I fear that male circumcision will never be seen as equivalent in
harm to female circumcision in the eyes of Americans. In places such as
America where circumcison has become the rule as opposed to the exception,
cultural conditioning will always dictate morals instead of ethics. As you
said in your letter, many circumcised men will never know the pleasures
of being intact.However despite this kno...
I fear that male circumcision will never be seen as equivalent in
harm to female circumcision in the eyes of Americans. In places such as
America where circumcison has become the rule as opposed to the exception,
cultural conditioning will always dictate morals instead of ethics. As you
said in your letter, many circumcised men will never know the pleasures
of being intact.However despite this known fact, many circumcised men
will continue to pressume that there is no difference whatsoever between
being circumcised and being intact. This cannot be allowed to continue,
men who were circumcised at birth have no place dictating whether or not a
young boy should be circumcised. Unfortunately though many women are no
better qualified, as they too have been conditioned to believe that
circumcison is normal and should be enforced no matter what the cost. We
are left wondering, who then is qualified? The answer is no one, this
life changing decision should be left soley to the person in question.
Although genetic selection has a slew of issues involved with the
process, what dictates hyper-parenting? If being a hyper-parent is the
same for genetic selection as it is for having an organized schedule for
one's child, at what point do you tier different levels of hyper-
parenting? If everyone seems to be a hyper-parent in their own right,
wouldn't the argument of "gene selector hyper-parents" become moot?
Although genetic selection has a slew of issues involved with the
process, what dictates hyper-parenting? If being a hyper-parent is the
same for genetic selection as it is for having an organized schedule for
one's child, at what point do you tier different levels of hyper-
parenting? If everyone seems to be a hyper-parent in their own right,
wouldn't the argument of "gene selector hyper-parents" become moot?
Technology they say is manipulation of Nature. It is now the time for
manipulation of behavior and even morality. Drugs will make in future a
more morally responsible person. Exogenous chemicals will influence human
behavior. Science and scientific inquiry seem to touch areas that are
sensitive for manipulation.
Morality is developed behavior through family, culture and customs.
It is spontaneous and not drug in...
Technology they say is manipulation of Nature. It is now the time for
manipulation of behavior and even morality. Drugs will make in future a
more morally responsible person. Exogenous chemicals will influence human
behavior. Science and scientific inquiry seem to touch areas that are
sensitive for manipulation.
Morality is developed behavior through family, culture and customs.
It is spontaneous and not drug induced. Oxytocin can be a marker of love
and it cannot replicate love.
We are humans we feel and respond to environment naturally. Even if
it is led to the corridors of research to be dissected the uniqueness of
what makes us human will be lost in the dissecting table.
I look to clarify and reinforce my criticisms of the Moorean defence by Curtis and Vehmas of their proposition that all humans have an equal moral status that is higher than that of all non-human animals. In particular, I point to the relative scope for inventive new arguments against that proposition, and suggest that what misgivings we have about rejecting it are inadequate to make that type of strategy appropriate.
I look to clarify and reinforce my criticisms of the Moorean defence by Curtis and Vehmas of their proposition that all humans have an equal moral status that is higher than that of all non-human animals. In particular, I point to the relative scope for inventive new arguments against that proposition, and suggest that what misgivings we have about rejecting it are inadequate to make that type of strategy appropriate.
Introduction
In 'Having hands and moral status', I made two principal claims about Curtis and Vehmas' Moorean defence of the following proposition:1
H>A: Humans have an equal moral status that is higher than the moral status of non-human animals.
The "basic idea" of their Moorean strategy "is that our confidence in the truth of this proposition is greater than our confidence in the propositions that make up those philosophical views that entail that it is false, and that this is sufficient to justify rejecting those views and to continue to believe H>A."3 In other words, any deductive argument for a contrary proposition is really "no more than an invitation to compare plausibility:"4 if it is more plausible that a premise of that argument is false than that its conclusion is true, then "we should not be moved by the argument".1
My first claim was that although their strategy is logically valid, "it is not powerful." My second, which I labelled "[m]y own view", was that "resort to the argument the authors make reflects too great a pessimism about the class of accounts which are unresponsive to PIDs", or profound intellectual disabilities. In a short rejoinder, Curtis and Vehmas explain why they believe I fail to establish those two claims. Since the authors misunderstand the points of both of them -- and given the significance of the issues our papers cover -- I look to clarify and reinforce those criticisms here.
Valid, but not powerful
Arguments 'for' propositions
The first sense in which the Moorean strategy is "weak"3-- a word I never use -- is general to any issue to which it is applied. This is that "it does not give one any stronger reason than one had" to believe in the proposition defended: "all it does is point out that one's confidence in that position is a reason not to believe in others."1 In that particular sense, it is not an argument for H>A or for an external world: what disagreement we have about that label is in principle purely semantic.
Curtis and Vehmas also note -- and read a great deal into -- my aside about ghosts: that a conviction in their reality is a reason to doubt attempts to explain them away, but not a reflexive reason to believe in them more. The comment was not a reductio of their argument, not least because I disagree with their assumption that using the Moorean strategy to defend one's ghostly beliefs against empirical attacks "is obviously not something that one would be justified in doing".3 Rather, my point was precisely that a Moorean argument which plays on how strongly you disbelieve a conclusion does not, as I use the label, count as an argument for your disbelief: "[h]aving confidence in the existence of ghosts is a pro tanto reason not to put stock by attempts to explain away ghostly appearances with optics or psychology, but it is not a reflexive reason to be confident in the existence of ghosts."1
Out of the sceptical context
The more important sense in which the Moorean strategy is "weak" is specific to its application to the issue of moral status. In my reply to Curtis and Vehmas' paper, I wrote that:
Moore's original argument from his confidence he has hands to the existence of external things is unusually powerful because the sceptical arguments he opposes tend not to offer reasons to be confident about any alternatives: rather than suggesting just that we do not have hands, scepticism challenges our reasons to be confident about any of the possibilities; there need not be a change to the order of the options we have confidence about.
The case of moral status is fundamentally different. Each plausible argument for an account which conflicts with all and only humans having full moral status is potentially capable of tipping the balance against that proposition. Such arguments are not sceptical reasons to doubt our confidence in everything: they advance opposition to the defended account relative to it.1
The authors assert that I misconstrue Moore's argument, which, on the "common interpretation" which they ascribe to Lycan, "is not from [Moore's] confidence that he has hands to the existence of external things, but from his confidence that he knows he has hands to that he knows that external things exist".3 Lycan actually attributes both versions to Moore, with Curtis and Vehmas' reading being a development of what Moore first intended which makes "a rubber arrow" of an objection to any role played by common sense.4 Moreover, my claim that "[t]he case of moral status is fundamentally different"1 remains importantly true regardless of to which level the shared schema is applied.
A typical sceptical argument asks us to imagine that we are, for example, brains in vats, fed artificial neural signals which generate a convincing illusion of reality. It then invites us to note that we cannot rule this possibility out, since all of our perceptual experiences would be as they are in actuality; deduces that we cannot know that this possibility is not actual; and concludes that, since we would not have hands were we brains in vats, we do not meet the standard for knowledge of whether we do have hands.
The Moorean insight is that if it is more plausible that we know that we have hands than that it is possible that we are brains in vats, then the sceptical argument need not be threatening: rather than accepting its conclusion, we ought to -- or at least are free to -- deny that it is possible that we are brains in vats. What makes Moore's anti-sceptical position exceptionally secure, or his defensive strategy "unusually powerful",1 is how difficult it is to make it more credible that a sceptical possibility could be real: that we could be brains in vats or be plugged into the Matrix, or be duped by Cartesian demons or locked in vivid dreams.
That security is not transferrable to questions of moral status. As a project, sophisticated opposition to H>A is still relatively immature. There is plausibly plenty of scope for inventive new arguments for positions with which H>A conflicts, whether drawing on unconsidered intuitions, metaethical innovations, zoological discoveries, or studies of psychological biases. Curtis and Vehmas note in their original paper how the best-known objections to H>A are "based upon a set of theoretical claims, such as the claim that moral status can depend only upon the possession of intrinsic properties," and that new arguments which drew on empirical facts would be "of an entirely different sort than those usually offered".2 The point is that there is ample latitude for such arguments to be developed or publicised, whereas the same is not nearly so plainly true of sceptical opposition to Moorean dogmatism. In this sense, the authors' deployment of the strategy is importantly different and significantly less enduringly effective.
Reflecting too great a pessimism
Denying H>A
Recall that my original second claim was that "resort to the argument the authors make reflects too great a pessimism about the class of accounts which are unresponsive to PIDs."1 The Moorean strategy is one to adopt when none of the positions we can positively defend are anything but barely appealing: when the arguments for them are so uncompelling that we feel free to assume their conclusions are false. With this in mind, I used the final paragraph of my discussion to outline an account on which a being's moral status is proportionate to the "magnitude" of their interests, or more roughly to their capacity for satisfactions and dissatisfactions. Non-human animals -- or at least those of which we know, and then as far as we know them -- plausibly do have a smaller scope of interests than we as humans do.
That account is "unresponsive to PIDs" in the sense that it does not make any person's moral status directly dependent on their cognitive capacities: that is, to borrow from Curtis and Vehmas, "those capacities to do with conceptual abilities, understanding, problem solving and rational decision-making."2 Instead, the entitlements, rights, or distributive heft of a person depend entirely and exclusively on their capacities for joys, disappointments, excitements and distresses: if PIDs are relevant to moral status, it is via those amplitudes only.
In their restatement of my claim, Curtis and Vehmas replace "the class of accounts which are unresponsive to PIDs" with "the accounts available that purport to justify H>A", then finding my comments "puzzling" because on my proposal H>A is false.3 The conclusion they should instead have drawn is that I do not think an account needs to vindicate H>A to be compelling enough to make a struthious Moorean strategy inappropriate; it is in that sense that falling back on the strategy "reflects too great a pessimism".1 In particular, I do not think that accounts which satisfy H>A are unique in respecting what we find most troubling about the traditional criteria for moral status, nor that H>A is robust and self-evident enough to be aptly labelled "common sense".2
What is troubling about those accounts of moral status which follow the liberal Lockean tradition -- making one's status contingent on autonomy, agency, or cognitive capacities -- is not in itself that they are sensitive to real differences within and across species, but rather that they fixate on distinctions which ought not at all to matter. Lacking cognitive capacities does not make a person any less inherently and importantly valuable and dignified: it does not justify inequalities of moral consideration. As Alastair Norcross put it, the fact that beings "can't be moral agents doesn't seem to be relevant to their status as moral patients: moral status "is not some kind of reward for moral agency."5 We agree, I think, in opposing "the view that such intrinsic psychological capacities as rationality and autonomy are requisites for claims of justice, a good quality of life, and the moral consideration of personhood",6 but we part soon after there.
If one human is ever entitled to less than another, it ought to be because they have less use or need for what is at stake: that they lack some latitude to be satisfied or dissatisfied. That latitude, or that magnitude of interests, plausibly does matter to our dues or to our heft in distributive algorithms, and it plausibly is what creates moral gradations amongst known sentient beings.7, 8 It is not that we are innately unequal as beings or as humans, but rather that our interests are:9 that "a mayfly imago which needs not even feed will also not be fearing homophobia or pondering the frustration of its childhood dreams."1 Provided we keep this distinction in mind, H>A might if anything seem implausible in principle; short of that, it does not just seem "common sense".
Non-human animals
Curtis and Vehmas draw attention, however, to the account's implications for those humans and non-humans who share their sentient capacities for joys and disappointments.2, 3 Suppose, to take their example, that equality is true of humans with PIDs and dogs, and that we begin with the credible assumption that the moral status of a humans with PIDs exceeds -- perhaps significantly -- that of a dog. The standard argument is that we then face a trilemma: either acknowledge that dogs have greater moral status than we thought, being equal to that of humans with PIDs; accept instead that the status of humans with PIDs is lesser than assumed, being equal to that of dogs; or endorse, after all, something similar to H>A, and here defend it with a Moorean shift. I have, like many, no attraction to the second option. I will close this paper by both suggesting that the first is favourable to third and attempting to undermine any concerns.
Many of our thoughts about the moral status of animals relative to humans with PIDs may, firstly, stem simply from a lack of knowledge of what most humans with PIDs are like. Eva Kittay, for example, describes her own daughter -- "diagnosed as having severe to profound retardation" -- as "enormously responsive, forming deep personal relationships with her family ... and friendly relations with her therapists and teachers," and with a discerning taste for "especially but not exclusively classical symphonic music".10 Kittay's daughter is not comparable to any non-human animal as most of us understand them: if there is a dog which matches her for sentience, then that dog is truly exceptional. Our misgivings may not be about genuinely equal cases.
Secondly, we need to be clear that moral status need not even closely align with how a person should be treated: it is not a guide to whether we can "farm and eat the flesh" of people,2 or an indication of how much we value them. We stand in relations to humans with PIDs which we rarely if ever do with any non-human animals: we care deeply about them and about our relationships with them, and the facts that they matter so much to us, that we identify with them, and that they may depend on us give us perfectly permissible reasons to treat them exceptionally well. It is a fallacy that two beings with equal moral status need to be treated the same, and we should consider how much this accounts for the extent to which we find the first option challenging.
Thirdly -- and finally -- recall the reasons I gave for thinking the Moorean strategy which Curtis and Vehmas proposed to be, albeit "valid", far from "powerful."1 We must be incredibly careful not to see that strategy as permitting us to be more confident about the truth of H>A: despite the titles of both their papers, it is not an argument for that proposition in the most conventional evidential sense. If H>A was ungrounded before, it remains as ungrounded now: it is a dialectical last resort. I suggest that we have greater reason to adopt an alternative view than we do to maintain H>A in the face of foundational difficulties "that we do not know how to overcome";2 H>A is, at least, nothing like our convictions that we really know that we have hands.
References
1. Roberts AJ. Having hands and moral status: a reply to Curtis and Vehmas. J Med Ethics 2016;42:265 doi:10.1136/medethics-2015-103355.
2. Curtis B, Vehmas S. A Moorean argument for the full moral status of those with profound intellectual disability. J Med Ethics 2016;42:41--5 doi:10.1136/medethics-2015-102938.
3. Curtis B, Vehmas S. The Moorean argument for the full moral status of those with profound intellectual disability: a rejoinder to Roberts. J Med Ethics 2016;42:266--7 doi:10.1136/medethics-2016-103437.
10. Kittay EF. The personal is philosophical is political: a philosopher and mother of a cognitively disabled person sends notes from the battlefield. Metaphilosophy 2009;40:616 doi:10.1111/j.1467-9973.2009.01600.x.
This is a very telling paper, for if it is true that forced
circumcision of an adult male is a violation of his human rights, it must
follow that forced circumcision of a male minor - a boy or an infant - is
a violation of his human rights and equally wrong. The age at which it is
done does not matter - as you can see from a simple thought experiment.
It is held by many people in Australia and the United States...
This is a very telling paper, for if it is true that forced
circumcision of an adult male is a violation of his human rights, it must
follow that forced circumcision of a male minor - a boy or an infant - is
a violation of his human rights and equally wrong. The age at which it is
done does not matter - as you can see from a simple thought experiment.
It is held by many people in Australia and the United States that
parents have the right to circumcise their (male) children, and by even
more people in the Middle East, North Africa and South East Asia that they
have the right to circumcise their female children as well. How old do the
children have to be before parents lose this right? Would it be OK for
parents to forcibly circumcise a 25-year-old, male or female? Most people
would probably say No, but what about an 18-year old? A 15-year-old? Ten
years? Five years? Two years? Six months? Six weeks? We may predict that
the number of people answering Yes will increase as we go down the age
scale, but what is the basis for their judgement? Where is the dividing
line where circumcision without consent becomes unacceptable (going up),
or acceptable (going down)? And what are the criteria for placing it
there? The fact is that it really makes no difference when a boy or girl
is circumcised; whatever the age, it is just as much a violation of his
(or her) physical integrity and personal autonomy, and the result is just
the same: permanent loss and/or disfigurement of a functional body part.
No matter when it is done the result is the same: for the rest of his life
he will be deprived of his foreskin, and she will bear the scars of
whatever operation was performed on her.
The reason that circumcision advocates insist on circumcision in
infancy or early childhood is not because circumcision at that age is
safer or attended by fewer complications, despite their claims to the
contrary, and certainly not because it has to be done that early for the
full extent of the "benefits" to be available. The real reason advocates
demand infant circumcision is that early circumcision is simpler and more
convenient for the adults because the infant or child has little or no
power to object or resist. The older he or she is, the greater his/her
powers of resistance.
Seems odd that you gloss over the fact that there were two versions
of this copyright-owned 'care' pathway, and that you only cite 'evidence'
from a review that examined only one of them, whilst neatly skirting
around the other.
Version 11 had no consent process attached.
Version 11 did not even inquire whether the patient and their family could
speak English until after a decision to put them on the pathway had...
Seems odd that you gloss over the fact that there were two versions
of this copyright-owned 'care' pathway, and that you only cite 'evidence'
from a review that examined only one of them, whilst neatly skirting
around the other.
Version 11 had no consent process attached.
Version 11 did not even inquire whether the patient and their family could
speak English until after a decision to put them on the pathway had been
taken.
Version 11 was still in use AFTER the Code of Conduct accompanying the
Mental Capacity Act came into force (1st October 2008) - this demanded
'Informed Consent' for ALL medical treatment recommended.
I would have thought someone with an interest in 'Medical Ethics'
would have spotted that!
Since the first version was published in 2003, up until the LCP renal
prescribing guidelines were issued in 2008, versions of the Liverpool Care
Pathway issued to staff in Acute Hospitals mandated the use of Diamorphine
for relief of both 'pain' and 'breathlessness'.
Administering these drugs to anyone in renal compromise must have led
to thousands of appalling and undiginified bad deaths - delirium and
hallucinati...
Since the first version was published in 2003, up until the LCP renal
prescribing guidelines were issued in 2008, versions of the Liverpool Care
Pathway issued to staff in Acute Hospitals mandated the use of Diamorphine
for relief of both 'pain' and 'breathlessness'.
Administering these drugs to anyone in renal compromise must have led
to thousands of appalling and undiginified bad deaths - delirium and
hallucinations are as dreadful for the patient and those witnessing their
demise.
I appreciate that the owners of the copyright to this pathway will
have to shed a few of their better paid senior staff if the new NHS
Commissioners don't use it, but they really are flogging a dead horse.
And paying the RCP to produce a selective audit relating to 'poor
implementation' doesn't really constitute the kind of evidence needed to
convince a public to consent to being put on this pathway.
You seem to have based your article on the evidence contained in the
Neuberger Review [NR]. I note myself with some dismay that the actual
evidence submitted to it was never published in full (names redacted of
course), so we'll never know what complaints were actually received or
considered by this panel. John Ellershaw (who wrote the LCP) was
permitted to use his complaints databases in Liverpool as examples,
accord...
You seem to have based your article on the evidence contained in the
Neuberger Review [NR]. I note myself with some dismay that the actual
evidence submitted to it was never published in full (names redacted of
course), so we'll never know what complaints were actually received or
considered by this panel. John Ellershaw (who wrote the LCP) was
permitted to use his complaints databases in Liverpool as examples,
according to the 'Rapid Evidence Review' published with the NR itself.
According to this review, the methodology was approved by the panel,
but involved a search of a database specifically using the Key Word
'Liverpool Care Pathway' for a tiny tiny period of time. In the area used
for the review, covered by the CNG for Wirral and Cheshire, the End of
Life care pathway was called variously 'The Vigil Pathway' and other
descriptors. One complaint about its use at the HQ of the LCP appears to
have been missed out completely - it is this case:
http://www.dailymail.co.uk/news/article-1219853/My-husband-beaten-cancer-
doctors-wrongly-told-returned-let-die.html - the case involved someone who
was in charge of the Liverpool Deanery and training for the Joint Royal
Colleges - perverse to blame 'poor training' therefore when the authors
cannot even use it safely themselves!
Cannot agree more than this title. This "Live and Let die" attitude
is probably highest amongst doctors, whether in academic or non academic
set up.
You send a manuscript for publication; You will find a jealous reviewer
colleague (often donot even know you personally, but have competing
interest) will turn it down as "reject" only to publish his similar work
in a short time by clever means of planted peer review. So, "o...
Cannot agree more than this title. This "Live and Let die" attitude
is probably highest amongst doctors, whether in academic or non academic
set up.
You send a manuscript for publication; You will find a jealous reviewer
colleague (often donot even know you personally, but have competing
interest) will turn it down as "reject" only to publish his similar work
in a short time by clever means of planted peer review. So, "offence is
the best defence"? This disgustingly painful attitude of grown ups, often
called Gods by their patients act in so demeaning way that one needs to
think how to purify these souls. I think the so called "publish or perish"
culture is responsible for it.
One more reason is the rat race of making science more complex and
complicated ( and you must know for sure that information not understood
easily is far from truth, as all truths are simple) by basic science
without clear clinical correlate and industry driven, so called "evidence
based medicine". True personalised medicine (and that is true basic
science of medicine) may be the answer . Respect for clinical science also
needs be preserved at the earliest. Just imagine, there is no nobel prize
for true Clinical medicine. Why not - if it can be there for economics and
peace?
Will the childish behaviour in the form of professional jealousy ever
disappear? If only they understand the real ethos of a physician which is
forgotten by most of us.
Eline Bunnik's comment(1) concludes with the observation that not all
existing direct-to-consumer genetic tests enhance the autonomy of their
consumers, not if autonomy is understood in the Razian sense employed in
my article.(2) This is a demanding sense of autonomy, one that requires
the presence of an adequate range of valuable options from which to
choose. Bunnik's conclusion is difficult to disagree with, but that's...
Eline Bunnik's comment(1) concludes with the observation that not all
existing direct-to-consumer genetic tests enhance the autonomy of their
consumers, not if autonomy is understood in the Razian sense employed in
my article.(2) This is a demanding sense of autonomy, one that requires
the presence of an adequate range of valuable options from which to
choose. Bunnik's conclusion is difficult to disagree with, but that's
because it is sheer commonsense. No existing services of any kind are
guaranteed to enhance their consumers' autonomy. It all depends on various
factors such as the nature and quality of the service, the conditions
under which it is delivered, and the use made of it by consumers. What is
surprising is that Bunnik reads me as disagreeing with this banal truth.
Contrary to Bunnik's interpretation, in the article I explicitly
stated that '[my] defence of DTC genomics in principle is not to be
confused with the defence of existing DTC genomic services, which may be
deficient in various ways. The point is that these deficiencies are not
inherent and ineradicable' (p.4). So, contra Bunnik, I was not engaged in
the na?ve, cheerleading enterprise of defending all existing forms of DTC
genomic services, many of which are problematic in ways identified in the
article. Instead, I argued that such services can, in principle, enhance
autonomy if they meet certain conditions, and that this fact is sufficient
to yield a pro tanto case for the legal permissibility of services that do
in fact satisfy those conditions.
Putting aside this radical misunderstanding, I turn now to the three
'crucial considerations' Bunnik claims that I overlook in supposedly
rejecting her truistic conclusion.
The first consideration is that 'genomic testing' is very
heterogeneous, and that this limits our ability to make general moral
assessments of such tests, including judgments about their utility. Again,
it is odd that Bunnik reads me as disagreeing with this further truism. On
the contrary, I emphasized that the medical actionability of DTC genomics
depends on variables such as which kind of test is employed and which sort
of condition is being investigated. Indeed, precisely because DTC genomic
services exhibit considerable variety, I argued, it is wrong to endorse a
sweeping skepticism about their utility, clinical or non-clinical.
From the fact that DTC genomic services exhibit this variation, does
it follow that it is impossible to identify general principles bearing on
their legal permissibility? This is what Bunnik suggests, but provides no
argument. Many of the phenomena regulated by law exhibit a similar
variability, but it does not mean that we have to resort to a case-by-case
assessment of their permissibility, one that does not draw on more general
considerations. Indeed, Bunnik herself, in offering an alternative
approach to autonomy-based arguments for DTC genomic services in her final
paragraph, seems committed to the possibility of the sort of general moral
assessments regarding which she expresses skepticism. If the heterogeneity
of DTC genomic services stands in the way of a general assessment based on
Razian autonomy, why is such an assessment suddenly possible when we
substitute Bunnik's favoured concepts of agency, control and freedom?
Inexplicably, she seems to want to have it both ways: denying the
possibility of a general moral assessment while simultaneously offering
one.
Second, Bunnik claims that I 'confound' two distinct senses of
autonomy, asking whether I argue 'that DTC genomic testing generates
valuable options or that it is a valuable option'. Although there is a
genuine distinction here, Bunnik does not explain why she thinks I
overlook it and, if so, what trouble this causes for my argument. For the
record, I believe that under certain conditions, DTC genomic testing can
enhance autonomy in both ways: acquisition of the information it provides
can itself be a valuable option, e.g. acquiring ones' raw data, knowledge
of one's genealogy or the likely course of one's future health, and
possession of this information can generate additional valuable options,
e.g. to pursue family connections, or even to seek medical care, etc.(3,4)
Third, I come to perhaps Bunnik's key criticism, i.e. 'most of these
tests do not generate (actionable) options at all, medical or non-
medical'. Everything here depends on the slippery qualification 'most'.
The success of my argument does not depend on showing that all or most
existing DTC genomic services generate valuable options. It only requires
a plausible case for believing that DTC genomic services are capable of
generating such valuable options under feasibly attainable circumstances.
In the article, I enumerated a number of valuable options such services
are able to generate beyond clinical utility: enhanced knowledge of one's
genetic constitution, participation in medical research, information about
ancestry, and so on. Bunnik asserts that these options lack the value
necessary for Razian autonomy, but in the absence of an adequate
supporting argument, this remains an assertion. At one point, Bunnik
appears to dismiss such utilities by saying there is a difference between
perceived utility and actual utility. However, this distinction does not
license the somber conclusion that the enjoyment people derive from DTC
genomic services, e.g. by participating in research, fails to enhance
their well-being. (5,6) Enjoyment, knowledge and accomplishment, which can
be achieved through such participation, are familiar elements of human
well-being.(7)
Finally, it is worth noting Bunnik's claim that autonomy-based
arguments for a liberal regulatory approach to DTC genomic services should
appeal to a narrow sense of autonomy, rather than the 'thick' Razian
employed in my article. This narrow sense would, among other things,
dispense with the requirement of an adequate range of valuable options.
Bunnik's contention, summarily delivered in the final paragraph, is that
autonomy-based arguments should instead rely on the less demanding
'values' of agency, control, and freedom to decide. Bunnik is certainly
right that this would be an easier way of defending DTC genomic services.
But the real question is whether it is so easy that it provides no real
defence. Such a defence will be made out only if bare agency, control and
freedom to decide are truly 'values' and, moreover, values with a claim to
be respected and promoted through law and public policy. Yet this is
precisely what leading philosophical critics of the narrow sense of
autonomy, such as O'Neill and Raz, have called into questioned. In the
absence of a response to such critics, Bunnik's alternative approach to
autonomy remains under-motivated.
In short, for the greater part of her response, Bunnik wrestles with
an opponent of her own imagining. To the extent that she genuinely engages
with claims that I make, her contentions - about clinical/non-clinical
utility and the proper understanding of autonomy - ultimately beg the
question.
References:
1. Bunnik E. Do genomic tests enhance autonomy? J Med Ethics. 2014
Jun 30. pii: medethics-2014-102171.
2. Vayena E. Direct-to-consumer genomics on the scales of autonomy. J
Med Ethics. 2014 May 5. doi: 10.1136/medethics-2014-102026.
3. Roberts ME, Riegert-Johnson DL, Thomas BC. Self diagnosis of Lynch
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Dear Patricia
I fear that male circumcision will never be seen as equivalent in harm to female circumcision in the eyes of Americans. In places such as America where circumcison has become the rule as opposed to the exception, cultural conditioning will always dictate morals instead of ethics. As you said in your letter, many circumcised men will never know the pleasures of being intact.However despite this kno...
Although genetic selection has a slew of issues involved with the process, what dictates hyper-parenting? If being a hyper-parent is the same for genetic selection as it is for having an organized schedule for one's child, at what point do you tier different levels of hyper- parenting? If everyone seems to be a hyper-parent in their own right, wouldn't the argument of "gene selector hyper-parents" become moot?
C...
Technology they say is manipulation of Nature. It is now the time for manipulation of behavior and even morality. Drugs will make in future a more morally responsible person. Exogenous chemicals will influence human behavior. Science and scientific inquiry seem to touch areas that are sensitive for manipulation.
Morality is developed behavior through family, culture and customs. It is spontaneous and not drug in...
I look to clarify and reinforce my criticisms of the Moorean defence by Curtis and Vehmas of their proposition that all humans have an equal moral status that is higher than that of all non-human animals. In particular, I point to the relative scope for inventive new arguments against that proposition, and suggest that what misgivings we have about rejecting it are inadequate to make that type of strategy appropriate.
...
This is a very telling paper, for if it is true that forced circumcision of an adult male is a violation of his human rights, it must follow that forced circumcision of a male minor - a boy or an infant - is a violation of his human rights and equally wrong. The age at which it is done does not matter - as you can see from a simple thought experiment.
It is held by many people in Australia and the United States...
Seems odd that you gloss over the fact that there were two versions of this copyright-owned 'care' pathway, and that you only cite 'evidence' from a review that examined only one of them, whilst neatly skirting around the other.
Version 11 had no consent process attached. Version 11 did not even inquire whether the patient and their family could speak English until after a decision to put them on the pathway had...
Since the first version was published in 2003, up until the LCP renal prescribing guidelines were issued in 2008, versions of the Liverpool Care Pathway issued to staff in Acute Hospitals mandated the use of Diamorphine for relief of both 'pain' and 'breathlessness'.
Administering these drugs to anyone in renal compromise must have led to thousands of appalling and undiginified bad deaths - delirium and hallucinati...
You seem to have based your article on the evidence contained in the Neuberger Review [NR]. I note myself with some dismay that the actual evidence submitted to it was never published in full (names redacted of course), so we'll never know what complaints were actually received or considered by this panel. John Ellershaw (who wrote the LCP) was permitted to use his complaints databases in Liverpool as examples, accord...
Cannot agree more than this title. This "Live and Let die" attitude is probably highest amongst doctors, whether in academic or non academic set up. You send a manuscript for publication; You will find a jealous reviewer colleague (often donot even know you personally, but have competing interest) will turn it down as "reject" only to publish his similar work in a short time by clever means of planted peer review. So, "o...
Eline Bunnik's comment(1) concludes with the observation that not all existing direct-to-consumer genetic tests enhance the autonomy of their consumers, not if autonomy is understood in the Razian sense employed in my article.(2) This is a demanding sense of autonomy, one that requires the presence of an adequate range of valuable options from which to choose. Bunnik's conclusion is difficult to disagree with, but that's...
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