An excursion into time machine ethics

We missed this, sorry, but October 21 was #BackToTheFutureDay, the day Marty McFly travelled to in Back to the Future II. The internet was abuzz with the kind of stuff the internet buzzes about better than anyone else and even POTUS tweeted “Ever think about the fact that we live in the future we dreamed of then? That's heavy, man.”

But with all the palaver about time travel, the only person who studied the bioethical conundrums of time travel was Dr Janet D. Stemwedel, a columnist for Forbes who specialises in time machine ethics. She took seriously a question posed on Twitter by the New York Times Magazine: “If you could go back and kill Hitler as a baby, would you do it?” (Only 42% said yes!)

First of all, she notes that this is question that only a utilitarian will take seriously. Killing an innocent child now is deemed right because it will prevent great evils later. But she counters:  “Given all the moving parts in a world of many people who raised, nurtured, enabled, and assisted Adolf Hitler, why is baby Hitler the moving part to eliminate? If you gamble on killing this baby, who has done nothing wrong and for whom there is no guarantee yet of eventually committing the horrors you hope to prevent, aren’t you using the kind of logic that could justify mass exterminations of other people?"

Furthermore, given the large number of people who shared Hitler’s depraved ideas, someone else would probably step into the gap left by his non-existence. She concludes: “In the process of trying to avoid a great harm that, at the stage of Hitler’s infancy, is in no way inevitable, you’ve made yourself a baby killer, which is surely a harm to baby Hitler, to his survivors, and (if you have any kind of conscience) to you.”

Sound advice, readers, if you ever get your hands on a reliable time machine. 

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Are there limits to informed consent?

If you don’t have a strong stomach, you are allowed to skip what follows and proceed directly to the article links below.

Earlier this month the New York Post, a great source of bioethical conundrums, reported the strange case of 30-year-old North Carolina woman Jewel Shuping.

Ms Shuping is convinced that she was always meant to be blind. But by some terrible accident at birth, she had normal eyesight. “I really feel this is the way I was supposed to be born, that I should have been blind from birth,” Shuping explained. Doctors say that she has Body Integrity Identity Disorder.

Finally she found an obliging psychologist in 2006. After giving her some counselling, he gave her some eye-numbing drops and then washed her pupils with drain cleaner. “It hurt, let me tell you,” she says in a YouTube video. “My eyes were screaming and I had some drain cleaner going down my cheek burning my skin,” she said. “But all I could think was, ‘I am going blind, it is going to be okay.”

So here is the bioethical conundrum: was the psychologist right to destroy his patient’s eyesight if she freely requested it, was happy with the treatment, and was living in psychological torment because she could see?

And if he was wrong and unethical, why is participating in gender reassignment surgery or euthanasia right and ethical? 

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Supervision of euthanasia breaking down in Belgium

The theme of control is at the heart of debates about assisted suicide and euthanasia. For the patients, it’s control of their own lives. For legislatures, it’s control of doctors who end lives. Wherever legalisation has failed, it is due to fears about whether people who have been authorised to kill without police supervision will be adequately monitored. Wherever it has succeeded, those fears have been allayed. 

At the moment euthanasia in Belgium, where it is legal, is not being adequately monitored even by the loose local standards. Its parliament has delegated oversight to a commission of 16 professionals who are supposed to review the file for each case of euthanasia. That system is breaking down. Members are resigning, perhaps because of the huge workload, and the vacancies have been mounting. Legally speaking, the commission has lost its mandate. 

But even though control has manifestly broken down, doctors continue to euthanise their patients at the rate of at least five a day. Is this the system that Belgians voted for in 2002?

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More gendercide

We overlooked an amazing story three years ago -- a study of abortion rates in Nepal. Lately Nepal has been in the news as a hotspot for surrgacy. But it is also a natural experiment in sex-selection.

Abortion was legalised in Nepal in 2002. Almost immediately the sex-ratio in the country began to change. Around 2002 the ratio of girls born to boys born was 942 to 1000 for second-born children. By this ratio had fallen to 742. Amongst the richest urban women, just 325 girls were born for every 1000 boys.

In other words, the legalisation of abortion has been a death warrant for Nepalese girls. Abortion provider Marie Stopes International calls Nepal a "unusual success story" because fertilty there has fallen from 4.1 to 2.6 in just 10 years, one of the most dramatic declines in history. But this was achieved by allowing gendercide to flourish. 

PS -- apologies to our readers. We mixed up mailing lists last week and some of you may have received a daily newsletter meant for subscribers to MercatorNet. We have fixed the issue and I hope that it will not happen again. 

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An historic moment

This week YouTube made history. Literally. Assisted suicide became legal in California after Governor Jerry Brown put his signature on a law passed by the state's legislative assembly and senate. And it would never have happened without a YouTube video which was released on this day, exactly one year ago. 

Compassion & Choices, America's leading right-to-die group, financed, produced and promoted a short video about Brittany Maynard, a 29-year-old, recently married woman with a brain tumour. She was "forced" to move to Oregon where assisted suicide is legal. The video went viral and was seen by millions of people who watched Brittany plead tearfully for the right to die.

It shows the immense power of story-telling in an era which respects emotions more than reasoned argument. 

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The virtuous surgeon

There is a hoary medical joke which runs: “What is the difference between God and a surgeon? God does not think he is a surgeon.” Perhaps there is a bit of truth in the implication that surgeons tend to be brash and bullying. Certainly the disturbing allegations made against Australian surgeons bear it out, as we report in our lead story.

After some appalling reports of sexual harassment by surgeons hit the media, the surgeons’ professional body asked a group of eminent experts to investigate. They found that “discrimination, bullying and sexual harassment are pervasive and serious problems in the practice of surgery in Australia and New Zealand” and called for “a profound shift in the culture of surgery”.

A noble goal, indeed, but how will it be achieved? By creating new lists of standards and writing more reports? The most natural way, surely, is to make character, not just competence, part of medical training. Unless surgeons are virtuous, in the old-fashioned sense of the word, I suspect that it will be impossible to eliminate this seedy behaviour.  

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Is there a “right” to euthanasia?

Milou de Moor committed suicide after her doctor refused to euthanize her.    

When it comes to lawsuits, doctors are extremely gun-shy. Their business is healing people, not lining the pockets of lawyers. That's why the fall-out from a euthanasia case in the Netherlands may be highly significant.

As you can read in this week's BioEdge, a family doctor refused to sign off on the euthanasia of a 19-year-old woman suffering from lupus-related depression, so the teenager committed suicide. Her bereaved family believes that she was denied the right to a peaceful death and has brought the case to a disciplinary tribunal. 

If the doctor is censured, will this effectively lead to euthanasia on demand in the Netherlands? Rather than fight to have their professional judgement respected, I'll bet that most doctors will just rubberstamp every request that passes across their desks. It will be interesting which the Dutch respect more: the informed consent of the patient or the informed consent of the doctor. 

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Euthanasia for unbearable mental suffering in Belgium

Euthanasia in Belgium is an increasingly popular subject for documentaries. The latest comes from Dateline, a program of Australia’s SBS network. (See the video below). Journalist Brett Mason interviews several people who have featured in BioEdge reports over the years. But the main focus is on Simona, an 85-year-old woman whose only reason for requesting death is grief over the sudden death of a beloved daughter.

“It was, without question, the most difficult day I’ve had as a journalist,” he told Daily Mail Australia. “As a foreign correspondent, I’ve seen a lot of people dying. I’ve witnessed a lot of final moments. All of those people, I remember very clearly, didn’t want to die. They had something to live for, something they feared losing.

“What I struggled with most, was that despite being in near perfect physical health, Simona believed she had nothing and no one in her life worth living for,” he said.

Simona is adamant that she wants to die. “I don’t have to justify myself to anyone,” she says defiantly. However, it seems like a pretty miserable way to depart. A doctor, a friend, a nurse, a journalist and a cameraman at her bedside – no relatives. She drinks a lethal dose, asks to put her feet up and dies. It is a scene which will make anyone ask whether Belgian doctors understand what compassion for the vulnerable, the disabled and the elderly means. 

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UK Parliament votes against assisted dying

Too often I have described the deliberations of the British Parliament – most legislatures, really – as an Olympic stadium for windy blatherskite. This is unfair, especially in London, for there are occasions when the honourable members rise to the occasion and deliver excellent speeches. Such was the case on Friday when 85 MPs debated the merits of assisted suicide. The outcome was a resounding defeat for the Yes campaigners; the vote was 330 votes to 118 against a bill presented by Rob Marris, a Labour MP.

However, the quality was outstanding, on both sides of the issue. The former Director of Public Prosecutions, Sir Keir Starmer, revealed his reasons for not prosecuting 79 of the 80 cases of assisted suicide which came before him. This was highly informative, as it could be argued that the guidelines he issued were tantamount to stealth legalisation of helping a loved one to die.  

A number of MPs had accompanied parents or spouses through their last days or were doctors who had rich experience in dealing with dying patients.

I found the speech of Nadine Dorries, a former nurse, particularly interesting, as it confirmed me in my impression that opponents to the right-to-die are not all fuddy-duddies and ideologues. This colourful MP was once described as “a tropical bird in amongst all that dull, grey plumage on the Commons benches”. I particularly relished her cheek in ignoring the dull, grey plumage and participating in a reality TV show called “I'm a Celebrity...Get Me Out of Here!” She was suspended from the Conservative Party for several months over that. 

Anyhow, her speech concluded with a cogent warning about government involvement in assisted dying:

There are people all over the country who do not have a family member or relative as their next of kin. They do not have loved ones. For them, the next of kin is the state. It sends a shiver of fear down my spine to think that such a Bill might be legislated for and approved when so many people who are protected by the law may not have such protection in future because their next of kin is the state. When they feel that they are a burden or they feel under pressure, who will coerce them and who will feel the budgetary constraints involved in looking after them? 

That sums up many of my concerns, as well. 

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The Lancet and assisted dying

At long last, Richard Horton, editor-in-chief of The Lancet, appears to have made up his mind about whether to support “assisted dying” in the United Kingdom.

As he points out in a comment this week, “Careful readers of The Lancet may have noticed that we have had little to say about assisted dying (or physician-assisted suicide) in recent years. Moral cowardice? Perhaps more that we couldn't easily make our minds up.”

A ringing endorsement of a private member’s bill to be introduced this week Dr Horton’s comment is not. But in his carefully worded assessment of its safeguards he rings no alarm bells and he underscores a “growing consensus” on the issue. Altogether, it is a world away from his position in 2006. Back then, commenting on another assisted dying bill, he wrote: “A commitment to life may present troubling dilemmas to the modern physician; but a commitment to death will undermine the very nature of doctoring itself.”

Editors are free to change their minds without explaining why. Unhappily, this is not a courtesy that Dr Horton extended to Baroness Ilora Finlay, whom he describes as “the most high-profile campaigner against assisted dying” in the UK. Baroness Finlay is the immediate past president of the British Medical Association and a leading palliative care physician. She obviously knows more than most of us about death and dying.

Yet Dr Horton slyly suggests that the real reason why she opposes assisted dying is her religious beliefs. “Some of those resisting changes to the law do so by deliberately using speculative and misleading arguments—‘fibbing for God’,” he writes.

Funny about that. In her eloquent essay against assisted dying in The Economist earlier this year, Baroness Finlay put forward powerful arguments. I have no idea what her religious beliefs are, but they weren’t needed to make her case.

If the sharpest arrow in Dr Horton’s quiver is to insinuate that his opponents are insincere and tainted by faith, his others must be blunt indeed. Personally, I can't understand this prurient interest in people's religious lives. Arguments stand or fall on their merits, not on supposed links to extramural activities. One might as well attribute Sartre's atheism to his chain-smoking or Berkeley's idealism to his chronic constipation. 

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