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PaperclipPerfector  1yr ago (text post)   30730 thread views

Culture War Roundup for the week of July 3, 2023

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Medical ethics is a field I am interested in, and I came across an old article in particular in the New York Times that drew my attention lately

https://www.nytimes.com/2014/03/02/magazine/nursing-home-pitfalls.html?ref=theethicist&_r=0

The article in question in The Ethicist column describes a method used to keep dementia patients from wandering to unsafe areas by placing a black doormat in the way. According to the writer, the patients tend to perceive the doormat as a “hole” and feel deterred from passing, and raises the question about whether it is ethical to use one’s disability and/or fear to guide behaviour. In the columnist’s opinion, this application is ethical.

It got me thinking about the treatment given to individuals affected by the most common form of intellectual disability, that is called childhood (I say that half jokingly. Just half).

The fact that the aforementioned question about dementia patients is raised, in a world where adults guiding the behaviour of children through their lack of judgement is just a fact of life, is curious to me. Is there a good reason why childhood and intellectual impairments should be considered fundamentally different, and that the dilemmas of one should be considered separately from the other?

That is not to claim that the purposes and effects of a given treatment are uniform in every context. Of course, there are different degrees and forms of intellectual disabilities, each requiring different types of treatment. But it seems to me that it is relevant to question whether these differences in context justify the difference in treatment.

Right now I tend to think that disproportionately more regard is given to the autonomy of adults with an intellectual disability than to that of children

The careful consideration of even minor interventions with negligible potential harms like this by medical ethics always struck me as admirable. As for why this was discussed for dementia patients and not parenting, I think medical ethics simply cared way more about the details of what they were doing. There's nothing fundamental stopping a similarly detailed childraising ethics field from existing, but it just doesn't.

All this makes it even sadder that medical ethics completely jumped the shark in 2020 and thoroughly discredited itself as a field in doing so.

I have an extremely jaundiced view of medical ethics as a field, seeing it as drag on progress that invisibly kills a hundred people for every dozen it saves.

To the extent I obey its dictats (the ones that haven't been enshrined over a century of normal practise) it's because I'm legally compelled to, or because I don't want to get into trouble with my licensing body.

I'm not saying it's 100% bad, but there's no way of fighting to only adhere to the parts of it that make sense or are good for us.

There's nothing fundamental stopping a similarly detailed childraising ethics field from existing, but it just doesn't.

Yes there is- parents would completely ignore them. Medical ethicists continue talking because doctors and hospitals listen.

Medical ethicists continue talking because doctors and hospitals listen.

The events of the past few years would suggest otherwise.

Assuming you're referring to covid hysteria, the medical ethicists seemed on board with it.

Purely off the cuff: One difference I see is that while dementia patients will only get worse and eventually die, children usually get better and have long lives as self-sufficient adults ahead of themselves, which makes it important to cultivate good habits in the children whereas the same seems to have little importance in dementia patients. Controlling children via unfounded fears may lead to bad habits.

As I said in my post, a treatment has different purposes and effects in each case. Yes, very often the fact that children are expected to learn is a good reason to dispense a different treatment.

What I am saying is that the reasoning about purpose and effect of a treatment is sometimes simply overriden by an automatic assumption of difference of the subject.

Like autonomy and emotional comfort are unduly taken less into consideration in the treatment of children (in my view); and I don't believe that is a result of reasoning, but probably due to a fragmentation of the ethical standards applied to care.

I can't help but chuckle to myself every time I see the phrase "medical ethics" or "bioethics". The millions of physician assisted homicides of unborn children are totally fine -- in fact, it would be unethical to withhold them -- but it is absolutely verboten to participate in the execution of convicted murderers.

I flat out do not trust them. The "medical ethics community" will complain that lethal injection procedures are potentially faulty, but they never come up with alternatives. There is absolutely no reason why it is possible to perform painless heart surgery but not painless execution. They are either lying, or they are perpetuating the unnecessary pain of inmates for political gain. I will not defer to the ethical judgements of these people.

If it means anything to you, I endorse this as a doctor myself.

I don't see why the legal system doesn't go for easier solutions like dosing a patient up on benzos and then putting them in an anoxic room (say with a 100% nitrogen atmosphere), or use something we already know is insidious and painless like carbon monoxide poisoning. You can even skip the benzos, if they strictly need a doctor to hand them out.

As I see it, there's no real point in quibbling over a little discomfort or even a lot of it when you've already consigned someone to death. Just get the damn thing over it, and don't become more concerned about assuaging your soft first world sense of guilt in the field of state-sanctioned killing. (I have nothing against the death penalty either)

I was under the impression that carbon monoxide poisoning is extremely unpleasant and not at all painless. Nitrogen is the way to go, in my opinion. You don't even need the benzos.

Hmm, you're right. It is more unpleasant than I thought, I must have been mislead by the cases of people passing away in their sleep during house fires.

I don't see why the legal system doesn't go for easier solutions like dosing a patient up on benzos and then putting them in an anoxic room

Because if you execute prisoners by any method that hasn't been specifically determined as okay in a previous court decision, death penalty opponents will use lawfare to tie up the system in court cases, preventing you from using that method.

Sure, but firing squads have been ok’d by previous court decisions. It’s just that the USA requires every execution to use the method specifically authorized by state legislatures, and the states which allow firing squads have a torturous process to get there from lethal injection.

I believe Oklahoma is moving towards the use of nitrogen asphyxiation.

I suspected so, and it only cements by general dismay at the level of competence of our global civilization.

At least in India, while getting a prisoner onto Death Row isn't an easy task, with plenty of legal hurdles along the way, we don't fuck around at the very end.

Your comment is not sufficiently related to the topic I am trying to explore here.

If you would like to discuss views on abortion or death penalty, I recommend you start your own thread.

  • -12

Just because you start a thread doesn't mean you own it.

We like to go off on tangents here.

It's fractal tangents all the way down. You won't believe how divorced basement level comments become from the OP's starting point.

I respectfully disagree. My comment may appear to be about abortion and the death penalty, and on one level it is, but the main point I was trying to make is that medical ethics discussions when viewed in context are often patently absurd. I do not have a strong object-level opinion on the specific topic you brought up, but my meta-level take is to be skeptical of the “experts” here when they ask you to trust their judgment.

I agree with you that the general opinions of "professional" bioethicists are very well up for questioning - I mentioned one particular instance of it but refrained from making any judgements about it, as it was not necessary for my exploration.

The way you illustrate this however doesn't seem very adequate as it derailed the debate, leading subsequent comments to the topic of death penalty.

I find that another interesting topic and would genuinely be interested in reading more and perhaps even participating if you create another thread.

Just wanted to give you a friendly advice for you to be more mindful about where to fit your takes, I think it would be more productive for both debates.

The millions of physician assisted homicides of unborn children are totally fine -- in fact, it would be unethical to withhold them -- but it is absolutely verboten to participate in the execution of convicted murderers.

Don't pretend to be stupid. Obviously they don't consider them 'homicides', and you know that.

I was very deliberate in my language. I concede that they do not consider them murders. There are some good arguments that the circumstances reduce or remove moral culpability, but it is willful ignorance for anyone familiar with the biological process of gestation to deny that the intentional killing of a fetus is "homicide".

Well the terminology is almost irrelevant; the point is there's no inconsistency, one can reasonably hold the positions of being pro-abortion and anti-death penalty. You presented it as some kind of contradiction.

but it is willful ignorance for anyone familiar with the biological process of gestation to deny that the intentional killing of a fetus is "homicide".

They decline to classify the fetus as human, and lacking litmus strips for humanity, you can't prove their definition is wrong.

A human is a living thing that either was previously born as an infant homo sapiens or given proper time or care, barring natural medical issues, will be so in the future.

Seems airtight to me. Covers the favorite abortionist argument of "why aren't you crying over the load of cum in the toilet." If it was, is or is going to be an infant homo sapiens, it's a human, and it shouldn't be killed for convenience.

They are either lying, or they are perpetuating the unnecessary pain of inmates for political gain.

Of course they are lying. This article in Voices of Bioethics journal describes wonderful evolution in Canada from right to suicide in 2016 to current murdering of ill people (not even terminally ill, just ill) under euphemism of "death with dignity" or MAID (medical assistance in dying). There were over 10,000 people killed in 2021, over 13,500 in 2022 and the number is rising and quickly becoming leading cause of death in Canada. Presumably unlike executions, killing ill people is painless and wonderful.

I never liked MAID type ideas for just that reason. Killing people is almost always cheaper than treating a complex illness, and medicine like all other industries is about efficiency even if the government is the only payer.

Come on. I am not in favour of euthanasia for non-terminally ill patients, but having said that to act like being in favour of it and being against the death penalty are two somehow contradictory positions is just silly. Clearly the voluntary nature of euthanasia changes their perspective.

But what's the principle behind the distinction? "Consent"? Surely the sort of depressed and chronically ill people who assent to their execution were never in any sort of position to make this decision rationally in the first place. Not to mention those pressured in it for financial reasons, which make it just a roundabout way of executing some subset of the poor without recourse.

I know what mine is when I distinguish between forms of killing: it is right to kill some criminals because it is justice, and society is upholding some metaphysical order in doing so. Whilst letting people you could have helped die because it's easier or cheaper is abominable cowardice that betrays that self same metaphysical order.

What's the argument for the converse view really? Any attempts at constructing some distinction through some liberating principle of self determination immediately crumble in the face of the contradiction between free will and materialism. The core problem of the Rousseauist project of liberating the mind from tye body.

What level of constraint turns assisted death into murder? Apparently it's not a third party's intent to kill. Nor is it being killed when you'd prefer to live.

I don't think the two issues are particularly connected. There is a whole grab bag of potential reasons to be against the death penalty; false convictions, it's seemingly non-existent effectiveness as an additional deterrent, the 'sanctity of human life'. It seems that only the final one of those justifications also entails being against euthanasia

some liberating principle of self determination immediately crumble in the face of the contradiction between free will and materialism

Look, I'm hardly going to try to litigate centuries of debate over free will here, but it seems pretty clear to me that justifying euthanasia on the grounds of respecting the autonomy of the person is a legitimate perspective which is in no way contradictory with a number of legitimate criticisms of the death penalty. I don't even subscribe to the former but to rather glibly discount it as you do is pretty arrogant.

I'm hardly going to try to litigate centuries of debate over free will here

Neither am I, which is why I handwave it.

I'm sure it's possible to extract a position where one has a strong belief in free will and thinks that killing oneself through the State is moral, but it's pretty unconventional.

People who believe in individual will usually go one of two ways.

Either they believe existence is a prerequisite of morality and therefore that suicide is impermissible.

Or they believe whims/reason are beyond question because individual autonomy is paramount, and then the morally reprehensible part isn't that one is permitted to die, but that they have to rely on an institution to do it.

This is the paradox at the heart of Rousseau's idea of liberation: this nonsensical idea that the individual can be freed by dissolving his individual will into the General Will. Which taken to its logical conclusions ends in totalitarian modernisms which would say this scheme is not impermissible, but would justify it through the idea that it benefits the State rather than the individual, which does not exist under such conceptions.

Autonomy is a legitimate perspective indeed (within some moral paradigms anyhow), that's not the issue The issue is an autonomous person doesn't need the State to kill them.

Whilst letting people you could have helped die because it's easier or cheaper is abominable cowardice that betrays that self same metaphysical order.

I can help many poor Africans by selling all my worldly possessions and donating to some charitable cause. This implies that my failure to do so is abominable cowardice on my part, and in fact that everyone except such Africans is engaged in abominable cowardice.

You have no duty to care for proverbial poor Africans. This isn't true of the countrymen a national healthcare system is sworn to protect.

The people being offered death are citizens and in some cases direct wards of the State, sovereignty implies a moral duty to care for your subjects under even purely utilitarian conceptions of it.

Someone is clearly responsible for this particular senseless waste of human life.

This can be true of your proverbial Africans as well, but without a specified scenario it's impossible to tell. That said the problem is unlikely to be one of cowardice in that continent rather than more blatant forms of tyranny, incompetence and corruption, in my experience. Canada has no such excuses.

I think "letting them die" is the wrong term. What is happening here is the state is "actively killing them."

No? I struggle to see how you even came to that conclusion. Would the opposite also be the case? Anyone not spending everything they have on Africans can kill anyone that's costing them money?

You The OP said that "... letting people you could have helped die because it's easier or cheaper is abominable cowardice."

I have failed to help such Africans, and I've failed to help them because it was easier and cheaper to not do so. Some of them will die because of this.

So it follows that I am engaged in abominable cowardice.

If that's the standard for cowardice, rest assured I'm standing by your side and competing to become an even bigger one. I never claimed to be omnibenevolent, merely a net positive of the same. I feel no shame about the matter either!

The question OP posited was that bioethicists claim that medicines used for executions are faulty, they can cause pain and suffering etc. I do not hear these types of complaints when it comes to medicines used for euthanasia. What a coincidence that political motivation clouds judgment of bioethicists in virtually the same scenario of administering lethal drugs.

The WaPo article linked about the American Board of Anaesthesiologists suggests that their objections were not, primarily, about the potential for botching but regarding the mere fact of execution. The quote they give from the Board; 'we are healers, not executioners'. They would be against it even if it was guaranteed to be painless; or at least that seems to have been the case in 2010.

I can't help but chuckle to myself every time I see the phrase "medical ethics" or "bioethics".

Much like "social justice" it's the sort of euphemism that Satan wraps himself in to obscure the fact that the actual goal being pursued is the opposite of what anyone would describe as "ethical" or "just".

I do not agree with ethical views that abortion is a good thing while executions are a human rights violation, but consistent views to that effect are very much possible.

Such as what?

"It is wrong to kill a person who cannot defend themselves." ∩ "Personhood begins at birth."

There is absolutely no reason why it is possible to perform painless heart surgery but not painless execution.

One to the back of the head should suffice. You don't have to tell them it's coming either. I suppose the only real objection is that it's somehow undignified to execute someone that way. Despite the fact that convicted murders gave up that mantle with the direction in life they chose for themselves. Or I suppose a medical ethicist would throw up their hands at that point and claim that's outside the purview of their expertise.

I suppose the only real objection is that it's somehow undignified to execute someone that way.

On the contrary! Kinetic force is a far more dignified way to die than poison. Physical destruction is the proper end for a being who conducts himself uprightly: the only way I will allow myself to die is in direct confrontation with a strength that is greater than my own. Poison is a ghastly and alien force that works by subterfuge instead of direct engagement; it exposes the fundamental precarity of the biological organism in such a shameful way, it smothers and effaces the vital force instead of allowing it to make a proper last stand.

(I have sometimes meditated on the significance of the fact that female serial killers are more likely to use poison than male serial killers.)

"Deleuze extolled the virtues of becoming-child, becoming-woman, the rhizomatic over the arborescent - but he committed suicide by jumping out of a window. What could be more arborescent than that? A straight drop from top to bottom, a hierarchical relationship. Poison would be a truly rhizomatic way to die - why didn't he use poison? Isn't that the final refutation of his philosophy?"

Your value judgements on manner of death don't make sense. "A strength that is greater than your own" can be interpreted in a great many number of ways.

An adult human is capable of 2 kW from time to time. It's pretty easy to buy sodium lightbulbs that are rated at 1000 Watts. By that logic, it's somehow not-shameful to die to three large grow lights - whether by burning or by a slow increase in heat or some other creative method- but not by one large grow light.

How?

If you're cycling...a Joe off the street, untrained, can probably do around 600 watts. A guy that half-asses cycling and doesn't have much sprinting talent might do 1,000. A solid amateur, 1,300. 2,000 watts is a very high number: a large, talented, dedicated amateur or a professional might be able to put down that much power.

I'll bite the bullet.

Three lightbulbs good, one lightbulb bad.

Have you ever had to put down a family pet? If so, what was the method? If not, what method would you use? I’d be very interested in hearing what type of kinetic force you would use on your dog or cat to relieve them of their suffering.

I don't really share your views regarding poison being some extra evil forms of killing, if I was marked for death I find myself strictly agnostic to the means as long as it's quick and as painless as possible.

I'd still like to know it was coming so I can settle my final affairs.

I mostly agree, but Plato's death seemed to me to be a righteous way to go.

I’m assuming you meant Socrates.

Yes. For some reason, I always confuse which of them took the hemlock.

“Your appeal has been denied. The sentence of death will remain unchanged. Your sentence will be carried out shortly.”

Lol, I knew exactly what this video was going to be before I even clicked the link. Well played.

The punishment fits the crime? I get that the character is sympathetic (and attractive...) but she did spy for a foreign government when she was placed in a position of trust. Sounds like espionage and treason to me.

Hard to argue against it, that's for sure.

I think a big part of why we care so much more about the rights of disabled adults is that children already have their autonomy reduced by default. Adults do not, and proving that adults are having their autonomy reduced justifiably is a rightfully high bar because it sets a precedent.

Also, institutions usually care less about their charges than parents do about their kids. Most people understand the iron law of bureaucracy unless it’s convenient for them not to, and understand what that means for individuals at the mercy of an institution, and understand why it doesn’t apply in the case of parents with their children, unless they already dislike those parents.

I personally would feel no qualms about doing something like that, though my usual practise is thankfully limited in its exposure to dementia patients. Call me overly sentimental, but I'm more fond of fields where I can mostly expect my patients to get better or my aid to ameliorate their symptoms, instead of holding their hands till they inevitably croak. There's a reason Geriatricians have a reputation for being unusually cheerful, kind and patient, they need it, because god knows they're not getting much validation from their patients skipping out the door.

The article in question in The Ethicist column describes a method used to keep dementia patients from wandering to unsafe areas by placing a black doormat in the way.

There are entire care homes/neighborhoods in Nordic countries that are designed to carefully mimic a "normal" neighborhood, with cafes, parks and the lot. It soothes the minds of those who find normal care homes too clinical and scary, especially when they're too far gone to understand why they're there.

Is it bad to deceive them into thinking they're in a "normal" place? I don't think so, and at the very least I wouldn't if I imagined myself in their place.

In this case, the deception is in the direction of being intentionally more scary, but I can't find myself to begrudge the people who are otherwise at a wit's end to handle such problems without shackling their wards to a bed.

Is there a good reason why childhood and intellectual impairments should be considered fundamentally different, and that the dilemmas of one should be considered separately from the other?

Well, for one, children grow up and (usually) become more mentally mature. That seems like an important point to me.

There are indeed cases of deception being applied to increase one's well being, as well as for causing discomfort in order to guide behaviour. Both for children and for the elderly.

What I would like to focus however are some things like for example:

-Use of fear to guide behaviour.

-Use of routines in favour of the caretaker's convenience, in detriment of the patients autonomy.

-Use of punishment for undesired behaviour

-Use of rewards as incentive for good behavour

-adequation of responsibilities according to the patient's ability

I think there are some double standards in the general view of how acceptable these things are in the care of children and people with intellectual disabilities. Of course, there is no consensus in each case, and it may even vary for different cultures. Also, the actual treatment is heavilly affected by the circumstances, and children more often enjoy the care of more goodwilling caretakers. But even in ideal situations, I think there is significant fragmentation between what what people believe are the best ethical standards for the treatment of children and for the treatment of the intellectually disabled

I think it would help if you add more clear examples of double standards in your top level post, so we can argue on an object level basis.

As is, I struggle to think of any overarching statements to make.

I will give some examples that come to my mind when it comes to double standards in the care of children and of the intellectually disabled.

  • it is more socially acceptable to say "If you don't stop crying I am going to walk away and leave you here forever" to a child. The same is more frowned upon if said to a disabled person.

  • it is more socially acceptable to ignore a child's wishes to control the time when they eat, shower and go to bed, while for the disabled it is more often seen as a harmful disrespect to their autonomy.

  • it is more socially acceptable to ground a child for misbehaviour than it is to do the same to a disabled person.

  • It is (sometimes) more socially acceptable to allow an intellectually disabled person to engage in activities that are harmful to their health (smoking, opting out of a medical procedure) than it is for children.

I don't claim these things have the same purposes and effects in all cases, and no treatment is a one size fits all. So yes, very often the difference in treatment is reasonable and justified.

But I think people put the "ethical considerations for treating a child" and "ethical considerations for treating a disabled person" in two different boxes for no justified reason.

There’s probably a lot of interesting overlap, but a key distinction in my mind is that a child is the creation and heir of a parent. The parent has an evolutionary instinct to love their child and vice versa. So we allow for more freedom in how parents raise children because we assume that it is done with good intent, and we also assume a parent has certain rights about how to deal with children. Are these rights deserved? I think so, not out of any magical principle of fundamental rights necessarily, but because no one on earth is more likely to have your best interests in mind and be more invested in you than your parents. And no one will know your genetic inclinations more than your mom and dad. As such it makes sense to preserve the power of parents over children. In exceptional cases this power is taken away, which is also good. And if our society finds that parents have an insufficient interest in their kids, this is probably a symptom of a very deep problem that needs to be addressed, because there is nothing that should come more naturally to a human. This is one of the invisible problems of too much economic competition by the way: stressed adults are less interested in their kids and have less energy to spend on them, which leads to net negative consequences down the line, including expensive diseases like obesity and addiction.

Another distinction is that a child will one day be an adult and have decades of freedom. So their period of “indentureship” is brief. We are more okay with contracts that last a few years than one’s whole life.

It is true that children generally enjoy a level of goodwill and competence from their caretakers that other people with intellectual disabilities will hardly come across, and that there are differences in context that justify differences in treatment - most notably, that children will develop and have a long future ahead of them, while other people won't.

What I criticise is that there are many similarities between the different situations that do not seem to be widely acknowledged, and that people seem to have two separate sets of ethical rules for treting children or the intellectually disabled.

What I propose integrating more the discussion of ethical treatment of children and of the intellectually disabled as they are arguably of the same in nature, in order to improve both.

Maybe there could be benefits in introducing more elements of parenting to the treatment of the adult intellectually insufficient, and more elements of incentivized autonomy to the raising of children.

But as of right now I feel there is undue fragmentation in the ethical standards in the treatment of vulnerable people

I don't see anything objectionable in this framing, so you'll find me in broad agreement.

(This is a stronger endorsement than a mere upvote, and the only reason I don't write a bigger comment is because I see no reason)

Edit: I thought this was a reply to me.

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