Torture is an issue on which the public might expect bioethicists to be moral absolutists. Never again! Never ever! It was somewhat surprising, then, to read in the New York Times that one of the world’s leading animal rights theorists, Oxford’s Jeff McMahan, support torture.
There are limits, of course. Mafia toe-cutting is out, along with the amusements of serial killers and the waterboarding used by the CIA in the bad old days of the Bush Administration. But there might be cases, McMahan argues, where “Torture can be morally justifiable, and even obligatory, when it is wholly defensive – for example, when torturing a wrongdoer would prevent him from seriously harming innocent people.”
Moral absolutism leads to impossible conundrums, says McMahan.
“It is one of the problems of the absolutist view of torture that it has to identify some threshold on the scale that measures the elements of torture, such as suffering, and then claim that nothing, not even the prevention of a billion murders, can justify the infliction of that degree of harm, even on a wrongdoer. But the view does not absolutely prohibit the infliction of the highest degree of harm below the threshold. It has to concede that the infliction of that degree of harm can be permissible, even to prevent harms far less bad than the murder of a billion people. The idea that there is such a threshold is wholly implausible.”
Another utilitarian who supports the use of torture in rare circumstances is the best-known of animal rights theorists, Peter Singer. In his book The Life You Can Save: How to Do Your Part to End World Poverty, he says, “I would argue, if I find myself in the highly improbable scenario where only torturing a terrorist will enable me to stop a nuclear bomb from going off in the middle of New York, I ought to torture the terrorist.”
Another prominent bioethicist who supports torture is Frances Kamm, who teaches at Harvard University. In her recent book Ethics for Enemies: Terror, Torture, and War , she argues that torture may well be permissible in a variety of cases. She writes, “it is sometimes permissible to torture someone, at least for a short time without permanent damage, if we would otherwise permissibly kill him”.
Ivory tower arguments for torture in philosophy journals have real world consequences. McMahan relates that an American philosopher, Henry Slue, admitted that torture was not absolutely wrong in an influential article in 1978. Two CIA agents later thanked him. They were relieved to find that their day jobs were ethically justifiable.
Nursing homes in New York State have been accused of using ‘guardianship petitions’ as a means to coerce elderly residents into paying outstanding fees.
A startling expose in the New York Times this week discusses a number of instances where nursing homes have requested courts to transfer guardianship away from the family. Ostensibly these requests are prompted by family feuds, suspected embezzlement or just the absence of relatives to help secure Medicaid coverage.
However, judges, legal experts, and others well versed in the guardianship process claim that often the petitions are used as a means of duress.
In a guardianship case last year involving a 94-year-old resident in a Jewish aged care facility, New York Supreme Court judge Alexander John Hunter issued a scathing 11-page critique of the motivations behind the petition made by the nursing home’s management.
“It would be an understatement to declare that this court is outraged by the behavior exhibited by the interested parties — parties who were supposed to protect the person, but who have all unabashedly demonstrated through their actions in connection with the person that they are only interested in getting paid,” he wrote.
In a more recent case, this time involving a family who refused to pay exorbitant rates to a Catholic nursing home, a court evaluator threw out the guardianship petition and questioned the motivations of the facility. The family spent US$10,000 in legal fees fighting the case.
Some nursing homes argue that guardianship petitions are the best way to resolve disputes about payment for care. The alternative is to sue an incapacitated resident who cannot respond.
“When you have families that do not cooperate and an incapacitated person, guardianship is a legitimate means to get the nursing home paid”, said Brett D. Nussbaum, a lawyer for the Catholic nursing home Mary Manning Walsh.
The days of anonymous sperm donation are over in Germany. The German Supreme Court has settled a patchwork of decisions and ruled that children of any age may request the identity of their biological father. "There is no specific minimum age necessary for the child," the judges said. Parents may make a request on behalf of the child.
The only limitation is that the parents (usually the mother) must be able to prove that the child wants to know and that the effect of disclosure upon the donor must be taken into account. However the decision stated that the right of children to know the identity of their fathers normally outweighs the donors’ right to privacy.
The case was brought by sisters aged 12 and 17 who had been denied access to their sperm donor father’s identity. Their parents had waived a right to access at the time of conception. The status quo of German legislation was that children can only access this information when they are 16. However the Supreme Court said that children begin to ask questions about their origins as early as kindergarten.
Since the 1970s, an estimated 100,000 children have been born from sperm donation in Germany.
For the first time ever, an Egyptian doctor has been convicted of performing female genital mutilation. Dr Raslan Fadl was sentenced to two years hard labour for operating on a 13-year-old girl in 2013 who later died of complications. Dr Fadl denied performing FGM, which is illegal in Egypt, and was backed up by the girl’s father. He was acquitted by a lower court but prosecutors appealed and the ruling was overturned.
By contrast, in England, recent statistics show that FGM is performed on at least 15 girls every day and not one single doctor has ever been convicted. In December alone there were 558 newly identified cases of FGM.
John Cameron, of the Health and Social Care Information Centre, said: "These new figures indicate that female genital mutilation is a bigger problem in the UK than we thought and there are obviously children at risk of being subjected to this cruel and unnecessary practice right now.
One case is currently being tried. Dr Dhanuson Dharmasena allegedly performed FGM on a patient at the Whittington hospital in north London. This is the first time a case has made it to the courts, although FGM has been illegal in the UK since 1985.
According to the National Health Service more than 20,000 girls under the age of 15 are at risk of FGM in the UK each year and that 66,000 women are living with the consequences of FGM. The true figures are unknown. Sometimes girls are taken back to their countries of origin during the summer holidays so that the primitive surgery can heal before they return to school.
Last year, a number of ministers signed a declaration of zero tolerance. “This government is absolutely committed to preventing and ending this extremely harmful form of violence,” they wrote. One year later, the figures seem to be rising.
Sex-selective abortion is almost universally reviled – by opponents of abortion because it kills an unborn child and by feminists because it entrenches discriminatory attitudes towards women. However, it has its defenders, even in the Western world.
Writing in The Conversation, Dr Pam Lowe, a sociologist at Aston University in the UK, argues that “You cannot promote gender equality by enacting laws that place restrictions on women’s bodies. Banning sex-selective abortion opens up a world in which there is such thing as a ‘good’ and ‘bad’ reason for an abortion.” To her mind, a ban is a plot by pro-life politicians to make incremental restrictions on a woman’s right to abortion, both in the UK and in the US.
“Although it may seem counter-intuitive, supporters of women’s rights need to oppose the banning of sex-selective abortion. This campaign has nothing to do with ending gender discrimination. It is a strategy of the pro-life movement to reduce women’s access to abortion more generally. While the continuing discrimination against women which leads to coercive abortion for gender reasons is a serious problem, you cannot end gender oppression by placing new restrictions on women’s lives.”
Withdrawal of life-sustaining treatment is a common and more or less accepted procedure in end of life care. There is, however, significant disagreement about the underlying moral framework used to justify it. A recent article in the journal Bioethics attempts to address one key question involved– whether withdrawal of life sustaining treatment is an act of killing.
Andrew McGee, a lecturer in health law from the University of Queensland, argues that withdrawal of care is an act that causes death, but that it should be considered an example of ‘letting die’ rather than ‘killing’.
Whereas many others have argued that withdrawal of care is a mere omission, McGee believes it implausible to characterise discontinuation of treatment as a passive procedure:
“Allowing a consequence can still be causing that consequence, in the sense that I turned off the heating and allowed the room to cool down by doing so…my turning off the heating is what allows the room to cool down and so causes the room to cool down in that sense.”
“One [cannot] distinguish letting things happen from causing to them to happen for once we concede that letting the room cool down can still be described as causing it to cool down, it would follow that letting someone die could, by parity of reasoning, be described as causing them to die.”
But while discontinuation of treatment is a kind of act, it is nevertheless not the cause of death itself; it is only the cause of the timing of death. McGee argues that withdrawal of treatment is part and parcel of the decision to provide life-sustaining measures in the first place. The end of this whole procedure is to extend life for a certain time; one is not causing the patient’s death when they chose to end the process:
“If we are merely delaying death by providing life-prolonging measures, then, in a sense, we are delaying the point at which we withhold those measures. The withdrawal merely allows a process that was underway, but then halted in its tracks, to resume, which is equivalent to a later decision not to halt the process in its tracks.”
I don't pretend to have provided a comprehensive account of McGee’s thesis, but I do hope to have indicated the direction of his argument. His thesis, when taken as an absolute statement on the matter, conflicts with a position held by two unlikely allies, bioethicist Julian Savulescu and Catholic ethicist Anthony Fisher. They both argue that withdrawal of life sustaining treatment is, at least in some cases, tantamount to killing. McGee in contrast, asserts that withdrawal only affects the time of death; it does not itself cause death.
The study, prepared by Celia and Jenny Kitzinger from the UK based Chronic Disorders of Consciousness Research Centre, provides empirical data on the attitudes of families towards withdrawal of end of life care. From the information collected the authors argue that families often desire to terminate the life of their loved one, but nevertheless are repelled by the thought of ‘starving’ him or him.
Kitzinger and Kitzinger interviewed over 51 individuals who had a relative with a severe brain injury that had rendered them unconscious or minimally conscious. Participants were given much time to tell their stories and the interviewers refrained from asking generic questions.
The authors found a number of trends:
1) Families generally concluded that the individual would rather be dead only after they had exhausted all possibilities of bringing the individual back to a fully conscious state.
2) Following on from this, it was evident that with time families tended to shift their attitudes over a period of years to the view that the participant would rather be dead.
3) At this point families put in place ‘ceilings of care’ such as ‘do not attempt cardiopulmonary resuscitation’ (DNACP) and an agreement not to aggressively treat infections (e.g., with intravenous antibiotics).
4) Despite their desire that their loved one’s life be ended, family members were generally very frightened at the thought of the patient ‘starving to death’.
5) A number of interviewees, with varying levels of seriousness, had thought of illegally killing their relative in a ‘human way’, so as to avoid the withdrawal of Artificial Nutrition and Hydration.
The authors conclude the article by suggesting that ‘other ways of bringing about death’ such as ‘terminal sedation’ be offered to patients and (as proxy decision makers) their families.
One does wonder, considering the situation that the families find themselves in, whether they have sufficient opportunity and encouragement to attend counseling services. This is the flip side of what the authors recommend, but perhaps of equal or greater importance.
Interested in getting an overview of bioethics? A Manhattan-based NGO, the Global Bioethics Initiative, has organiseda bioethics summer school in June and July. We asked Dr Ana Lita, the organiser, to explain what’s happening.
The Global Bioethics Initiative is a not-for-profit international organization founded in 2011. We keep the international community, policy decision-makers, the media, and the public informed of important bioethical issues through educational activities, like the summer school. Late last year, for instance, we organised a seminar on organ trafficking and human rights.
GBI is associated with the UN Department of Information and we are hoping for formal affiliation with the UN Economic and Social Council. We hope that our programs will eventually have a global reach through these links.
This is your first summer school. What prompted you to organize it?
Here in New York we have access to world-renowned experts and world-class institutions and hospitals. But we realized that there was no summer educational opportunity in bioethics from a global perspective in NYC, for students and professionals from allover the world. The globalized nature of bioethics lends itself to a more collaborative and international educational experience and in global capital like New York City, we have the benefit of having access to not only world-renowned faculty for the summer school, but also to world-class institutions and hospitals to facilitate learning in and out of the classroom.
The members of our faculty include bioethicists, lawyers, policy-makers, activists, transplant surgeons, researchers and practitioners. Many serve on influential international and national boards including, the WHO, UNESCO International Bioethics Committee, the United States Senate Committee on Aging, and the United Network for Organ Sharing.
Where will most of the students come from? Are many younger students taking an interest in bioethics?
We welcome students of all ages, including health care professionals, policy makers and journalists, but we are aiming especially at undergrads and post-grads planning to work in academia, biomedical and health-related industries.
Several interns work with your organization every year. Do many of them continue working in bioethics?
Yes, GBI has regular unpaid internships. We welcome intern students and volunteers interested in actively participating in our programs. Our interns and volunteers should expect to gain practical skills in organizing and advertising events, a greater understanding of the daily running of an international NGO as well as the opportunity to work alongside international organizations and UN agencies. As a former assistant professor of Applied Ethics myself, I work with students to accommodate university or departmental requirements to receive school credit for the internship. We welcome candidates interested in interning with GBI to contact us.
The summer school's lectures cover a wide range of topics. Which do you think will attract the most interest?
Controversial issues such as embryonic stem cell research, human cloning, cryonics, human genetic engineering, markets in organs, euthanasia and abortion, and human enhancement are topics of interest for most students.
There are other summer programs in bioethics but I am sure that none of the others offers a global perspective and a UN affiliation. The faculty is exceptional, with a complex multicultural educational and experience background. Many are full professors sitting on active international bioethics committees and boards.
Over five weeks, we hold lectures Monday through Thursday, and have field trips on Friday, plus social events. The early registration deadline is March 15. Contact Ana Lita for information.
Cows grazing at the U.S. Meat Animal Research Center in southern Nebraska
The Obama Administration has reacted swiftly to a scathing report on animal welfare at a Federal government laboratory in Nebraska in the New York Times. Agriculture Secretary Tom Vilsack has demanded an updated animal welfare strategy within 60 days. An animal welfare ombudsman has been appointed for the unit.
The Times expose claimed that treatment of animals at the US Meat Animal Research Center was far below basic animal welfare standards. Instead of trying to minimise animal pain, the center’s goal was to maximize meat production. It described some stomach-churning experiments in animal breeding and care: sows which produced so many offspring that they were crushed to death; cows which bore twins and triplets which were deformed and stillborn; lambs left to be torn apart by coyotes, among others.
Although the US Congress passed a landmark Animal Welfare Act in 1966, there was a gaping loophole: its provisions did not apply to research on farm animals used in agriculture.
“They pay tons of attention to increasing animal production, and just a pebble-sized concern to animal welfare,” James Keen, a veterinarian who worked at the center for 24 years told the Times. “And it probably looks fine to them because they’re not thinking about it, and they’re not being held accountable. But most Americans and even livestock producers would be hard pressed to support some of the things that the center has done.”
In a letter to the Times, Wayne Pacelle, the CEO of the US Humane Society, said that the “grotesque and inhumane” experiments at the center showed that government and business were colluding to treat animals as “throwaway objects”. “Is it any wonder that millions of Americans are now cutting their meat consumption and eating higher-welfare animal products when this is how government and agribusiness handle their animal-care responsibilities?”
While virginity tests for unmarried women have been universally regarded as unethical in Western countries, the practice is spreading in immigrant communities. Physicians in European countries have been asked to examine whether a girl’s hymen is intact, creating an ethical dilemma for them. If they comply, they may expose the girl to stigmatization, or even put her at risk of being the victim of an honour killing. If they certify her virginity regardless of the result, they will break the doctor’s compact of trust and honesty with patients.
Writing in the Journal of Medical Ethics, a South African physician argues that medical colleges should declare that virginity tests are unethical, thus giving doctors a right to refuse. The Quebec College of Physicians has already done this.
The author, Dr Kevin Gary Behrens, of the Steve Biko Centre for Bioethics, University of the Witwatersrand, is familiar with the issue, as it is a serious problem in South Africa. Girls who “fail” are called “rotten potatoes”. But girls who pass could be targeted by rapists or men who believe that intercourse with a virgin will “cure” AIDS.
He points out that research in The Lancet and the BMJ has shown that “virginity testing” is devoid of scientific value.
“This has the effect of rendering every virginity certificate ever issued by a physician scientifically fraudulent. Thus, for a physician to agree to perform a virginity test entails a flagrant disregard of the principle that medicine should be practised on the basis of scientific principles. The moral obligation of a physician who is approached to perform such a test is clear: the physician should inform the client that it is simply not possible to do what is being asked. Since there is no scientific basis upon which any physician can certify that a particular woman is or is not a virgin, it would be unethical for any physician to concede to such a request.”
The tests are also socially harmful, argues Dr Behrens, as they perpetuate stereotypes about women, misogyny and patriarchal attitudes.