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PaperclipPerfector  10mo ago (text post)   30492 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

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.

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.

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