The Professional is Political
Yesterday it was reported that [more] that Prof John Ashton, a county medical officer for Cumbria, had been called by his Primary Care Trust (PCT) to attend a hearing. This had, apparently, been arranged to consider if he had broken the NHS code of conduct by appending his signature to an letter criticising Lansley's proposed NHS reforms. It seems that someone thinks that having a political opinion is not a privilege NHS employees enjoy and it started off another round of #iamspartacus on the twitters.
However, in the News and Star, a local Cumbrian newspaper, Prof Ashton is quoted as saying:
[Prof Ashton] stressed it was his professional – not personal or political opinion – that the reforms will cause irreversible long-term damage to the health service.
I am not sure what it is that makes Prof Ashton's opinion on these matters in some way a 'professional' one, as distinct from a personal or a political one. Indeed I don't think a professional opinion on these reform either needs or can be differentiated from a personal opinion and it certainly cannot be said to be apolitical. However I do not think there is any need for Prof Ashton to deny his professional opinion on NHS reform is in no way related to his personal or political opinion. They cannot and should not be separated. Certainly when he is speaking in a professional-political capacity then his 'mode of expression' might be somewhat different to when he is speaking in a purely personal-political capacity but professionals cannot, in some way, be deemed or demanded to be apolitical.
Death: Metaphysical and Epistemological
A little while ago I attended a workshop held by the Philosophy of Medicine research group at King’s College London. The focus of the day was on ‘Death’ and as one point I made a comment about how our discussion was, in my view rightly, beginning to range across what John Searle might call ‘brute’ and ‘social’ facts. In this particular case the ‘brute facts’ could have been understood to be some of the philosophical arguments we had discussed as well as the largely implicit or assumed biological facts, or biological metaphysics, of death. In contrast the ‘social facts’ would be related to our cultural acceptance of death as a part of life; our ability to discuss death and plan for our own and that of others; the way in which we handle death in hospitals and elsewhere; the way in which death is written into law, professional guidelines and in actual (clinical) practices. In the break another of the days attendees asked me how death could be a social construct and I am afraid I did a rather bad job of answering. I think this is because it wasn’t exactly what I was trying to say with my comment and because the concept of death isn’t really something I focus on in my research, although it was a minor topic of concern when I undertook the MA in Health Care Ethics at Leeds.
Elective Ventilation and Opting-In or Opting-Out
The biggest UK bioethics story of this past week (apart from the on going attempt to ruin the NHS by the Tory led coalition) has been the BMA's report 'Building on Progress: Where Next for Organ Donation Policy in the UK' which proposes and considers a number of ways in which the supply of organs suitable for transplantation might be increased. Public discussion has been particularly focused on the idea of 'elective ventilation' which involves extending life support to patients who will derive no benefit from the treatment (although since they will derive no benefit it is questionable if it can be called treatment). Dominic Wilkinson, an Australian Consultant Neonatologist and Assistant Professor of Medical Ethics at the University of Adelaide, discusses the ethics of elective ventilation here, on Oxford's Practical Ethics blog and here, cross posted on the JME blog. Broadly speaking elective ventilation is where the sole reason for commencing or extending 'life support,' i.e. artificial ventilation, is to allow for the harvesting of organs in the best possible condition for transplantation.
Documentaries and Social Science Research Ethics
I have a particular interest in social science research ethics and, in contrast to my perception of the views of many ‘(bio)ethicists’, I don’t think that biomedical research ethics provides a good model for the social sciences. It seems to me biomedical research ethics provides a rather blunt tool for understanding and addressing the ethics of social science research and particularly, perhaps especially, or even only, interpretative and qualitative social science. The kind that involves detailed involvement with research subjects on the part of the researcher.
My concern for a research ethics appropriate to the social sciences is twofold. First, I think that the qualitative social scientist can be presented with particular ethical challenges that are not addressed, or too simplistically addressed, by the concepts of biomedical research ethics. A more ethical social science needs tools more appropriate to the domain. Second, I think that in some cases biomedical research ethics can prevent or stymie certain social science research projects.
Deeper Concerns with Ectogenesis
This post over on Bioedge pointed me towards a couple of essays published in the current edition of the Cambridge Quarterly of Healthcare Ethics on the subject of ‘Ectogensis’ or ‘Extra Corporeal Gestation’ (ExCG). The first, by Murphy, is a critique of an earlier paper by Smajdor. The second is her response.
The arguments they present do not, as Bioedge’s title a little misleadingly suggests, concern the ethical status of pregnancy per se. Rather they concern whether we have a moral motivation to develop a technology that would relieve women of the burden of pregnancy given the basic facts of human reproductive biology and the prima facie inequality between the sexes it presents. This is Smajdor’s argument and her approach is a Dworkinesque (and Rawlsian) approach. In the final flourish of her initial paper, she asks us to consider if, from behind a veil of ignorance,
“Would you prefer to be born into society A, where women bear all the risks and burdens of gestation and childbirth, as they do now, or society B, where ectogenesis has been perfected and is routinely used”?
There is a lot one could say about these papers and the way in which the argument is conceived, presented and developed. As evidenced by the veil of ignorance approach, behind which we are supposedly rendered gender neutral but are in fact constructed according to a masculine schema, Smajdor's conception of gender and sexual equality is one where female difference is neutralised. It is, therefore, one in which women are rendered equal to men rather than gaining equality on their own terms. Rendering women equal to men by reconstructing them as men has obvious implications, already articulated within feminist discourse, for the way in which we understand gender and gender neutrality. One might respond that, in this case, we are dealing with the 'brute facts' of reproductive biology however I do not think that, particularly in this case, sex and gender are as fully distinct as we might think.
The VIth UK Postgraduate Bioethics Conference
The Call for Papers for the VIth UK Postgraduate Bioethics conference has been announced over on www.postgradbioethics.co.uk. This years theme is 'Bioethics and the Body' and the areas of particular focus are: The Treatment/Enhancement Distinction; Disability Ethics; Sociology of the Body; and Transhumanism. The guest speakers will be: John Harris (Manchester), Jackie Leach Scully (Newcastle), Gill Haddow (Edinburgh) and Kevin Warwick (Reading).
Suggested topics for postgrad papers are:
¤ Philosophical, legal, anthropological and sociological discussions on the boundaries of medicine and science.
¤ What constitutes “the Body”?
¤ Human enhancement and the extension of biological, physiological, and neurological capacities.
¤ The moral status and significance of emerging forms of biomedical technology.
¤ Ethical issues in transgenics and the human body.
¤ Feminist and Queer approaches to “the Body”.
¤ Methodological approaches to researching “the Body”.
But I am sure they are interested in postgraduate's whose falls in any area of bioethics and is interested in attending. There will be sessions on the academic environment, networking opportunities and masterclasses with the speakers. Contact postgrad.bioethics@gmail.co.uk for more info.
New Website, New Blog.
So, this is my brand new, ever so slightly amateur, website. I plan on making more use of the blogging facilities that it affords me. The few posts that predate this one have been rescued from my old site. Mostly for posterity. Mostly so that there is at least something here.
Beyond Philosophical Bioethics: A Reading List
[The below was ported from a previous blog/ website. It was written in early 2011 and contains some minor edits made in early 2012)
I recently organised a postgraduate conference on social scientific approaches to bioethics. As perhaps I do too much I offered a number of people my views on what they should be reading. As someone who has spent too long reading academic books across a range of disciplines I kid myself that I might have read something they would not otherwise have come across, or, if they came across it today rather than tomorrow, it might have an immediate and positive impact. Whether or not it was merely politeness a couple of people asked me to email them my recommendations and one for my ‘social scientific’ reading list. Having myself traversed the current bioethical trajectory from philosophy and law to social and human sciences I guess that many people would appreciate a quick guide to doing so. Of course there is no substitute to getting down and doing your own research and finding your own material but if I had to tell you what to read, I guess this would be it.
Oh, Mr Self, with these Blog Posts you are really spoiling us.
So, I sent Mr Will Self (of Shooting Stars fame)* my essay “Literature, History And The Humanization Of Bioethics” because it had a passage about one of his short stories. (Leberknödel, which can be found in Liver.) I am glad to say he didn’t hate it and was kind enough to have the relevant extract put on his website here. Anyway, I don’t know if this counts as ‘impact‘ but I am going to crow about it indefinitely.
Sorry.
* Obviously Will is more famous for being an Author and getting fired from the Observer for the most spectacular of reasons but to a certain generation (my generation) he will always be remembered as the Captain of Team A!
Why do Human Scientists sometimes shun Bioethicists? A GLEUBE Polemic
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Globalising European Bioethics Education, or Gleube as it is more commonly known, is a project headed up by the University of Central Lancaster and in partnership with Cardiff University, Dublin City University, University of Helsinki and University of Oslo. Along with its various other endeavours i welcomes ‘polemics’ on bioethics or bioethically related subjects for publication on its website. A couple of previous ones caught my eye, particularly two by Markus Neuvonen of the University of Helsinki and a Gluebe Research Associate. These were "How hard we want our facts?” and “Why do bioethicists sometimes shun social sciences?” Lets just say I don’t entirely agree. So I wrote my own, as anyone is welcome to do so.
The result was: Why do Human Scientists sometimes shun Bioethicists? Let me know what you think!
These bioethicists certainly are a funny lot, anyone would think that those who see to examine, analyse and proffer ethical advice would be some kind of human scientists. You know, an interdisciplinary sort who draws on an interdisciplinary perspective. A general academic intellectual type who makes use of the diverse knowledge and methodologies of fields such as history, the humanities, sociology, anthropology, medicine, psychology, cognitive science, law and education all tied up in a socio-cultural philosophy which recognises the centrality of Wittgenstein’s and Austin’s insights on language. I mean it is an ideal, one which perhaps no-one could live up to, but wouldn’t you think that such an approach would be the central one for an emergent and developing modern discipline seeking synthesis in a multicultural, ethically and interpretively pluralist society? Yet for some reason they all seem to be analytic philosophers or, worse, those legal, jurisprudential types. Perfectly acceptable in its way, but do they all have to do that?
ESPMH Young Scholar Prize. (W00T!)
I am absolutely chuffed, indeed over the moon, to have been awarded the European Society for the Philosophy of Medicine and Healthcare (ESPMH) 2010 Young Scholar Prize for my essay “Anti-Theory in Action? Planning for Pandemics, Triage and ICU Or: How not to bite the bullet.” The full essay is not available yet but it has been submitted accepted for publication published with to the journal Medicine, Healthcare and Philosophy. I will be presenting the work at the ESPMH 2010 annual conference in Zagreb. Should be a great conference, I went to 2009 in Germany. See you there!
The paper is here: http://www.springerlink.com/content/t368j79j87342036/
The full reference is: Medicine, Health Care and Philosophy. 2011: 14(1): 91-100. DOI: 10.1007/s11019-010-9289-5
Abstract:
Anti-theory is a multi-faceted critique of moral theory which, it appears, is undergoing something of reassessment. In a recent paper Hämäläinen discusses the relevance of an anti-theoretical perspective for the activity of applied ethics. This paper explores her view of anti-theory. In particular I examine its relevance for understanding the formal guidance on pandemic flu planning issues by the Department of Health (DoH) in the UK and some subsequent discussions around triage and reverse triage decisions which may be considered by Primary Care Trusts (PCTs) in setting their own policies and which may face clinicians in the eventuality of a pandemic. Following Hämäläinen in contrasting reflective equilibrium with her anti-theory inspired suggestion of an instrumental approach to moral theory in practice I demonstrate how this understanding complements the diversity of our intuitive moral judgements. Consequentially I suggest that this anti-theoretical instrumental approach is in greater accord with the conditions under which such policy planning and decision making is, or will be, made. Furthermore, on the grounds of keeping open the ethical dimensions of medical practice in conditions of uncertainty, i.e. during a pandemic, I suggest that the anti-theoretical instrumental perspective is, ethically, the preferable approach to producing such policies and guidelines.
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