Ethical discussion from the Bioethics Centre / Te Pokapū Matatika Koiora and elsewhere.
Diluted Delusion
How a Frenchman thought water had memory, and how a magician proved him wrong
By Steve Ting
Thursday 24 May 2012
12 – 12:50pm
Centre for Science Communication
Annexe Seminar Room
Abstract:
In the late 1980s, the prestigious journal of science known as Nature printed an article that sent shockwaves throughout the scientific world. Homeopathy is a form of ' alternative' medicine that scientists had deemed to be nothing but sheer quackery. However this paper seemed to suggest that homeopathy actually might have some sort of medicinal effect.
So the lines were drawn in the sand and the battle for the 'memory of water' commenced. One was led by a charismatic yet stubborn French scientist and the other by the rock band KISS's former on-stage magician.
Come join me as we revisit this now infamous battleground of science history. Twenty years after the offending article was first published, we shall see that indeed the winning side had truly won the war.
H/T to Colin Gavaghan for this information.
From the label provided by the Philadelphia Museum of Art:
Dr. Samuel D. Gross appears in the surgical amphitheater at Jefferson Medical College, lit by the skylight overhead. Five doctors (one of whom is obscured by Dr. Gross) attend to the young patient, whose cut left thigh, bony buttocks, and sock-clad feet are all that is visible to the viewer. Chief of Clinic Dr. James M. Barton bends over the patient, probing the incision, while junior assistant Dr. Charles S. Briggs grips the patient's legs and Dr. Daniel M. Appel keeps the incision open with a retractor. The anesthetist (Dr. W. Joseph Hearn) holds a folded napkin soaked with chloroform over the patient's face, while the clinic clerk (Dr. Franklin West) records the proceedings. A woman at the left, traditionally identified as the patient's mother, cringes and shields her eyes, unable to look. Confident of the outcome of the operation, Dr. Gross calmly and majestically turns to address his students, including the intent figure of Thomas Eakins, who is seated at the right edge of the canvas.
Here is a close-up of Dr. Gross's hand (via)
More information about this painting can be found here.
Created by: MedicalTranscription.net
Thanks to Jen Rhee for getting in touch with this.
The recent debate around Maryan Street’s End of Life Choice Bill has been intriguing from a range of perspectives. One interesting feature – to me at least - has been the relative absence of explicitly religious objections to euthanasia and assisted suicide. Even John Kleinsman, Director of the Roman Catholic Nathaniel Centre, has recently emphasised that ‘I am, in all honesty, not interested in imposing my religious views on anyone.’
The extent to which law and politics in New Zealand ought to be insulated from matters of faith is a contested question – one which was the subject of an interesting recent discussion at Otago University’s Centre for Theology and Public Affairs.[1] Nonetheless, there does seem to be an interesting level of tacit understanding that the euthanasia debate should be thrashed out on broadly secular grounds (though of course there is no reason at all why theologians and members of the clergy can’t be involved in this debate). Thus, Kleinsman – like most of the Bill’s opponents to date – seeks to base his opposition on concerns that would be widely, if not universally shared by New Zealanders of all faiths and none.
So which universally shared principles could be threatened by allowing assistance in dying? The most commonly expressed can be roughly divided into two camps. First are the deontological objections. These are concerned with the inherent moral wrongness of the act itself. In this case, they would contend that intentional, active killing is always wrong.
Of course, the law does allow one famous exception to this: when the killing in question is in self defence. There have been whole books published on the question of why self-defence ought to be a permitted exception to the rule, but the fact that it is accepted – and that practically no-one would argue that it should not be accepted – is our first clue that the ‘absolute’ barrier against killing is at least somewhat permeable.
More relevant to the present debate, though, is the fact that NZ law presently allows doctors, in various ways, to assist people who choose to die. The Bill of Rights Act provides that ‘Everyone has the right to refuse to undergo any medical treatment.’ This means that competent adults can choose to have life-support machines switched off. They can – like Margaret Page – choose to starve themselves to death. Jehovah’s Witnesses can insist on refusing blood transfusions.
For some people, this is not at all the same thing as Maryan Street is proposing. As Don Evans wrote last year, ‘There is a great deal of difference between cases of withdrawing treatment and allowing a person to die on the one hand and deliberately administering substances or using other means to deliberately commission the death of a patient.’ And it’s certainly true that NZ law – just like the law in the UK, and throughout the common law world – attaches considerable significance to the line between acts and omissions.
Closer inspection, however, shows that this line – so important in theory – is neither as bright nor as straight as we might expect. People like Margaret Page do not just have the right to be left alone to die in peace; they can in fact insist on having the treatment that is keeping them alive stopped. What this means is that a doctor or nurse must enter the patient’s room and physically switch off or remove the apparatus on which the patient’s life depends. A doctor doing this will not have to worry whether the courts will regard this as a justifiable or excusable act. In fact, the courts will – in contravention of logic and language – deny that it was an act of any kind.
As the Scots ethicist Ken Boyd has said: ‘Even among doctors, who often find the omission/act distinction psychologically helpful, there are those… who find it difficult to see how switching off a ventilator in such circumstances can be regarded as other than an act.’
That this is a bizarre classification becomes even more apparent if we consider what would happen if anyone else were to creep into an intensive care ward and begin switching off ventilator machines. Could they possibly hope to take refuge behind the argument that they were omitting to act rather than acting? The very notion is absurd – and fortunately, the criminal courts would agree. But how can the very same thing be ‘an act’ at my hand, and ‘not an act’ at a doctor’s?
Doctors can also assist in their patients’ deaths by using the doctrine of double effect. This means that a doctor who administers a large dose of diamorphine to a suffering patient, in the knowledge that this will probably shorten their life, will not be deemed to have committed a crime. Though the precise rationale for the defence in NZ law is somewhat murky, it seems to rely on a distinction between outcomes that are intended, and those which are foreseen as extremely likely, but not actually intended.
This is complex territory, for lawyers as well as philosophers. On the one hand we have the sort of view put forward by Michael Jefferson, who argues that ‘By imbibing alcohol you may foresee a hangover as a certain result, but one would not say that you intend to have a hangover.’ This distinction has some intuitive appeal. When, on that very rare occasion, I pour myself that one glass too many of Central Otago pinot noir, I’m certainly not doing so because I want to have a hangover. There again, the law doesn’t generally require that I want something in order to have intended it. It’s possible to act intentionally, but with mixed feelings, or even with the greatest reluctance.
Furthermore, we might take the view that this sort of argument risks losing sight of the real question: when ought the law to hold someone accountable for the results of their actions? If I drink so much that I’m unable to go to work tomorrow, should I have to answer to my employers, colleagues and students for that decision? Or should I be able to shrug off responsibility on the basis that, while I knew I would probably be too hung over to go to work, I didn’t actually intend the hangover? I intended to drink the pinot, but merely foresaw the headache.
Looked at like that, it isn’t entirely clear that the doctrine of double effect offers a morally credible get-out for doctors, any more than it should for pinot-loving lecturers. As Ted Honderich has argued, in a different context, ‘It is nonsense to suppose that something is to be judged right as a result of ignoring some of what you know or believe it will do.’
The second class of arguments could broadly be classed as consequentialist: allowing voluntary euthanasia, however well-intentioned, will end up with people being pressured, coerced or guilt-tripped into ‘choosing’ death, or possibly even flat-out killed against their will. This is what John Kleinsman is getting at when he says his argument ‘centres on safety and protection of those who are vulnerable’, while Don Evans worries that ‘The elderly, the severely disabled, the seriously ill might be concerned that in times of scarce resources they might well be considered as usefully dispensable by the medical profession.’
This is a line of argument with serious emotional resonance for almost everyone. Even those of us firmly committed to the ‘right to die’ for the determined and competent worry about the prospect of this coming to seem like a burden for the frightened, the vulnerable and the confused: ‘If you tolerate this, then your granny will be next’, as the Manic Street Preachers may have sung.
The problem for proponents of this view is that there is no obvious reason to suppose these concerns are any more valid or serious when someone requests assisted suicide than when they insist on having their life-support switched off. If there are dangers arising from coercion, deception or desperation, they are, presumably, as likely to arise in the one case as in the other.
Think about one example I mentioned earlier – the Jehovah’s Witness who wants to refuse a blood transfusion. Is there a possibility that this refusal is actually a result of emotional pressure from his family, elders or fellow religionists? Or what of the paralysed woman who wishes to have her ventilator turned off? Can we be absolutely confident that she isn’t acting out of transient despair, or out of fear of being a burden to her family? If we’re being honest, I think we’d have to concede that these dangers can’t be entirely ruled out.
So how does the law proceed in such cases? Does it deny everyone the right to make these choices, for fear that some people will be pressured into them? In fact, what it actually does is rely on the medical profession and the courts to guard against these dangers, and to scrutinize the authenticity of the choices in question. Where the court is not satisfied that the patient’s decision was sufficiently well informed and free from outside pressure, it can order psychiatric assessment. The judge can, as in one famous case, go to the patient’s bedside and interview her in person. Ultimately, if still not satisfied, the court can instruct doctors to ignore the apparent refusal and keep the patient alive– as it did in another well-known English case involving a Jehovah’s Witness blood refusal.
These will not always be simple decisions, and hard questions may well arise. Can depression be consistent with competent choice? How about fear of being a burden? I can easily imagine good arguments in both directions about such instances. What I can’t imagine is why the answers to these questions should be different in the context of treatment refusals and in the context of requests for euthanasia. There may be other reasons to distinguish between these two scenarios – though as I’ve argued above, the division between ‘acts’ and ‘omissions’ is not particularly clear or compelling, either in law or in ethics. But with regard to consequentialist concerns about vulnerability and coercion, the truth is that they apply no more to euthanasia than to the choices we currently allow.
Associate Professor Colin Gavaghan is Director of the New Zealand Law Foundation Centre for Law and Policy in Emerging Technologies in the Faculty of Law at the University of Otago.
[1] There have also been a few interesting recent books dedicated to the subject of secularism; see, for instance, Russell Blackford’s Freedom of Religion and the Secular State
This controversial policy was discussed on the Radio New Zealand National show "The Panel". The panel (this week) consists of host Jim Mora, panelists Raybon Kan and Tony Doe. University of Auckland philosopher Tim Dare was called on to provide his view. (H/T to Lynley Anderson for alerting me to it.)
The Bioethics Centre / Te Pokapū Matatika Koiora is within the Division of Health Sciences at The University of Otago. We aim to promote discussion and understanding of bioethics and bioethical issues. We are actively researching and teaching in this area. More information can be found at our website. Follow us on Twitter and Like us on Facebook.
Unless stated otherwise, all posts are managed by Mike King.
