes that play a part in how severe a dog bite may turn out to be, then using physical attributes as a guide to which individuals should be restricted seems not unreasonable. Second, I do not think that, were the legislation to be enforced via genetic testing rather than breed standard, the RSPCA, British Veterinary Association or any of the other opposed groups would be any happier with it. Third, it’s not clear what additional information a genetic test will give you beyond the visible phenotypes that are used in the current system to determine breed. From my Crufts-watching days, the judges were looking at how well the dogs matched up against the breed standard. Of course, genes are partially responsible for what dogs end up looking like, but the relevant thing for dog breeds seems to be what they are actually like rather than what their genetic make-up is. The ‘you shouldn’t judge a book by its cover’ claim seems to be a piece of rhetoric rather than a genuine complaint about how the legislation is enforced.
A plea for better communications
As I said, I don’t want to defend Breed Specific Legislation. But it’s hard to evaluate the value of a policy on the basis of communications that are so clearly aimed at achieving a particular outcome (scrapping the legislation) rather than providing informative arguments. At the moment, the arguments made by the RSPCA, the British Veterinary Association and others could apply as equally to wolves as to any other dog breed. If I want to keep a wolf then, extrapolating from the above claims, I could defend myself against accusations I was risking others’ safety by saying “any dog can bite, and no one has shown me evidence that a wolf bite is worse than any other dog”. Indeed, none of the lethal attacks on humans by dogs in the UK in the last 50 years came from wolves. As long as the wolf hasn’t bitten anyone else yet, subjecting it to restrictions would be equivalent to ‘punishing the innocent’. Children just need to treat wolves respectfully and then they should be fine; there should be more of an emphasis on (potential) victims of wolf attacks to avoid putting themselves at risk, rather than restricting people’s freedom to keep wolves. Even though it looks and behaves exactly like a wolf, it’s not fair to say it’s a wolf unless this has been genetically proven.
Is this really the argument the RSPCA, British Veterinary Association and others want to make? It seems to me it would be vastly preferable to present the best evidence in support of their claims, and acknowledge where uncertainty lies so people can form a sensible and well-informed view on Breed Specific Legislation.
By Abeezar I Sarela.
Consent is fundamental to good medical practice. The General Medical Council (GMC) advises doctors to comply with the law in obtaining patients’ consent for medical treatment. Currently, the law on consent derives from the judgment of the Supreme Court in the case of Montgomery v Lanarkshire Health Board. This judgment emphasizes that patients require information about more than just the risks of the treatment that is proposed by the doctor. Patients also need information about ‘reasonable’ alternatives to the proposed treatment because a meaningful choice cannot be made without awareness of options.
The duty to inform patients about reasonable alternative treatments is theoretically sound but it can pose serious practical difficulties. What if a doctor considers that only one treatment is appropriate for a certain patient; and that other treatments, whilst available in general for the patient’s disorder, are not suitable in view of that patient’s particular condition? Now, is the doctor required to discuss these other treatments with the patient? There are differing views on this issue. These differences are sufficiently serious that a case was recently heard by the Supreme Court, and the judgment is awaited.
The facts of the case before the Supreme Court exemplify the problem. The patient, Mr Neil McCulloch, was admitted under the care of an acute medical team. He had pericardial effusion. The acute team made a diagnosis of pericarditis and sought advice from a cardiologist, Dr Labinjoh, who disagreed with the diagnosis. In her view, the pericardial effusion was part of some systemic disorder, with co-existent ascites and pneumonia. Accordingly, she did not advise any specific treatment for pericarditis. Mr McCullough was discharged from hospital and, unfortunately, he died two days later because of pericardial tamponade. His widow, Mrs Jennifer McCulloch, has claimed that Dr Labinjoh should have discussed the option of non-steroidal anti-inflammatory drugs (NSAIDs), which are well-established as the first-line of treatment for acute pericarditis. Her claim is supported by two experts in cardiology. But another cardiology expert disagrees. In his view, NSAIDs were not indicated in Mr McCulloch’s particular case.
At trial in the Scottish Court of Session, the judge considered whether Dr Labinjoh’s advice was reasonable by posing two questions. First, was her advice supported by colleagues in cardiology? (In legal terminology, this question is called the ‘Bolam test’). Second, was her advice logically sound? (the ‘Bolitho test’). In law, a doctor’s action is deemed reasonable if the answer is ‘yes’ to both questions. As mentioned earlier, a cardiology expert endorsed Dr Labinjoh’s advice. Also, her advice was deemed logical because, as per evidence presented to the court, the primary purpose of NSAIDs in pericarditis is to relieve chest pain; and Mr McCulloch did not have significant pain. Accordingly, the judge concluded that Dr Labinjoh had acted reasonably in not advising Mr McCulloch of the option of NSAIDs. The trial judge’s decision was upheld at appeal in the Court of Session.
The argument before the Supreme Court is, essentially, that Dr Labinjoh’s advice was not the only reasonable advice. NSAID therapy, too, would have been reasonable. Two cardiologists, who supported Mrs McCulloch’s claim, would have prescribed NSAIDs for Mr McCullough. Although he did not have a typical presentation of acute pericarditis, he did have a pericardial effusion. It was suggested that NSAIDs might reduce the size of the pericardial effusion even in the absence of pain. As such, NSAIDs were a reasonable option, and the pros and cons should have been discussed with Mr McCullough in order for him to make an informed choice.
More than one treatment may be considered as a reasonable option in many situations. But, legal analyses take place after the event. In real time, a treatment option that is considered reasonable by some doctors can seem unreasonable to others. Doctors have no way of canvassing and debating the opinions of colleagues at every step. Surely, it is each doctor’s job to use their own clinical judgment to identify reasonable options, and then involve their patient in shared decision-making about these reasonable options only. In some cases, as for Mr McCulloch, the doctor might find that only one option is reasonable.
The crux is reasonability. The word ‘reasonable’ appears 13 times in the GMC’s guidance on consent; but the GMC does not clarify the meaning of this term. The meaning remains hotly debated in political and legal philosophy. The Supreme Court’s judgment in the McCulloch case might offer some answers. Yet, it does not seem fair to expect doctors to fathom the demands of reasonability from philosophical literature and case law. The GMC should act upon the Supreme Court’s forthcoming judgment by providing some guidance on what it means to be ‘reasonable’.
Author: Abeezar I Sarela
Affiliations: Department of Surgery, The Leeds Teaching Hospitals NHS Trust
Competing interests: None declared
The post Consent for medical treatment: What is ‘reasonable’? appeared first on Journal of Medical Ethics blog.
By Adrian Thorogood and Eva Winkler.
Our paper tackles a question that policymakers and public healthcare systems are wrestling with around the world: should for-profit companies be given access to medical data derived from patients for research?
In public healthcare systems, medical data is generated as part of the routine care of patients, and through administrative processes like billing and reimbursement. Medical data is a valuable resource for research and innovation that can advance medical science and improve healthcare. Beyond academic research, for-profit companies are increasingly interested in access to “real world” medical data to inform the discovery and development of drugs, medical technologies, and data-based health applications such as AI. Many countries are actively promoting data sharing to advance public health and wealth goals.
Despite this enthusiasm, for-profit re-use of medical data from public healthcare systems continues to be a source of controversy. Hospitals and data sharing initiatives have often been criticized for a lack of transparency and social license. Some have even been shuttered or sued. Empirical surveys consistently suggest patients and members of the public are less comfortable with companies accessing their sensitive health information than healthcare professionals or academic researchers. This tension between the interests of patients and those of the public and for-profit corporations calls for a closer look at the interests of all parties involved.
Inspired by political philosophy, our paper aims to identify and evaluate the competing claims of different stakeholders relating to for-profit re-use of medical data. This includes the patients providing data, the companies seeking to use data, the society who funds and relies on its public healthcare system, and the healthcare institutions and professionals who painstakingly generate medical data.
Patients have a right to have their medical data treated with confidentiality, and a right to actively determine who accesses this sensitive form of personal data and why. Any re-use of their data should be subject to strict privacy and security safeguards, and to high standards of consent, transparency, and accountability. Patients might expect to receive a direct share in profits generated from the contribution of data. Assuming such a scheme could be practically implemented, does this claim override those of companies, hospitals and society? We argue that this is a weak claim: while medical data certainly fall under patients’ control required by the right to informational self-determination, data are generated primarily for their healthcare and no right to share in profits can be deduced.
For-profit companies in the health sector do not have a right per se to access publicly funded medical data. However, they are entitled to freedom of research – a defensive right restricting state influence on research activities – and a right to a level playing field where access is provided (non-discriminatory access). Companies do have a legitimate right to pursue and realize profits from developing high-quality, life-saving or improving health products. Where products do not offer true value, are overpriced or are not domestically available, however, commercial practices can threaten the sustainability of health systems and patient access. This seems all the more unjust for products developed using data provided by health systems and patients. As part of corporate social responsibility, companies have ethical and reputational reasons to protect patient privacy and to deliver benefits to society, reflected by the current proliferations of guidelines around responsible AI.
Hospitals and clinics are ultimately the places where patient data is generated, through the dedicated efforts of healthcare professionals and staff. Do physicians and hospital leadership own the data and have a claim to share in eventual profits? These claims are complicated by the public funding supporting healthcare delivery, patient self-determination, and the fact that data generation is only the beginning of a complex value chain. They do, however, have a valid claim to appropriate compensation for data generation and curation, one that is all too often overlooked.
Society can benefit from for-profit re-use through things like improved drug safety, as well as more accurate and cost-effective care. How can the state ensure public funds invested in health systems and data infrastructure maximally benefit society, while also maintaining public and patient trust?
Two key tensions arise: between profit maximation versus societal benefit, and between commercial and societal interests in exploiting data versus patient self-determination and privacy. To address these tensions, we conclude by suggesting conditions for ethically sound for-profit re-use of medical data:
We conclude that there are good reasons to grant for-profit companies access to medical data if they meet certain conditions: among others they need to respect patients’ informational rights and their actions need to advance the public interest in better healthcare.
Paper title: Patient data for companies? – An ethical framework for sharing patients’ data with for-profit companies for research
Authors: Winkler EC1, Jungkunz M2, Lotz V1, Thorogood A3, Schickhardt C2
Affiliations:
Competing interests: ECW and CS have been receiving grants by the German Ministry of Education and Research (BMBF) in the frame of the German Medical Informatics Initiative (MII) and have been involved in the Working Group “Consent” of the MII
The post Patient data for companies: Patient privacy, private profits and the public good appeared first on Journal of Medical Ethics blog.
AristotleFriendship-v4
nathannobis
An image of Aristotle and Hypatia laughing together, next to the first page of a Latin and Greek version of Nicomachean Ethics. Generated using Midjourney AI and edited by G.M.Trujillo.
Reading up on Derek Parfit’s theory of personal identity as part of my research on non-essential accounts of self in literature, philosophy and neuroscience, I was astounded to come across a New Yorker feature on the philosopher which describes his inability to visualise imagery as an anomaly:
“He has few memories of his past, and he almost never thinks about it, although his memory for other things is very good. He attributes this to his inability to form mental images. Although he recognizes familiar things when he sees them, he cannot call up images of them afterward in his head: he cannot visualize even so simple an image as a flag; he cannot, when he is away, recall his wife’s face. (This condition is rare but not unheard of; it has been proposed that it is more common in people who think in abstractions.) He has always believed that this is why he never thinks about his childhood. He imagines other people, in quiet moments, playing their memories in their heads like wonderful old movies, whereas his few memories are stored as propositions, as sentences, with none of the vividness of a picture.”
Surely, Parfit’s experience would be representative of the norm, I thought – i.e. to only be able to see things that are actually there, physically present and immediately visible in the external surroundings? I certainly never had this seeming super-power of creating images myself and had always assumed that my subjective experience corresponded to the average.
As I was soon to find out, however, the absence of a visual component to Parfit’s imagination is part of a neurological condition which affects an estimated 2-5% of the population, including myself, namely aphantasia.
Recent studies into aphantasia (e.g. https://pubmed.ncbi.nlm.nih.gov/34296179/) connect it to a number of characteristics and personality traits, including introversion and autistic spectrum features, difficulty with recognition, including face-recognition, impoverished autobiographical memory and less event detail in general memory, difficulty with atemporal and future-directed imagination, including difficulties with projecting oneself into mentally constructed scenes and the future, reduced mind-wandering tendency, elevated levels of IQ and mathematical and scientific occupations.
In addition to these, I think aphantasia is likely connected to a certain philosophical belief or position, namely the non-essentialist view of the self that is found in both the reductionist account of personal identity in Western philosophy and the no-self doctrine in Eastern contemplative traditions. I offer a more extensive argument for this connection here: https://psyche.co/ideas/aphantasia-can-be-a-gift-to-philosophers-and-critics-like-me.
In Reasons and Persons Derek Parfit formulates the view that personal identity is reducible to physical and psychological continuity of mental states, and that there is no ‘further fact’, diachronic entity, or essence that determines identity. The belief that persons are separate entities with continuously existing selves, he argues, is to a great degree an illusion. The New Yorker profile only fleetingly connects Parfit’s philosophy to his aphantasia, but to me it seems an obviously relevant piece of explanation. Our philosophical views are based on our intuitions; our perceptual experience of the world guides our ideas about it.
As modern neuroscience is giving us deeper insight into the wide neuro- and perceptual diversity of people, it is also giving us new explanations of differences in people’s experience of reality and, accordingly, their philosophical intuitions and beliefs. According to the predictive processing theory of brain function, the reality we experience as objective and independently existing, is to a large degree created by our brain, a projection based on our brain’s best guesses about the external reality and as such a form of controlled hallucination. And as Anil Seth has recently pointed out, since we all have different brains, we will naturally make different guesses about the external reality we encounter and thus have different perceptual experiences of reality. “Just as it serves us well to occasionally question our social and political beliefs, it’s useful to know that others can literally see things differently to us, and that these differences may evolve into different beliefs and behaviours.”
The growing insight into perceptual diversity, then, gives way to an increased possibility of biographically understanding and explaining philosophers’ theories and as such allows for a new form of ‘neuro-biographical’ reading of philosophy.
It seems plausible that the flipside of a reduced sense of the past and future is an increased connection to and absorption in the present and a weaker identification with a continuous personal narrative and a coherent and substantial self. Parfit’s diminished sense of continuity of identity and substantiality of his own self – which he himself explicitly links to his aphantasia – may well have led him towards or at least strengthened his anti-essential views of personhood.
Likewise, my own aphantasia could at least in part explain my intellectual preference for and easy identification with non-essential conceptions of self in both Western philosophy and Buddhism. The question is, then, whether the condition of aphantasia gives people like Parfit and me a shortcut to enlightenment and clearer philosophical insight into and intuitive understanding of the human condition and nature of reality. Or, does it obscure the truth by barring us from dimensions that are integral to the most common human experience and installing intuitions that do not correspond to the norm?
As neuroscience and neurotechnology continue to develop and give us better understanding of the variations and differences in the neurological constitution of brains, it will be interesting to see to how far the awareness of perceptual differences and specificity can reach in the explanation of differences in philosophical intuitions and beliefs – and to what extent it can disqualify philosophical positions and theories. The notion of perceptual diversity offers a valuable route for philosophers to exercise self-criticism, scrutinise their theories and intuitions and investigate the underlying perceptions and experiences. At the same time, it troubles some of the fundamental concepts on which the discipline of philosophy relies, paving the way for further relativisation and destabilisation of the already undermined notion of objective truth and rationality and potentially removing us further from consensus.
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