The first doctor to be tried in Egypt for performing female genital mutilation has been acquitted, dashing activists’ hopes that a conviction would send a stern message parents and doctors.
Raslan Fadl, a medical doctor and Islamic preacher in the village of Agga, northern Egypt, was on trial for manslaughter after 12-year-old Sohair al-Bata’a died in June 2013 after an operation. He denied that the procedure was FGM and said that his accusers were “on drugs”.
“Of course there will be no stopping any doctor after this. Any doctor can do any FGM he wants now,” Atef Aboelenein, a lawyer for the Women’s Centre for Guidance and Legal Awareness, told The Guardian. Suad Abu-Dayyeh, of Equality Now, said: “It’s a very unjust verdict from the judge. It sends a very negative message. It was the first case in the country and we were hoping we could build on it.”
Made illegal in 2008, FGM still has popular support, especially in rural areas. The Guardian reports:
“According to surveys by Unicef, an estimated 91% of married Egyptian women aged between 15 and 49 have been subjected to FGM, 72% of them by doctors. Unicef’s research suggests support for the practice is gradually falling: 63% of women in the same age bracket supported it in 2008, compared with 82% in 1995.”
“We circumcise all our children – they say it’s good for our girls,” one housewife, told the Guardian earlier this year. “The law won’t stop anything – the villagers will carry on. Our grandfathers did it and so shall we.”
People who say Yes say often explain why by invoking the greatest good for the greatest number so critics have called these fat-man-sacrificers typical utilitarian thinkers. Digging deeper, several researchers have found a correlation between this decision and Machiavellian, egotistic or even psychopathic personalities. Utilitarian=Psychopath has never been a good marketing slogan.
Responding to this interpretation, a leading utilitarian bioethicist, Julian Savulescu, of Oxford University, and colleagues argue in the journal Cognition that this slur is based on a mistake. They looked more closely at people's reactions and found that these “utilitarians” were really motivated by “the more modest, unremarkable, and ordinary thought that it is, ceteris paribus, morally better to save a greater number”. In fact, they were more likely to be moral egotists, whose only motivation is to maximize their own selfish welfare. They were faux utilitarians.
The true utilitarianism, says Savulescu, is a lofty, cerebral and exacting doctrine which is diametrically opposed to egotism:
“Utilitarianism is a radically impartial view: it tells us to consider things as if ‘from the point of view of the universe, without giving any special priority to ourselves, or to those dear or near to us. Instead, we should transcend our narrow, natural sympathies and aim to promote the greater good of humanity as a whole, or even the good of all sentient beings. Needless to say, this view of morality is strongly at odds with traditional ethical views and common intuitions. It is also a highly demanding moral view, requiring us, on some views, to make very great personal sacrifices, such as giving most of our income to help needy strangers in distant countries.”
“Few people if any have ever been anything like a perfect utilitarian. It would require donating one of your kidneys to a perfect stranger. It would require sacrificing your life, family and sleep to the level that enabled you to maximise the well-being of others. Because you could improve the lives of so many, so much, utilitarianism requires enormous sacrifices.”
And then he makes an extraordinary confession:
“People think I am a utilitarian but I am not. I, like nearly everyone else, find Utilitarianism to be too demanding. I try to live my life according to ‘easy rescue consequentialism’ – you should perform those acts which are at small cost to you and which benefit others greatly.”
Which leaves his readers perplexed. If utilitarian sinners are psychopaths and utilitarian saints are non-existent, is utilitarianism a moral philosophy for ordinary human beings or only for the authors of obscure journal articles?
One of the most famous advertisements in history was supposedly written by South Pole explorer Ernest Shackleton: “Men wanted for hazardous journey. Low wages, bitter cold, long hours of complete darkness. Safe return doubtful. Honour and recognition in event of success.”
Perhaps egg freezing doctors have learned from Shackleton that highlighting the risks and dangers of cold places need not discourage clients. The video above suggests that it may actually inspire them. It features “The Egg-Whisperer” (aka Dr Aimee Eyvazzadeh at eggfreezingparty.com) and her “Tupperware parties” for fertility-conscious professional women working in and around Silicon Valley. “After you attend a party, we welcome you to become one of Dr. Aimee’s patients so that she can help guide you further. Join the party!” says her website. (Hat tip to the Center for Genetics and Society.)
Pope Francis has condemned euthanasia, calling it “a sin against God the creator”. The Roman Pontiff made the statement in an address to the Association of Italian Catholic Doctors . The Pope – who may be the single most influential bioethical voice in the world -- criticised the logic of what he termed “false compassion”. He also applied the notion to arguments for abortion and IVF.
“The dominant thinking sometimes suggests a ‘false compassion’, that which believes that it is: helpful to women to promote abortion; an act of dignity to obtain euthanasia; a scientific breakthrough to ‘produce’ a child and to consider it to be a right rather than a gift to welcome”.
Summarising his scepticism about contemporary trends, the Pope said:
“We are living in a time of experimentation with life. But a bad experiment. Making children rather than accepting them as a gift, as I said. Playing with life.”
In another recent address, Francis stressed the need to promote what he calls a new “human ecology”. This relatively novel idea draws together the Zeitgeist of the environmentalist movement with the natural law ethos of Catholic bioethics. The Pope is set to release a statement (possibly an encyclical) next year on “human ecology”, and the United Nations has suggested it will support the document.
The new publication is bound to be controversial. The idea of “human ecology” has its roots in Benedict XVI’s understanding of male-female complementarity, and the unethical nature of artificial reproductive methods.
An Australian academic has prompted spirited debate after suggesting that denying euthanasia to the mentally ill could be a form of unjust discrimination.
In a recent article in The Conversation, Dr Sascha Callaghan of the University of New South Wales suggested that mental illness in itself may be insufficient grounds to deny an individual euthanasia:
“The idea that euthanasia should not be offered for mental suffering is not universally agreed, and requires some further consideration… too stringent an approach risks locking people with mental illnesses out of the right to make decisions about the end of their lives – and this might be discriminatory.”
Callaghan referred to a case in the UK in 2012 in which a court ruled that an anorexic woman be force-fed despite her request that the treatment stop. “The implication of the decision was that, by definition, people with anorexia cannot make an end-of-life decision, no matter how harrowing and intractable their illness becomes.”
Whilst not committing to a particular viewpoint on the issue, Callaghan concludes that “certainly there are a range of defensible views on what is a good life and when assisted dying is acceptable.”
The Australian Medical Association recently suspended the medical license of euthanasia advocate Phillip Nitzchke, after he failed to dissuade a mentally ill man, 45-year-old Nigel Brayley, from taking his own life with a lethal barbiturate.
A US Navy nurse may be discharged after refusing to force-feed prisoners in Guantanamo Bay. The nurse, who has served in the Navy for over 18 years, used to participate but eventually concluded that it was “unethical”.
The US military’s preferred method of force-feeding involves inserting a tube through a detainee’s nostrils and into his stomach. The nurse changed his attitude to the procedure after seeing how much they resisted.
The American Nurses Association (ANA) recently released an open letter to Defence Secretary Chuck Hagel and the director of the Navy Nurse Corps, requesting that the nurse not be punished. The ANA invoked the ethical right of a nurse to “make an independent judgment about whether he or she should participate in this or any other such activity”. The Navy has not responded.
The World Medical Association has condemned force-feeding, and this week the lobby group Physicians for Human Rights declared its support for the nurse. “Nurses, like physicians, have professional duties to respect the autonomous decisions of their patients and never participate in ill-treatment or torture,” said Dr Vincent Iacopino, PHR’s senior medical advisor.
Whatever you think of transhumanism, one thing is quite certain: the transhumanist movement is alive, healthy and growing. In any ordinary week in the world of bioethics, several articles will be published exploring one aspect or other of transhumanism.
Consider, for example, Zoltan Istvan, best-selling author and self-proclaimed “transhumanist visionary”. Istvan has published 20 articles this year in the Huffington Post on transhumanism. He recently announced that he intends to run as a representative of the Transhumanist Party in the 2016 US presidential elections.
There is also a fully-fledged international transhumanist society, Humanity +. The organisation, founded in 1998, runs seminars around the world to discuss the latest developments in human enhancement technologies. The also organisation publish the online quarterly Humanity + magazine, a publication dedicated to discussing transhumanist news and ideas.
In a recent blog post, Wesley Smith argued that the transhumanist vision was a mere ‘utopian fantasy land’. A small army of transhumanist supporters came to the support of the movement, commenting extensively on the article and criticising Smith’s argument.
Nancy was a 12-year-old girl with severe disabilities. Born in 2002 with a streptococcus infection, she was blind, had hydrocephaly and was unable to talk, walk, eat or drink.
Her mother, Charlotte Fitzmaurice, gave up her job as a a nurse and became a full-time carer. Nancy only reached a developmental age of about 6 months, but she was reasonably healthy and had defied predictions that she would only live to the age of 4.
However, two years ago a routine operation for kidney stones went wrong. Nancy was in round-the-clock untreatable pain, to the great distress of Ms Fitzmaurice and her partner.
With the support of London’s Great Ormond Street Hospital, she applied to have Nancy euthanased by withdrawing nutrition and hydration. The matter went to the Justice Eleanor King, of the High Court, who ruled on August 7 that it was in the mother and daughter’s best interests to withdraw food and fluids. “In her own closed world [Nancy] has had some quality of life. Sadly that is not the case now,” she said. It was the first time that a child who was not terminally ill and was not on life support was permitted to die in this way.
Nancy died on August 21 after great suffering. “The last day was the hardest of my life. It was absolutely horrifying,” Ms Fitzmaurice told the Daily Mail.
The case was not widely reported, but the policy followed by the hospital and approved by the judge had severe critics. The Autistic Self Advocacy Network, an American group, described it as killing a disabled person.
“Euthanasia of people with disabilities is an extremely dangerous and wholly inappropriate solution to inadequate pain management. In cases where painkillers are insufficient, a number of alternatives for pain management exist. A policy of euthanasia targets vulnerable people, particularly when it is applied to children. People with disabilities who experience chronic pain should have same access as others to life-sustaining medical treatment.”
Bioethicist Arthur Caplan, of NYU Langone Medical Center, was guarded in his assessment, but told The Daily Beast that he would have preferred to increase the level of sedation rather than allow the girl to die of thirst.
There is a plethora of films about euthanasia and assisted suicide, but possibly none which takes place in a courtroom. However, a courtroom in the sweltering far north of Australia might provide an excellent script for an updated version of Inherit the Wind, pitting enlightened progressives against backwoods conservatives.
The progressive would be Philip Nitschke, one of the world’s best-known euthanasia activists. He has been battling to retain his medical registration before Northern Territory Civil and Administrative Tribunal. His lawyer, Henry Nugent, is terminally ill with colon cancer and ardently supports supported Nitschke’s cause.
Representing the antediluvian Medical Board of Australia is barrister Lisa Chapman. The MBA regards Nitschke as a public danger.
The trigger for the hearing was a police investigation of the death of 45-year-old Perth man Nigel Brayley. He was a fan of Nitschke’s work and committed suicide with Nembutal, Nitschke’s drug of choice. Unfortunately for Nitschke, it turned out that Brayley was being investigated for murdering one, possibly, two wives. He may have been depressed; he certainly evaded justice. If Nitschke’s cavalier response to Brayley’s request for information is not enough for the MBA to deregister him, there are 11 other complaints about how he practices as a doctor.
Nitschke tried to turn the hearing into a trial of the notion of rational suicide. "I am arguing that every rational adult has the right to determine what they do with their own body... and that may include ending their own lives,” he told the ABC. “The medical profession should keep out of it; they are not a body that should be controlling options that rational adults take.”
Ms Chapman refused to broaden the scope of the hearing. “This is not a debate about voluntary euthanasia," she said. "It is not a debate about rational suicide. This is a very precisely focused interim hearing regarding Mr Nitschke's conduct into the death of a man. He obtained scant information about Mr Brayley before he died."
The debate is also about the extent of a doctor’s professional commitment. Nitschke supports a transactional relationship in which he is a doctor only when a person approaches as a doctor. Ms Chapman supports a vocational understanding. "You can't say that today I'm going to be a registered medical practitioner but tomorrow I'm not going to be," she said. "It's not a matter of saying I'm going to decide when I wear that hat. The legislative scheme is that you wear that hat all the time."
Nitschke, who spends most of his time nowadays in his work as the head of Exit International, an assisted suicide and euthanasia lobby group, sounds fatalistic about losing his credentials as a doctor. "I wish I had never met Nigel Brayley, frankly, given the amount of damage that brief encounter has done to me and the time and energy and money that it's consumed," he says.
The legislature of the Swiss canton of Neuchâtel has voted overwhelmingly to force government-funded nursing homes to allow representatives of assisted suicide groups to advertise their services.
(Neuchâtel is in the west of Switzerland, bordering on France, and is predominantly French-speaking.)
There are no exemptions for conscientious objection by managers in the homes. The only critierion, according to Swiss.info, is the personal choice of the patients. Personal autonomy must take precedence over the rules of the nursing homes. About 60 institutions will be affected by the decision.
The new regulations specify that nursing home personnel will not be allowed to interfere if a patient chooses to die. In fact, they are required to set aside a room where the staff of the assisted suicide organisation Exit will help the person to die.
The law establishes some conditions for such procedures. The disease or condition must be serious and incurable and other end-of-life options must be discussed. If the nursing home refuses to cooperate, the patient can complain to the authorities. Only homes which do not accept government funding will be allowed to close their doors to Exit.
Exit (whose full name is Exit ADMD Suisse Romande) caters for French-speaking Swiss. Another group, called simply Exit, caters for German-speakers. Last year the French Exit began to offer its services to elderly people who did not have a terminal illness but wished to die. According to one report, it helped 155 people to die last year, and its German counterpart 459. Apparently nursing homes in the German cantons are far more amenable to visits by Exit.