Which is more egregious: euthanasia or plagiarism?

About five minutes before I was about to entrust this newsletter to MailChimp, I heard that the Canadian Medical Association had just withdrawn from the World Medical Association after the WMA's annual meeting in Reykjavík.

The CMA said that the trigger for this dramatic turn of events was the highly unethical behaviour of the incoming president of the WMA, Dr Leonid Eidelman. It accused Dr Eidelman of plagiarism. This was true and not very smart. A few sentences in Dr Eidelman’s inaugural address to the assembly had been lifted from the inaugural address of a former president of the CMA, Dr Chris Simpson. Since Dr Simpson was one of the CMA’s delegates in Reykjavík, it was highly unlikely that this would go unnoticed. Apparently other passages had also been copied from “various websites, blogs and news articles, without appropriate attribution to the authors”.

"As an organization that holds itself as the arbiter of medical ethics at the global level, the WMA has failed to uphold its own standards,” said Dr Gigi Osler, the current CMA president. “The CMA cannot, in all good conscience, continue to be a member of such an organization.”

The WMA Council and the Assembly accepted an apology from Dr Eidelman. He said that he had relied upon speechwriters – a plausible excuse, as he is a Latvian who emigrated to Israel and who speaks English with a heavy accent.  

This is not the first time that a WMA president has been accused of moral failings. The immediate past president, Dr Ketan Desai, was elected while facing criminal charges for corruption in India. At the time, medical ethicist Art Caplan urged the WMA to ditch him as morally compromised. It didn’t.

So the Canadians’ reaction seems disproportionate. It is more likely that it was prompted by the WMA’s firm opposition to euthanasia, which the CMA vigorously supports. One of the CMA delegates, Dr Jeff Blackmer, posted a bitter tweet about the irony that an unethical plagiarist had once openly criticised him for being unethical in backing euthanasia.

No doubt euthanasia will continue to split the medical profession. Any comments from readers?

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A dreadful weekend

It has been a dreadful weekend. On Saturday Collingwood lost the AFL Grand Final to the West Coast Eagles – in the last five minutes. It has taken me a while to get over this. On the brighter side, today the Roosters beat Melbourne Storm convincingly, 21-6, in the Rugby League Grand Final in Sydney. I just thought that our international readers might like to keep in touch with the world’s greatest sports.

These contests are a testimony to the strength and fitness of the athletes. It’s incredible that they can even walk after being buried beneath a mound of other bodies and sustaining a few quiet kicks to the ribs. But they rise, shake themselves and start sprinting around the paddock, begging for more punishment.

In an interesting analysis of American football below (the kind in which they wear helmets and shoulder pads and take four hours to complete a 60-minute game), two kinesiologists ask whether the sport should be considered unethical in the light of the significant injuries sustained by many players.

It’s a problem with all sports, including rugby league and AFL. Basketballers have terrible ankles; rugby union players have become quadriplegics; cricketers have died. They conclude: “Considering all the morally problematic aspects surrounding football, it is worth asking: Is this the kind of social practice around which Americans should imagine and build their national identity?”

What do you think? Should the threat of severe injury be enough to ban a sport? What level of harm is acceptable?

As for myself, I’m playing it safe. I’m sticking with my preferred sport, full-contact origami.  

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Help needed!

We have a very varied selection of articles this week, ranging from arguments for child euthanasia in Canada, digital smart pills and child transgender affirmation. We are always looking for comments, criticism, and leads. Please do your part, readers!

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Canada laying groundwork for child euthanasia

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About ‘top jobs’

Last year Sydney journalist Miranda Devine interviewed Australia’s first out-of-the-closet transsexual, Carlotta, a cabaret performer and TV actor. Carlotta had what is now called “gender-affirming” surgery in the early 1970s and built a career in show biz. Her advice to teenagers who want to transition to the opposite sex: “Don’t give the child hormones. Wait till 18. You shouldn’t fool around with the body until you’re mature.”

This seems common sense. However, as an article in JAMA Pediatrics (see below) reports, girls as young as 13 are receiving mastectomies to treat their gender dysphoria. Two years later (ie, when they’re 15) the transteens are supposedly as happy as Larry with their “top job”.

This doesn’t seem common sense. How can a girl of 13 give truly informed consent to a life-changing operation which removes both of her breasts? As a growing number of “detransitioners” bear witness, this is crazy. “I’m a real-live 22-year-old woman with a scarred chest and a broken voice and a 5 o’clock shadow because I couldn’t face the idea of growing up to be a woman,” says Carla in a YouTube video.

The risk of turning a young girl’s life into a misery is just too great to allow teen mastectomies before adulthood. In fact, it’s hard to describe it as anything other than child abuse by her physicians and psychologists. What do you think?

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The limits of ‘procreative liberty’

John Robertson was an American scholar in law and bioethics who died last year. He is best known for making a strong case for “procreative liberty”, whether procreation takes place naturally or with the help of technology. As a tribute to his influence, the current issue of the Journal of Law and the Biosciences contains several articles about this theory.  

Robertson’s theme was that reproductive choices which do not harm the interests of others should not be subject to regulation or prohibition. In his best-known book, Children of Choice, published in 1996, he discussed abortion, IVF, surrogacy and pre-natal genetic modification. But time has moved on. The principle of effectively unconstrained “procreative liberty” is being used to justify other developments, some of which are discussed in the Journal, including unisex gestation.  

What I found interesting was that Robertson, in a paper written not long before his death, agreed that a male pregnancy (after a womb transplant) could be ethically justified, but only if it were necessary for genetic reproduction. Even he wanted to draw a line somewhere.

However, the author of one of tribute essays questions this restriction. Enjoying the experience of gestation is reason enough, she says. (See below). I suppose that this raises the question of whether it is possible to draw any lines, anywhere, once we agree that reproductive rights should not be limited.

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Moral fluoridation

Why do I keep screwing things up? This is, IMHO, the first question of moral philosophy. I know what the decent, sensible and right option is, and yet I choose the nasty, mad and wrong option. Bad ideas, said Plato. Bad education, said Rousseau. Desire, said Buddha. Capitalism, said Marx. Nature red in tooth and claw, said Darwin. Myself, I’m partial to the notion of Original Sin, which, as G.K. Chesterton observed, is the only Christian doctrine which can be proved by reading the newspaper.

The second question is how do I stop screwing things up? Theoretically, this can be solved without answering the first question. A number of bioethicists believe that we could live the good life if we spiked the water supply with a kind of morality fluoride. This sounds a bit too much like living as a Delta in Brave New World for my taste, but their concern is preventing very bad hombres from destroying the world. Perhaps the loss of a wide range of human emotions would be worth it.

However, there are other considerations – should we force people to drink the water? Should we tell them that their water has been spiked? All interesting questions – read all about in this week’s newsletter below.

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Remembering the Unabomber

The Norwegian bioethicist Ole Martin Moen has published an unusual but intriguing article in the journal Bioethics. He analyses the arguments in the half-mad manifesto of the Unabomber, Ted Kaczynski. For those whose memories don’t stretch back that far, Kaczynski was a brilliant mathematician who became obsessed with the decay of American society. He retired to a backwoods cabin and worked as a serial postal bomber whose handiwork killed three people and maimed 23 between 1978 and 1995. The New York Times published his 35,000-word manifesto in 1995 which eventually led to his capture.

Moen says that Kaczynski’s concerns should be taken seriously and refuted philosophically, even if he is a terrorist. “Although philosophers can only play a modest role in fighting terrorism, it is striking that, today, the most obvious line of response to one’s adversaries—to listen carefully, to show that one has understood their position, and to explain why one believes they are mistaken—is hardly even attempted as a means to discourage terrorists.”

His words can usefully be applied to many other areas of public discourse today, not just dialogues with ideologically-motivated terrorists. It’s very seldom that opposing sides listen carefully to each other. In the Middle Ages, academic battles took the form of “disputation and debate”. Stating the other side’s argument in the strongest possible form was an essential part of the process – before demolishing it, of course. We need a bit more of this fairness, even for madmen like Kaczynski.

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The dangers of selfies

It’s not an original thought, but with every amazing technological advance comes an unheard-of and very dangerous drawback. Smashing the atom gave us nuclear power and the atom bomb. The automobile gave us hitherto unimaginable mobility and tens of thousands of deaths on the road. The Pill gave women control over their fertility and led to birth rates so low that some countries are in danger of disappearing.

And the mobile phone? Where do we start? This week, with selfies. They give Millennials a buzz, but according to cosmetic surgeons, they also can lead to a psychological disorder which has been dubbed “Snapchat Dysmorphia”. Young women (mostly) are so used to altering their images with apps that they demand the same service from cosmetic surgeons.

“This is an alarming trend because those filtered selfies often present an unattainable look and are blurring the line of reality and fantasy for these patients,” report the authors of an article in JAMA Facial Plastic Surgery.

It would take a sharper mind than mine to define the problem, but our relationship with technology is problematic. We don’t foresee the problems and we can’t control our dependence. Since so much of contemporary bioethics revolves around the proper use of technology, this is something we always have to bear in mind.

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Animal euthanasia

Every year, about 1.5 million cases of euthanasia take place in the United States. Does this have a negative impact on healthcare workers? Sorry, about 1.5 million cases of cat and dog euthanasia take place. But the question is still relevant. Veterinarians, veterinary assistants and shelter workers experience great stress at having to put animals down.

The emotional connection between the work of human doctors and animal doctors is closer than you might think. Owners often react to a pet’s death with the intensity of grief which appears equivalent to the loss of a beloved relative.

So the moral stress which vets experience is relevant. Suicide amongst vets has been the topic of several studies. “Veterinarians are four times more likely than members of the general population and two times more likely than other health professionals to die by suicide,” according to a 2012 study in the journal of The American Association of Suicidology, Suicide and Life-Threatening Behaviour.   

Why? Performing euthanasia day in, day out, also appears to make some vets less able to resist the temptation to commit suicide. The authors of the 2012 study found that “... all else being equal, veterinarians may be more likely than members of other professions to enact a lethal attempt when they desire suicide because their exposure to euthanasia has rendered them less fearful of death."   

Aren’t there lessons in these finding which are relevant to doctors who euthanize their patients? Sometimes doctors in Belgium or the Netherlands are quoted as saying that the death they helped was beautiful or peaceful. Could that be bravado masking their own nonchalance about human death?

How many times have we all heard the argument, “You wouldn’t let a dog suffer like this...” Its logic is that if the suffering of animals and humans is essentially the same, they both should be released from suffering in the same way. But if the animal-human parallel works for the patient, why not for the doctor? If we allow euthanasia, surely we can expect the same burn-out rates and the same suicide rates as veterinarians ... at least the same. That should scare us all – especially the doctors who will be responsible.

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