Every dramatic event in the headlines seems to have a link to bioethics. This is also true of the Boston Marathon bombings. In this issue we report that researchers at Boston University are eager to see the results of an autopsy of Tamerlan Tsarnaev, the alleged bomber who was shot dead by police. As a one-time boxing champion, he could have been tipped over the edge by brain damage from his sport.
The researchers were prudent enough to admit that neuroscience may not be able to explain the atrocity completely. However, is this an example of the increasing tendency of neuroscience to seek determinist explanations for human behaviour? For instance, a recent article in Neuroethics claims that conservatives are more associated with “the dark triad” of human behaviour: Machiavellianism, Narcissism, and Psychopathy. For instance, conservatives may be hard-wired to endorse the use of waterboarding and other “enhanced interrogation techniques” in the war on terrorism.
But is this really a useful way of analysing decision-making? Taken to extremes, could we say that both Muslim terrorists and CIA torturers have been driven to these extremes by their genes, or by faulty circuits in their brains. But if that is true, perhaps democracy and altruism are all determined by our neurons as well. The room for individual agency and free will seems to be shrinking.
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One of the impressive things about the reaction of the police and the government in Boston after the terrible bomb blasts near the marathon finishing line was restraint. The authorities dampened speculation about who was responsible for the atrocity. It could have been a lone lunatic, or a right-wing militia group. Even the media waited until the facts were in. As it turns out the two suspects, one alive and one dead, are Chechen Muslims. But there was no feverish speculation, no finger-pointing, no lynch mobs.
Would that the world media had acted the same way when it covered the death of a 31-year-old dentist in Galway last November. Savita Halappanavar died of septic shock when she was 17 weeks pregnant. As her condition worsened, she asked for an abortion, but her fetus was still alive and her condition seemed manageable, so the doctors refused. Abortion is illegal in Ireland except to save the mother’s life.
The media whipped itself into a frenzy. “Ireland's law and Catholic culture allowed Savita Halappanavar to die,” was the headline in the New Statesman. There were demonstrations in London, Brussels, Berlin and India. Her death was blamed on the Catholic Church and restrictive abortion laws. There could not have been a newspaper in the world that did not carry the story.
But this week the official inquest handed down its verdict. In a unanimous decision, the jury blamed “medical misadventure”. A series of mishaps led to Savita’s death, but at the time, they nearly all seemed like reasonable decisions. It was not a story of stony-hearted prejudice and religious bias. But I don’t think that we will see many of the newspaper columnists apologising. In fact, few newspapers have even reported the story.
In any case, legalising abortion might not help women like Savita at all. Despite -- or perhaps because of-- Ireland's ban, its maternal death rate (6 per 100,000) is one of the lowest in the world, lower, in fact, than countries where it is freely available, like Australia (7), England (12), New Zealand (15), or the United States (21).
Complaining about the media is like complaining about the weather: just shut up and get on with it. However, sometimes the relative coverage given to stories is quite puzzling.
Take the Kermit Gosnell trial in Philadelphia. This is a gory story which reads like a first draft of the torture porn film Saw. Dr Gosnell is an abortionist who has been charged with the seven counts of first-degree murder and one count of third-degree murder. He allegedly killed seven babies who survived abortions and a Nepalese refugee who died after a botched pain-killer injection.
But this is just the tip of the iceberg of thousands of abortions that he did in a poor area of a major American city. Live viable, babies in the third trimester of pregnancy were delivered – and then murdered by snipping their spinal cords with scissors. One of them was so developed that the doctor joked, before snipping, “he could walk me to the bus stop”. He kept amputated feet in glass jars.
"My comprehension of the English language doesn't and cannot adequately describe the barbaric nature of Dr Gosnell and the ghoulish manner in which he 'trained' the unlicensed, uneducated individuals who worked there," said the Philadelphia District Attorney when he investigated the case.
As they say in the profession whose motto is “if it bleeds, it leads”, this is great copy.
But almost no newspaper or network, outside of Philadelphia, has covered it. As Indiana Congressman Marlin Stutzman told an empty House of Representatives, “How is it that, in our age of constant news, not a single major news outlet—not a single major news outlet—has devoted serious attention to the atrocities that weren’t committed halfway around the world but in West Philadelphia, Pennsylvania? Has our national conscience been irreversibly seared by the deaths of more than 1.2 million unborn children every year in this country?”
OK, abortion is controversial. But isn’t the Fourth Estate supposed to be fearless in tackling controversy? Besides, the really important issue is not the guilt of one bad apple, but the failure of the state bureaucracy to detect and discipline him years ago, the failure of his colleagues to report him, the failure of “legitimate” abortion providers to blow the whistle. There was a complete bioethical collapse. The trial of Kermit Gosnell is, believe it or not, a bigger story than PSY’s new YouTube clip or even Kim Kardashian’s divorce. Why isn’t it on the front page?
The Age, a leading Melbourne newspaper, recently ran several articles chronicling a local woman’s decision to take her own life. It was not for any particular reason – 83-year-old Beverley Broadbent just thought it would be better to go while she was still mentally alert and physically active.
Health editor Julia Medew interviewed her and arranged to report how she had come to her decision and why rational old age suicide was a good idea. Under the headline “Suicide a calm and beautiful ending, says witness,” Medew described how a mysterious woman named Amanda accompanied her as she swallowed a lethal dose of Nembutal on the evening of February 11.
Miss Broadbent’s death raises a number of bioethical issues. But it also ought to spark a discussion about Medew’s journalistic ethics. In the first place, a journalist is first of all a human being. Didn’t Medew have a moral obligation to dissuade a relatively healthy woman from committing suicide?
Second, far from being an objective report, Medew’s articles were an unpaid advertorial for Exit International, the euthanasia lobby group headed by Dr Philip Nitschke. In an unsubtle bit of product placement, she even mentioned Nitschke’s “peaceful pill”.
Third, guidelines issued by the World Health Organization about reporting suicides counsel journalists to “Avoid language which sensationalizes or normalizes suicide, or presents it as a solution to problems”. Medew’s series of articles did all three.
And finally, in a bit of face-saving cognitive dissonance, The Age placed the following sentence at the foot of each article: “For help or information visit beyondblue.org.au, call Suicide Helpline Victoria on 1300 651 251, or Lifeline on 131 114.” That’s what I call having your cake and eating it too: painting a rosy picture of one woman’s suicide and then darkly warning everyone else of its dangers. It’s hardly convincing.
The WHO warns that media reporting of suicide can lead to copycat suicides. “It varies as a function of time, peaking within the first three days and levelling off by about two weeks, but sometimes lasting longer. It is related to the amount and prominence of coverage, with repeated coverage and ‘high impact’ stories being most strongly associated with imitative behaviours.” I wonder if The Age will investigate whether or not its irresponsible reporting has caused more deaths.
A bioethicist from Sikkim, in India, Subrata Chattopadhyay, and two US colleagues make a good point in a recent issue of the Journal of Bioethical Inquiry. Why are there so few bioethicists from developing countries on the editorial boards of the leading bioethics journals? Some major journals have none at all.
If the journals were more open to commentary from the developing world, would different perspectives emerge? I suspect so. The issues which keep us in the developed world awake at night revolve around autonomy – euthanasia, reproductive freedom, informed consent and so on.
If other countries were better represented, perhaps notions of naturalness and acknowledging the individual’s obligations to society would be highlighted.
There will be no BioEdge next week because of the Easter holiday here in Australia.
The big event of the week was the election of a new Pope in Rome. The fact that about 6,500 journalists were reporting on the white smoke suggests that his ideas on bioethics ought to be taken into account, whether or not you agree with them. I hope that my own sympathies don’t colour the articles in BioEdge too much, but I ought to disclose that I am quite partial to his ideas.
Even though Pope Francis has clocked up a list of firsts, bioethical innovation is unlikely. No headlines like: “New Pope summons Peter Singer to Vatican to hammer out encyclical on end-of-life issues”. We have translated a few paragraphs from one of his recent books to give you a feeling for his approach.
Xavier Symons has joined BioEdge as a staff writer. He is a philosophy post-graduate student at the University of Sydney. Welcome aboard, Xav!
Our lead story today is (I confess) a bit dated, but nonetheless important. It concerns a female gynaecologist and government minister in the Indian state of Gujarat who was sentenced last year for orchestrating a murderous riot in which 96 Muslims perished – as well as arson, beatings and rape. It came to my attention in the latest issue of the very interesting Indian Journal of Medical Ethics.
Which raises the interesting question of whether doctors who are politicians will always be more respectful of human rights. I’m thankful to a BMJ discussion forum for compiling a list of doctors who also led nations. While there are some admirable men and women among them, there seem to be a high proportion of rogues.
The list includes Bashar al-Assad, of Syria, an opthalmologist who has presided over a civil war which has cost 70,000 lives (so far) and Ayman al-Zawahiri, the elusive head of al-Qaeda. There is Hastings Banda, former president of Malawi*, who was notorious for corruption, and Che Guevara, the controversial Cuban/Argentinean guerrilla leader. There was George Habash, the PLO terrorist leader, and Radovan Karadžić, a psychiatrist who was the president of the Bosnian Serb Republic. He is currently being tried for genocide at the Hague.
There are other more beneficent rulers, quite a number of them. But it does seem that a course in medicine does not inoculate doctors against violence and oppression. They are human, after all.
* Formerly, we said Zambia. Editors, too, are human, after all.
You may recall that in July last year, Melinda Gates, one of the world's richest women, and the British government, organised a family planning summit in London. Rich nations and NGOs pledged US$2.6 billion to meet the unmet need for contraception in the developing world.
At the meeting, India’s representatives swore that there would be a “paradigm shift” in their family planning programs. Somehow the word doesn’t seem to have reached West Bengal, as you can read in the story below.
Early last month more than a hundred women were processed at a “sterilization camp” at the Manikchak Rural Hospital by two doctors. All the guidelines for this kind of event were broken. After the operation, the women, still under the effects of anaesthesia, were dumped in an open field without sanitation. There were no tents. According to the local media, “such frenzied sterilisation camps are routine”.
India no longer has centralised family planning quotas, but in practice state and district officials set targets, leading to disgraces like this.
As far as I can remember, no one ever mentioned “sterilization camps” at the London summit which was applauded so enthusiastically in the world media. It would be interesting to see if some of this $2.6 billion is flowing into the pockets of the doctors who treated these women like animals in the hinterland of India.
Enhancement, physical, intellectual and moral, is a lively subject of discussion among some bioethicists. Is it ethical? Should it be treated as a public good? Should moral enhancement be compulsory? Since the discussion is largely speculative, its more outlandish proposals verge on science fiction. So it makes sense to see what ethical dilemmas sci fi writers have highlighted in their own work.
In this respect, I recently stumbled across an intriguing novel published anonymously by the Victorian writer Edward Bulwer-Lytton. Nowadays Bulwer-Lytton’s memory is preserved by a fiction contest named after him for the opening sentence of the worst of all possible novels. But in his day, he was a best-selling author and much admired by dabblers in the occult.
He also had a gift for coining clichés. One of these, “the almighty dollar”, comes from his 1871 utopian science fiction novel The Coming Race. An American mining engineer discovers that an advanced civilisation, the Vril-ya, dwells in caverns deep beneath the surface of the earth. They possess a substance called vril (for UK readers, Bovril is named after it) which is the source of immense power, light and curing.
This race were once human but they have evolved into utterly superior beings – taller, stronger, wiser, morally upright, and telepathic. The women are the superior sex in every respect.
Their moral enhancement leads them to be serenely inscrutable and detached from emotions. But not more compassionate. In fact, as superior beings, they exterminate whole subterranean communities of more barbarous humans without compunction. “If they ever emerged from these nether recesses into the light of day, they would, according to their own traditional persuasions of their ultimate destiny, destroy and replace our existent varieties of man,” says the narrator ominously.
It’s an interesting reminder that before implementing “moral enhancement”, you need to ask, whose morals?
“A foolish consistency is the hobgoblin of little minds.” This quote from the American essayist Ralph Waldo Emerson is one of my favourite ripostes whenever I have my back to the wall. Nonetheless, inconsistent application of principles is definitely something that irks me in other people.
As, for instance, in the Australian state of Tasmania where the premier and deputy premier have released a long report on legalised euthanasia. They insist that there is no “sound evidence” of potential elder abuse. However, rates of child abuse are nearly 60% higher there than in other Australian states. Isn’t that a bit inconsistent? The kind of people who abuse children probably won’t mind abusing grannies.
And in the Australian state of Queensland (sorry about the focus on Down Under for readers elsewhere), the police union has argued that pregnant women who abuse alcohol should be forced to live in safe houses. "Those [unborn] children also deserve a right to full life and health and should not be disadvantaged simply because of the actions or inaction of their birth mother,” said Union president Ian Leavers.
Obviously this is a controversial issue, but I can’t understand how one can both defend access to legal abortion and lock up women who might harm their children.
On a more positive note, there is a story below from Colorado. Lawyers have been defending a Catholic hospital in a tragic lawsuit by referring to a law which said that foetuses have no rights. After being carpeted by the local Catholic bishops, they have recanted and have admitted that their defence was “morally wrong”. They will no longer cite this law in an appeal to the state Supreme Court.