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.
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!
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.
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 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.
Mazor proposes to deny core human rights to boys born into Jewish homes on the basis of their birth and sex, which is a violation of core principles of international human rights law.1
The universality of human rights is a core principle - that everyone has the same human rights without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin,...
Mazor proposes to deny core human rights to boys born into Jewish homes on the basis of their birth and sex, which is a violation of core principles of international human rights law.1
The universality of human rights is a core principle - that everyone has the same human rights without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.2, 3
The universality of human rights also applies to children. The United Nations Convention on the Rights of the Child (1989) provides:
"States Parties shall respect and ensure the rights set forth in the present Convention to each child within their jurisdiction without discrimination of any kind, irrespective of the child's or his or her parent's or legal guardian's race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status."4
The Universal Declaration of Human Rights (1948) provides:
"Everyone has the right to life, liberty and security of person."2
Although non-discrimination and equality are also core principles of international human rights law, Mazor would provide a lesser standard of protection of the right to security of the person for children born into Jewish households. He would provide that males born into Jewish households are entitled to lesser sexual pleasure than other males. Mazor would deny the right of self-determination to males born into Jewish households.1
Respect for patient rights is an essential element of medical ethics.5, 6 Mazor, however, would throw out this element of medical ethics.1
Mazor would permanently relegate males born into Jewish households to the position of Untermenschen -- sub-humans denied full citizenship. Mazor's recommendation of discrimination against boys born into Jewish households is incredibly anti-Semitic. One wonders how the editors of JME could accept this treatise for publication.
Mazor's completely unethical point-of-view must be rejected by the medical community.
References
1. Mazor J. The child's interests and the case for the permissibility of male infant circumcision J Med Ethics 2013;39:421-428 doi:10.1136/medethics-2013-101318
2. Universal Declaration of Human Rights, G.A. res. 217A (III), U.N. Doc A/810 at 71 (1948). Adopted 10 December 1948. Available at: HYPERLINK "http://www.ohchr.org/en/udhr/pages/introduction.aspx" http://www.ohchr.org/en/udhr/pages/introduction.aspx Accessed 9 December 2013.
3. The foundation of international human rights law. United Nations. Available at: HYPERLINK "http://www.un.org/en/documents/udhr/hr_law.shtml" http://www.un.org/en/documents/udhr/hr_law.shtml. Accessed 9 December 2013.
4. Convention on the Rights of the Child (1989). UN General Assembly Document A/RES/44/25. Adopted 20 November 1989. Available at: HYPERLINK "http://www.ohchr.org/en/professionalinterest/pages/crc.aspx" http://www.ohchr.org/en/professionalinterest/pages/crc.aspx Accessed 9 December 2013.
5. European Convention on Human Rights and Biomedicine (1997). Adopted by the Council of Europe at Oviedo, 4 April 1997. Available at: HYPERLINK "http://conventions.coe.int/Treaty/en/Treaties/Html/164.htm" http://conventions.coe.int/Treaty/en/Treaties/Html/164.htm Accessed 9 December 2013
6. Universal Declaration on Bioethics and Human Rights (2005). Adopted by the UNESCO General Conference, 19 October 2005. Available at: http://portal.unesco.org/en/ev.php-URL_ID=31058&URL_DO=DO_TOPIC&URL_SECTION=201.html
Accessed 9 December 2013.
Submitted on behalf of the Members of the Board of Directors of Doctors Opposing Circumcision. and its medical advisors:
George C. Denniston, M.D., M. P. H.,?President
Mark D. Reiss, M.D.,?Executive Vice-President
Richard B. Russell, IV, A.B., J.D., Director of Communications
Morris R. Sorrells, M.D., Pediatric Consultant
Andrew R. Biles, Jr, M.D., Pediatric Consultant
John W. Travis, MD, MPH, Infant Wellness Consultant
Michaelle M. Wetteland, RN, MMA, Nursing Consultant
Zenas Baer, Attorney at Law.
Any adult who is competent can refuse ANY treatment regardless of the
consequences, even death, and there is absolutely nothing any medical
person can do about it. If they try they will be in front of the medical
council and also in court for battery. It's about time medical
"professionals" ralised they are not important and it is not about them.
We pay their wages and we decide what happens to us, noone else.
Any adult who is competent can refuse ANY treatment regardless of the
consequences, even death, and there is absolutely nothing any medical
person can do about it. If they try they will be in front of the medical
council and also in court for battery. It's about time medical
"professionals" ralised they are not important and it is not about them.
We pay their wages and we decide what happens to us, noone else.
I do not agree with this article at all.Some People may have a
Religious objection to Organ Donation and,as a Cryonisist,I strongly
object to being Autopsied as that would delay My Cryonic Suspension and
most likely diminish My chances of ever being reaninmated.It is highly
immoral to make Autopsies and Organ Donation Mandatory.People DO have
Rights after they Die!!They have the Right to have there final wished
respecte...
I do not agree with this article at all.Some People may have a
Religious objection to Organ Donation and,as a Cryonisist,I strongly
object to being Autopsied as that would delay My Cryonic Suspension and
most likely diminish My chances of ever being reaninmated.It is highly
immoral to make Autopsies and Organ Donation Mandatory.People DO have
Rights after they Die!!They have the Right to have there final wished
respected and not to have anything done to there Bodies that they don't
want done to them.
Thanks Dr Milikovsky and team for doing a very fine piece of
research. This raises the issue of duty to treat. I like to give an
example from non-communicable diseases (mental disorders) and narrate my
own experience from medical student to now as consultant. As medical
students we were all energetic and compassionate to help sufferers. The
best time we use to enjoy was in wards holding hands of our patients. The
only t...
Thanks Dr Milikovsky and team for doing a very fine piece of
research. This raises the issue of duty to treat. I like to give an
example from non-communicable diseases (mental disorders) and narrate my
own experience from medical student to now as consultant. As medical
students we were all energetic and compassionate to help sufferers. The
best time we use to enjoy was in wards holding hands of our patients. The
only thing that kept us cautious and at times away from patient was risk
of being victim of violence. This apprehension gradually subsided with the
knowledge we received during medical school and during residency. None
taught us about the empathy, duty to treat and obligation to us till we
entered in residency. I feel level of compassion has not changed over the
years but now we know how to avoid violence and we can empathize little
better.
Dr Milikovsky, I strongly believe that bioethics and empathy should
be part of curriculum in medical schools. I do not agree with the notion
that empathy cannot be taught however role modeling remains the best way
to teach. We learn as we see our teachers practicing.
There is little more relevant issue that one cannot neglect in this
aspect. Conflict between professional duty and duty towards family as
discussed by Dr Dwyer in his article "Developing the duty to treat: HIV,
SARS, and the next epidemic" . In case of medical students also it becomes
important. Why a student, who has not yet taken an oath as a physician
endanger himself? He has duty towards his parents, siblings and friends.
Would it be ethical to justify all altruistic acts for medical students
because they have entered to become future doctors? Also I will question
the consenting capacity of medical students to work with patients'
suffering from communicable diseases. Medical students are at a point
where they cannot judge the risk in real sense because of their limited
knowledge. Secondly there is also some element of coercion is present when
attending (who will give marks at the end of rotation) is giving them
instructions. On the other hand being medical student and physicians we
have to take certain amount of risk as fire fighters do, and that's the
rule of game!
Reference:
Dwyer J, Tsai D. Developing the duty to treat: HIV, SARS, and the next
epidemic. Journal of Medical Ethics. 2008;34:7-10.
On Marquis's future of value account, "what makes it wrong to kill
those individuals we all believe it is wrong to kill, is that killing them
deprives them of their future of value" (1,2). Recently Carson Strong
(3,4), Don Marquis (1), and I (5,6) have been arguing about a set of
supposed counterexamples to the future of value account proposed by
Strong, involving either a terminally ill patient or an individual
severely...
On Marquis's future of value account, "what makes it wrong to kill
those individuals we all believe it is wrong to kill, is that killing them
deprives them of their future of value" (1,2). Recently Carson Strong
(3,4), Don Marquis (1), and I (5,6) have been arguing about a set of
supposed counterexamples to the future of value account proposed by
Strong, involving either a terminally ill patient or an individual
severely and permanently cognitively impaired. Strong argues that it would
be wrong to kill those individuals despite their not having a future of
value like ours. I have argued that there are some serious interpretative
problems with both Marquis's concepts of "future like ours" and "future of
value" and with Strong's counterexample (5); and that, on a charitable
interpretation that sets aside those problems, Strong's counterexamples
fail because they involve burdening and ultimately unacceptable moral
claims in violation of basic principles of equality: they involve, to put
it simply, the claim that the individuals in the counterexamples do not
have a valuable future.
I have distinguished (6) between a narrow interpretation of "future
of value", according to which those individuals do not have a future of
value; and a liberal interpretation of "future of value", which allows us
to regard the future of terminally ill patients and severely cognitively
impaired individuals as valuable. And I have argued that we must not
interpret "future of value" as narrowly as Strong proposes - so that we
can avoid his violation of basic principles of equality; and that a more
liberal interpretation has the consequence that it will enlarge the domain
of wrongful killing: we should welcome this outcome.
Marquis has responded by also distinguishing between a narrow and
broad interpretation of his future of value account; arguing that, on the
narrow view, Strong's terminally ill counterexample does not work -
because the terminally ill patient does have a future of value
qualitatively like ours, just shorter. But Marquis concedes that Strong's
second counterexample, involving a severely and permanently cognitively
impaired individual, does succeed - because on the narrow view the
cognitively impaired individual does not have a future of value like ours.
This counterexample would not work against a broader view of future of
value, concludes Marquis. "According to the broad view, one has a future
of value just in case, if not killed, one's future will consist, on
balance, of experiences one will value" (1).
While I argue (6) we should adopt the more liberal interpretation of
"future of value", Marquis opts for the narrow view, because "the narrow
version does not even suggest that killing rabbits or mosquitoes may be
wrong" (1). Here I argue, contra Marquis, that we should instead pursue
the broader more liberal interpretation of "future of value". There are
overwhelming reasons for it: first, the broad view does not violate basic
principles of equality; second, the broad view is not subject to Strong's
severely and permanently cognitively impaired counterexample; third, the
broad view, in widening the domain of wrongful killing, is ethically
preferable.
Let me emphasize the sorts of problems involved in endorsing the
narrow view: the narrow view cannot account - by Marquis's own admission -
for the wrongness of killing severely and permanently cognitively impaired
individuals; and it therefore cannot account for the wrongness of killing
foetuses that will develop into severely and permanently cognitively
impaired individuals. Those foetuses, according to the narrow view, do not
have a future of value. So they might be killed - or, at least, their
killing is not wrongful. That is going to represent a substantial
exception to the general rejection of abortion that Marquis (2) put
forward with his "future of value" account. It is wrong to kill some
foetuses and it is not wrong to kill other foetuses. What's the
difference? It is wrong to kill foetuses that have a "future of value";
while it is not wrong to kill foetuses that do not have a "future of
value". This emphasizes in what sort of intractable moral territory the
narrow view forces us: as I have argued before (6), we are forced into the
nasty business of evaluating futures.
Now, it might be objected that this dirty work needs to be done.
After all, recognising the differences between severely cognitively
impaired individuals and healthy ones acknowledges the tragedy for those
born with such impairments and their families. Those differences, the
objection goes, must be emphasized. And that is painfully true. But the
question is whether this difference should be emphasized in terms of moral
value. That's where I think that the narrow view of "future of value" is
in violation of basic principles of equality. We may be as brutal as to
say that the lives of severely cognitively impaired individuals are
qualitatively inferior to ours. And I agree that such brutality is
necessary, as a form of respect towards the lives of the severely
cognitively impaired. But that is still not the same as saying that those
lives are morally less valuable than our lives. It is not the same as
saying that it is wrong to kill some foetuses and not wrong to kill
others. And it is in this respect that I think the broad view should be
preferred to the narrow view.
A note of clarification: it might be thought that I have overstated
my argument by emphasizing that the narrow view would imply that it is
wrong to kill some foetuses and not wrong to kill other foetuses. It might
be proposed that, rather, all that the narrow view implies is that killing
some foetuses is morally worse than killing other foetuses; that there are
differences in the various moral evaluations of the different killings is
not the same as saying that some killings are permissible while others
not. Those who might find it an unacceptable consequence of the narrow
view that some foetuses may be killed while others may not, could on the
other hand live with the weaker claim that the narrow view implies
different moral evaluations for different killings. I agree that this
latter proposal is importantly different and in this respect not as
problematic, but I think that the narrow view implies the former claim,
namely that killing some foetuses is wrong while killing others is not
wrong. To see this, take Marquis's statement of the narrow view:
"Let us call our (ie, yours and mine, readers) futures of value `p-
futures of value`. P-futures are the kind of future lives that can be
characterised as the lives of persons. I have a p-future. The fetus I once
was had a p-future. (Note that this claim is a simple consequence of the
way 'future of value' was defined and well-known facts.) According to what
I shall call `the narrow view` valuable futures are futures like ours as
long as they are p-futures of value... The severely retarded human beings
to which Strong refers do not have p-futures of value" (1)
Don has a p-future and it is therefore wrong to kill Don. The foetus
that Don once was had a p-future and it was therefore wrong to kill that
foetus. On the other hand John, a severely and permanently cognitively
impaired 40-year-old, does not have a p-future. The foetus that John once
was did not have a p-future either. Therefore it is not wrong to kill John
now, and forty years ago it would not have been wrong to kill the foetus
that John then was. So the narrow view does imply that it is wrong to kill
some individuals while it is not wrong to kill others. And it does imply
that it is wrong to kill some foetuses while it is not wrong to kill
others.
So the narrow view allows for too much killing, I have argued. But
Marquis is rather worried that the broad view does not allow for enough
killing - that's his reason for sticking to the narrow view. I think,
contra Marquis, that we should welcome the restrictions of the broad view.
Here I should first of all caution about the difficulty in evaluating the
future of value account against the worry that it does not allow for
enough killing. Recall the statement of the future of value account with
which we started: "what makes it wrong to kill those individuals we all
believe it is wrong to kill, is that killing them deprives them of their
future of value" (1). The account is a bit more specific than just the
wrongness of any killing. The future of value account is, specifically,
about the wrongness of killing a certain class of individuals: those
individuals we all believe it is wrong to kill.
In assessing the worry that the broad view does not allow for enough
killing, we need to know who those individuals we all believe it is wrong
to kill are. I guess Don Marquis is one of them. I am probably one too, as
are most if not all the readers that Marquis addresses. Already when we
move to the foetuses that the aforementioned individuals once were, it
becomes trickier. But that's ok, because after all that was exactly the
point of Marquis's original argument (2): not to have to deal directly
with the status of the foetus, but rather with the much less controversial
status of the future individuals in which foetuses normally develop. But
what about John? Do we all believe it is wrong to kill John? Amongst
philosophers it is perhaps unsurprising that we don't all agree. (7,8) But
it seems that in society at large there is also no consensus.
Why is this important? Individuating which individuals the future of
value account of the wrongness of killing refers to is important because
Marquis's reason to choose the narrow view against the broad view is that
"the narrow version does not even suggest that killing rabbits or
mosquitoes may be wrong" (1). If society cannot agree on John, it
certainly cannot agree on the killing of rabbits. Are rabbits individuals
we all believe it is wrong to kill? No, they are not - it's a simple
statistical fact about human opinion that we don't all believe it is wrong
to kill rabbits, nor do we all believe it is not wrong to kill rabbits. In
this respect, there is a simple solution about Marquis's worry with
rabbits, and therefore a simple rebuttal of his argument in favour of the
narrow view: if we should choose the narrow view over the broad view
because the narrow view, as opposed to the broad view, does not suggest
that killing rabbits may be wrong, then that is no reason to choose the
narrow view over the broad view simply because the future of value account
is not about rabbits; and therefore neither the narrow view of the future
of value account nor the broad view of the future of value account suggest
that it may be wrong to kill rabbits simply because the future of value
account does not talk about rabbits.
In one sense, then, we are already finished: we have given
overwhelming reasons against the narrow view; and we have refuted the
stated reason against the broad view. But it might be objected that we
should not be so strict in the application of the future of value account;
after all, the objection might go, the account is only interesting in so
far as it deals with more individuals than just those about whom we all
agree - there might not be many of those around, I am afraid. Therefore we
should be charitable about the future of value account, and at least also
evaluate it as a general account of the wrongness of killing, and not only
as a particular account of the wrongness of killing those individuals that
we all believe it is wrong to kill.
Let us pay our dues to the principle of charity and evaluate the
future of value account also as a general account of the wrongness of
killing. What should we then say about the worry that the broad view of
the future of value account does not allow for enough killing because it
suggests that killing rabbits might be wrong? I think we should just
embrace this worry, and consider this consequence of the future of value
account as a positive upshot. Indeed, progress in animal ethics might
suggest that a general account of the wrongness of killing might have to
say something about non-human animals. A particular account of the
wrongness of killing only those individuals that we all believe it is
wrong to kill does well to avoid the intricate questions of animal ethics
- as we said, it is a statistical fact about human opinion that there is
no agreement on that point in either philosophical circles or society at
large. But a general account of the wrongness of killing has to say
something about non-human animals, especially now that animal ethics has
earned its place within moral philosophy. So it is a further advantage of
the broad view that it accounts for the wrongness of killing animals.
Someone might be worried that we have gone too far: they might accept
that including some non-human animals amongst those to which the account
applies might be a welcome consequence, but object that the problem for
the future of value account arises when it can no longer distinguish
between the wrongness of killing an healthy adult human being and the
wrongness of killing a rabbit. So that the application of the future of
value account to non-human animals might be seen as a reductio of the
original argument. This reductio could take two forms:
1) future of value reasoning shows that it is wrong to kill non-human
animals. But it is absurd to think that it is wrong to kill non-human
animals. So future of value reasoning must be flawed.
2) Future of value reasoning shows that it is just as wrong to kill a
non-human animal as it is to kill a human. It is absurd to think that it
is just as wrong to kill a non-human animal as it is to kill a human. So
future of value reasoning must be flawed.
We have already addressed 1. Two points here about 2: first, many
might actually want to go that far and welcome an account that does not
distinguish between the wrongness of killing humans and the wrongness of
killing non-human animals. Looking at the animal ethics literature
suggests that an account such as the one 2 criticises would not be taken
to be going particularly far (7,8,9).
Secondly, I don't think that the broad view of the future of value
account must imply that there is no moral difference between killing
humans and killing animals. Recall the statement of the broad view:
"According to the broad view, one has a future of value just in case, if
not killed, one's future will consist, on balance, of experiences one will
value" (1). That seems to embrace at least some non-human animals (10).
But it does explicitly refer to the subjective evaluation of one's
experience. The point about the broad view is, indeed, that we are no
longer evaluating and comparing futures and experiences across different
individuals; it is enough that the one individual values (or would value)
her future experiences.
This still leaves room for various possibilities, all of them short
of the view that there is no moral difference between killing humans and
killing animals. It may be that the sense in which humans value their
experiences is not available to non-human animals. That is, for example,
where many introduce consciousness: it is not as if non-human animals do
not have phenomenal experiences (think of pain); it is rather that their
experiences are not conscious or self-conscious the way human experience
is11. One might think that this is a relevant moral difference: not enough
to deny that it is wrong to kill some non-human animals (because they have
the experience of pain, for example); but enough to deny that there is no
significant moral difference between killing humans and killing animals.
Alternatively, one classic strategy (from Mill's higher-lower pleasure
distinction (12)) is to distinguish between the quality of human
experience and the quality of animal experience: again, that might suggest
that there is a moral difference between killing humans and killing
animals. Still, killing animals would not be morally irrelevant. So there
is no reason to think that the broad view of the future of value account
will lead to conclusions about killing animals that some might hold to be
implausibly demanding.
Summing up, I have argued against Marquis's argument for the narrow
view over the broad view and for my earlier suggestion6 that we embrace
the more liberal version of the future of value account. This I have
motivated by raising some serious problems with the narrow view and by
arguing that the implications of the broad view, in particular about the
killing of non-human animals, are not problematic and should, rather, be
welcomed.
References
1) Marquis D. Strong's objections to the future of value account. J
Med Ethics (forthcoming).
2) Marquis D. Why abortion is immoral. J Philos 1989;86:183-202.
3) Strong C. A critique of 'The best secular argument against
abortion'. J Med Ethics 2008;34:727-31.
4) Strong C. Reply to Di Nucci: why the counterexamples succeed. J
Med Ethics 2009;35:326-7.
5) Di Nucci E. Abortion: Strong's counterexamples fail. J Med Ethics
2009;35:306-7.
6) Di Nucci E. On how to interpret the role of the future within the
abortion debate. J Med Ethics 2009;35:651-52.
7) Singer P. Practical Ethics. Cambridge: Cambridge University Press,
1979.
8) Singer P. Animal Liberation. New York: New York Review Book, 1975.
9) Regan T. The Case for Animal Rights. Berkeley: University of
California Press, 1984.
10) Allen C. Animal Pain. Nous 2004;38:617-43.
11) Carruthers P. Brute Experience. J Philos 1989;86:258-269.
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...
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...
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...
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...
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...
Mazor proposes to deny core human rights to boys born into Jewish homes on the basis of their birth and sex, which is a violation of core principles of international human rights law.1
The universality of human rights is a core principle - that everyone has the same human rights without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin,...
Any adult who is competent can refuse ANY treatment regardless of the consequences, even death, and there is absolutely nothing any medical person can do about it. If they try they will be in front of the medical council and also in court for battery. It's about time medical "professionals" ralised they are not important and it is not about them. We pay their wages and we decide what happens to us, noone else.
...I do not agree with this article at all.Some People may have a Religious objection to Organ Donation and,as a Cryonisist,I strongly object to being Autopsied as that would delay My Cryonic Suspension and most likely diminish My chances of ever being reaninmated.It is highly immoral to make Autopsies and Organ Donation Mandatory.People DO have Rights after they Die!!They have the Right to have there final wished respecte...
Thanks Dr Milikovsky and team for doing a very fine piece of research. This raises the issue of duty to treat. I like to give an example from non-communicable diseases (mental disorders) and narrate my own experience from medical student to now as consultant. As medical students we were all energetic and compassionate to help sufferers. The best time we use to enjoy was in wards holding hands of our patients. The only t...
On Marquis's future of value account, "what makes it wrong to kill those individuals we all believe it is wrong to kill, is that killing them deprives them of their future of value" (1,2). Recently Carson Strong (3,4), Don Marquis (1), and I (5,6) have been arguing about a set of supposed counterexamples to the future of value account proposed by Strong, involving either a terminally ill patient or an individual severely...
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