The deficiencies and dangers of ‘radical individualism’

Book Review: What it means to be human: The case for the body in Public Bioethics

BioEdge

Margaret Somerville*

The deficiencies and dangers of ‘radical individualism’

O. Carter Snead, What it means to be human: The case for the body in Public Bioethics, Harvard University Press, 2020, pp.321

Anyone concerned about the current values conflicts in our societies should read this book. Although it focuses on conflicts in public bioethics, the insights of the author, O. Carter Snead, have application to a much broader range of values conflicts in what are sometimes called the “culture wars”.

Snead starts with a history of American Public Bioethics. He then asks, “What does it means to be human” and addresses two competing responses – “expressive individualism” and “embodiment” – and articulates the anthropology (the study of human beings and societies) that informs each of these views. He argues the former is inadequate on at least two fronts. First, it “forgets the body” and sees the person as only a mind, a self-actualizing will. Second, it does not contemplate or accommodate human relationships and the reality that we are social beings.

Snead then takes an innovative approach to legal scholarship. He proceeds to an in-depth analysis of six judgments handed down by the Supreme Court of the United States in relation to abortion. He undertakes this analysis in order to determine the law’s view, as manifested in these cases, of what it means to be human, that is, the anthropology that undergirds and informs the judgments he considers. . . continue reading

How should a liberal democracy react to conscientious objection claims

Panel 4: Reacting to Conscience Claims in the Public Square

Royal Irish Academy Symposium

Chair:

  • Mr Bryan Dobson, RTÉ

Panellists:

  • Dr John Adentire, Queen Mary University of London
  • Professor Fiona de Londras, University of Birmingham
  • Senator Michael McDowell, Houses of the Oireachtas

How legislators and governments in liberal democracies should react to claims of conscience.


Royal Irish Academy: How should a liberal democracy react to conscientious objection claims

How should a liberal democracy react to conscientious objection claims

Panel 3: Theological and Religious Perspectives on Conscience

Royal Irish Academy Symposium

Chair:

  • Mary McAleese, MRIA, Professor of Children, Law and Religion, University of Glasgow

Panellists:

  • Professor Linda Hogan, Trinity College Dublin
  • Professor David Albert Jones, The Anscombe Bioethics Centre
  • Professor David Novak, University of Toronto

Religious and theological conceptions of conscience; role of conscientious objection within faith traditions; freedom of religion, freedom within religion. Resistance motivated by faith and conscience: military service, health care.


Royal Irish Academy: How should a liberal democracy react to conscientious objection claims

How should a liberal democracy react to conscientious objection claims?

Panel 2: Conscience in Legal Perspective: Challenges and Controversies 

Royal Irish Academy

Chair:

Professor David Smith, RCSI University of Medicine and Health Sciences

Panellists:

  • Advocate General Gerard Hogan, Court of Justice of the European Union
  • Professor Ronan McCrea, University College London
  • Dr. Regina McQuillan, St Francis Hospice

Conscientious objections in healthcare, services, resistance to authoritarian regimes: effects on third parties: meaning of ‘complicity’ .


Royal Irish Academy: How should a liberal democracy react to conscientious objection claims?

How should a liberal democracy react to conscientious objection claims?

Panel 1: Concepts of Conscience

Royal Irish Academy Symposium

Chair: Professor Bert Gordijn, Dublin City University

Panellists:

  • Professor Kimberley Brownlee, The University of British Columbia
  • Dr Katherine Furman, University of Liverpool

Discussion of concepts of conscience, freedom of conscience, conscientious objection, civil disobedience, individual and corporate conscience


When Physicians Engage in Practices That Threaten the Nation’s Health

Philip A. Pizzo,David Spiegel, Michelle M. Mello

When Physicians Engage in Practices That Threaten the Nation’s Health

In December 2020, less than a year after severe acute respiratory syndrome coronavirus 2 was identified as the cause of the coronavirus pandemic, an extraordinary collaboration between scientists, the pharmaceutical industry, and government led to 2 highly efficacious, safe vaccines being approved by the US Food and Drug Administration to prevent coronavirus disease 2019 (COVID-19) infection.1,2 Had the US been in its expected role as a global leader in medicine and public health, this would have been a fitting capstone of US commitment to science and how that can change the course of morbidity and mortality related to a frightening new disease.

However, a less flattering story emerged about the inadequate US response to COVID-19. A number of leaders in federal, state, and local government, guided by political exigency and recommendations from a small number of physicians and scientists who ignored or dismissed science, refused to promote sensible, effective policies such as mask wearing and social distancing. This contributed to the US having more infections and deaths than other developed nations in proportion to population size . . .

Among the ways in which science-based public health evidence has been dismissed in the US is the replacement of highly experienced experts advising national leaders with persons who appear to have been chosen because of their willingness to support government officials’ desire to discount the significance of the pandemic. . .

. . . History is a potent reminder of tragic circumstances when physicians damaged the public health, from promoting eugenics to participating in the human experiments that took place in Tuskegee to asserting erroneously that vaccines cause autism. It can be difficult to hold physicians accountable, especially when they are acting in policy roles in which malpractice lawsuits will not succeed. Professional self-regulation serves as the primary vehicle for accountability and is critical if trust in science and medicine is to be maintained.

To that end, action from within the medical profession is an important but underused strategy. . .


Pizzo PA, Spiegel D, Mello MM. When Physicians Engage in Practices That Threaten the Nation’s Health. JAMA; 2021 Feb 04. Published online February 04, 2021. doi:10.1001/jama.2021.0122

Why human germline genome editing is incompatible with equality in an inclusive society

Calum MacKellar

The New Bioethics

Abstract

Human germline genome editing is increasingly being seen as acceptable provided certain conditions are satisfied. Accordingly, genetic modifications would take place on eggs or sperm (or their precursor cells) as well as very early embryos for the purpose of bringing children into existence with or without particular genetic traits. In this context, a number of already discussed and separate arguments, such as the (1) synecdoche, (2) non-identity (3) inherent equality and (4) expressivist arguments, can be brought together in the new context of examining, from an ethical perspective, some of the possible consequences of such germline genome editing. In so doing, it becomes clear that these novel procedures are incompatible with the concept of equality in value and in worth of all human beings in a genuinely inclusive society. Such equality is expressed in Article 1 of the United Nations’ Universal Declaration of Human Rights which states that: ‘All human beings are born … equal in dignity and rights.’


MacKellar C. Why human germline genome editing is incompatible with equality in an inclusive society. New Bioeth. 2021 Mar;27(1):19-29. doi: 10.1080/20502877.2020.1869467. Epub 2021 Jan 17. PMID: 33459206.

Euthanasia in the Netherlands: a claims data cross-sectional study of geographical variation

A. Stef Groenewoud, Femke Atsma, Mina Arvin, Gert P. Westert, Theo A. Boer

Euthanasia in the Netherlands: a claims data cross-sectional study of geographical variation

Abstract

Background The annual incidence of euthanasia in the Netherlands as a percentage of all deaths rose from 1.9% in 1990 to 4.4% in 2017. Scarce literature on regional patterns calls for more detailed insight into the geographical variation in euthanasia and its possible explanations.

Objectives This paper (1) shows the geographical variation in the incidence of euthanasia over time (2013–2017); (2) identifies the associations with demographic, socioeconomic, preferential and health-related factors; and (3) shows the remaining variation after adjustment and discusses its meaning.

Design, setting and methods This cross-sectional study used national claims data, covering all healthcare claims during 12 months preceding the death of Dutch insured inhabitants who died between 2013 and 2017. From these claims all euthanasia procedures by general practitioners were selected (85% of all euthanasia cases). Rates were calculated and compared at three levels: 90 regions, 388 municipalities and 196 districts in the three largest Dutch cities. Data on possibly associated variables were retrieved from national data sets. Negative binomial regression analysis was performed to identify factors associated with geographical variation in euthanasia.

Results There is considerable variation in euthanasia ratio. Throughout the years (2013–2017) the ratio in the three municipalities with the highest incidence was 25 times higher than in the three municipalities with the lowest incidence. Associated factors are age, church attendance, political orientation, income, self-experienced health and availability of voluntary workers. After adjustment for these characteristics a considerable amount of geographical variation remains (factor score of 7), which calls for further exploration.

Conclusion The Netherlands, with 28 years of legal euthanasia, experiences large-scale unexplained geographical variation in the incidence of euthanasia. Other countries that have legalised physician-assisted dying or are in the process of doing so may encounter similar patterns. The unexplained part of the variation may include the possibility that part of the euthanasia practice may have to be understood in terms of underuse, overuse or misuse.


Groenewoud AS, Atsma F, Arvin M, Westert GP, Boer TA. Euthanasia in the Netherlands: a claims data cross-sectional study of geographical variation BMJ Support Palliat Care. 2021 Jan 14:bmjspcare-2020-002573. doi: 10.1136/bmjspcare-2020-002573. Epub ahead of print. PMID: 33446488.

Twin pregnancy, fetal reduction and the ‘all or nothing problem’

Joona Räsänen

Journal of Medical Ethics

Abstract

Fetal reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. Use of assisted reproductive technologies increases the likelihood of multiple pregnancies, and many fetal reductions are done after in vitro fertilisation and embryo transfer, either because of social or health-related reasons. In this paper, I apply Joe Horton’s all or nothing problem to the ethics of fetal reduction in the case of a twin pregnancy. I argue that in the case of a twin pregnancy, there are two intuitively plausible claims: (1) abortion is morally permissible, and (2) it is morally wrong to abort just one of the fetuses. But since we should choose morally permissible acts rather than impermissible ones, the two claims lead to another highly implausible claim: the woman ought to abort both fetuses rather than only one. Yet, this does not seem right. A plausible moral theory cannot advocate such a pro-death view. Or can it? I suggest ways to solve this problem and draw implications for each solution.


Räsänen J. Twin pregnancy, fetal reduction and the ‘all or nothing problem’. J Med Ethics. 2020 Dec 21:medethics-2020-106938. doi: 10.1136/medethics-2020-106938. Epub ahead of print. PMID: 33443129.

The Declaration of Geneva: Conscience, Dignity and Good Medical Practice

Sean Murphy, Ramona Coelho, Philippe D. Violette, Ewan C. Goligher, Timothy Lau, Sheila Rutledge Harding, Rene Leiva

World Medical Journal

Since 1948 the Declaration of Geneva (the Declaration) has insisted that physicians must practise medicine “with conscience and dignity.” In 2017 this provision was modified by adding, “and in accordance with good medical practice” [1].

Good medical practice in Canada is said to include providing euthanasia and assisted suicide or arranging for someone else to do so. From this perspective, physicians who cannot in conscience kill their patients or collaborate in killing are not acting “in accordance with good medical practice,” and – some might say – the revised Declaration.

However, this merely literal application of the text cannot be correct, since the WMA later reaffirmed its support for physicians who refuse to provide or refer for euthanasia and assisted suicide even where they are considered good medical practice [2]. A reading informed by the history of the document is necessary and consistent with the care taken in its revision [1]. This yields a rational and coherent account of the relationship of conscience and dignity to medical practice.


Murphy S, Coelho R, Violette PD, Goligher EC, Lau T, Harding SR, Leiva R. The Declaration of Geneva: Conscience, Dignity and Good Medical Practice . WMJ [Internet]. 2020 Aug; 66(4): 43-47.