461 e-Letters

  • What is the use of existing?

    Before any question about the existence, during the existence, one must ask what is the use of existing, because if it is useless, the debate on the existence itself is only a moral judgment invented by us humans. But I do not see how life will have served me when I was in the grave or reduced to ashes. If I am told that I have served someone else, I say what is the value of existing for the person I served? Have I been made as a therapy for this person? As for society that has a life span just a little longer than mine, I do not see the value of its existence either, since society is not a conscious entity and will end just as my existence will end without interest for me. So if I serve society, have I been made to be a social slave? Once this paradox of existence is solved, what are all the philosophies about existence itself? This is for me only a useless debate, an absurd gloss. And now a question: why do not men prevent women from taking the mortal risk of having a child, since this is indeed a deadly risk? For the sake of this woman, should not a man do everything to prevent him from committing suicide, because the conception is the equivalent of a Russian roulette suicide?

  • Odd article

    The depth of ethical analysis in this article is stupefyingly superficial, ill informed and immature. The author's "critical reflection"comprises some half guesses and frankly irrelevant conjecture about what the deceased's intentions were before his untimely death. The author apparently can't see any good reasons for a child to have a two parents, despite this being a foundation of western civilisation, recognised as beneficial in the literature, and given effect in our laws. The author sees nothing odd in a woman wanting to have a baby with a dead man. Where do the universities find these people.

  • Ethical innovation from the roots- a response to Ethics and innovation in medicine

    Innovation is derived from the Latin innovatus which means “to renew or change”. In the broadest sense of the term, it can be viewed as the stimulus that modifies existing processes. Further, innovation has been one of the driving forces in the evolution of society through various revolutionary periods. This concept incorporates connotations of invention and creativity as impulses in themselves, however has recently been applied to commercialised settings. Hence, despite scientific interests, civic duties and altruism providing motivation for innovation, the strongest motive in recent times seems to be with a view to increasing profit. From a bottom-up level, inexperienced and junior innovators with the former inclinations could be met with resistance from the complexity of deriving economic viability. Furthermore, a central component to successful innovation involves promoting a culture to challenge outdated norms and the status quo. Change cannot occur if it is believed that present methods are infallible, as this removes the impetus for a goal-driven action. Consequently, many ideas may not reach fruition. However, within the medical field, it is wise that innovation occurs with incremental and calculated adjustments by enlarge, rather than with abrupt renovations. Wherever innovation leads to novel technology, the ultimate outcome of such is unforeseeable. The collingridge dilemma highlights an important notion that in early stages a new technology is still open to soc...

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  • A conceptual mistake in the definition of access in post-trial access implementation discussion?

    Paul et al. (2018) “Implementing post-trial access plans for HIV prevention research” present a much-needed discussion on the implementation of post-trial access plans. Here, I just want to signal a mistake on the conceptual definition of access, to an otherwise flawless paper.

    If I am correct, the mistake would be related to the formulation of the following question:

    "it the responsibility of researchers and sponsors only to ensure that all participants have access to effective preventive therapies, or does that responsibility extend further, to ensuring that participants actually receive them?" (Paul et al 2018:4)

    I believe that "to ensure that participants have access to an intervention" is logically equivalent to "ensuring that participants actually receive an intervention". The MRCT Center's framework on post-trial responsibility defines access as “[…] the ability, right or permission of an individual to use an object or asset, and implies the removal of barriers to allow such use” (MRCT Center 2017:76). If a person does not actually receive an effective preventive therapy, she does not have the ability to use it. Therefor she has no access. Hence, distinguishing between the above expressions is conceptual mistake.

    Instead, what I believe that the authors wanted to discuss is how much sponsors and researchers need to do to ensure access to an investigational intervention. In fact, irrespective of the abo...

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  • Unconvincing claims in this article

    On p.5 the authors comment on the use of mindfulness exercises as "a tool to relieve suffering
    and increase functioning". They claim that "This goes against common epistemic values" where these epistemic values are described as "the sort of values that lead one to accept uncomfortable truths, and to be honest, even brutally honest, with oneself."
    As far as I can see there is no argument given for that claim, and what is more, it seems to go precisely contrary to the purpose of mindfulness exercises in that these are intended to enable one to be honest with oneself and face uncomfortable truths (e.g.: "... we cultivate acceptance by taking each moment as it comes and being with it fully, as it is [...] receptive and open to whatever we are feeling, thinking, or seeing". [Kabat-Zinn, Full catastrophe living, p.28f: https://books.google.at/books?id=fIuNDtnb2ZkC]). Mindfulness is to a large extent a tool to enable one be "honest, even brutally honest, with oneself".

    There is a number of other strange claims in this article, I will mention only one: "Suppose an atheist was having trouble coping emotionally with a natural disaster in which there were many casualties. They might object to imagining the people who died in the disaster frolicking in heaven, even if doing so would help them cope. They do not believe in heaven, thus the imaginati...

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  • Lessons learnt from the past: “Conscientious objection” to abortion in Chile will lead to widespread disobedience of the new law

    Authors Montero and Villarroel discuss problems that might arise from “conscientious objection” (CO) to the new law in Chile that legalized abortion in cases of life endangerment of the woman, fatal fetal abnormality, and rape. (“A critical review of conscientious objection and decriminalisation of abortion in Chile”, Jan 6). The law provides the “right” to exercise CO, with the only caveat that health institutions are required to immediately refer patients to non-objecting practitioners. We share the authors’ concerns that conscientious objection may prove be quite widespread in Chile with the new law. In fact, we argue it will create serious, widespread problems for access to safe and legal abortion, despite the referral requirement.

    Of course, in a Catholic-dominated country like Chile with a total abortion ban, the new law represents a major advance, and it will undoubtedly help many women. We appreciate the challenges and hard work to get the law passed and acknowledge it may have been difficult to do so without CO as a political compromise. Unfortunately, last-minute lobbying by Catholic hospitals resulted in a court’s expansion of the CO clause in the law, giving the “right” of CO to not just doctors, but also support workers and even institutions (when only individuals can have a conscience). This law will be very difficult to reverse and women will suffer the consequences.[1]

    The authors rightly recognize the difference between conscientious object...

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  • I'm so glad I practice in the UK, not USA!

    I was intrigued to read this article about US practice relating to consent and minors.

    Intrigued; and very pleased that I practice in the UK, where this was agreed, very sensibly, years ago.

    The UK law permits a minor to consent to treatment, as long as they are capable of understanding the issues involved. And for vaccination, the issues (when you leave out the non-science-based scary stuff) are usually straightforward.

    This means that vaccinating adolescents against HPV is straightforward - a few simple questions to establish that they understand what the vaccines for, and have an acceptable understanding of the almost-negligible risks involved, and you can vaccinate them, without requiring parental consent and with the full support of healthcare systems and the courts.

    The ludicrous situation in the USA where some parents can prevent their children from accessing vaccines at the right time (before sexual debut), when the children themselves have a clearer understanding of the issues than their parents and want to be vaccinated is now, thankfully, a largely historical issue here.

  • If..

    The article by Brennan [1], which has just been drawn to my attention, only exists in hypothetically perfect world in which medical evidence is always clear cut and bureaucracies beyond fallibility, bias, corruption or perhaps even scrutiny - it hinges like a lot of ethical investigations round the word "if". You could agree "y" if "x" (though I am not sure whether in this case it would be a libertarian argument as opposed to just an argument) but we do not have flawless bureaucracies making perfect decisions based on immutable scientific laws. Of course, a crucial argument relating to political liberty is just that bureaucracies are inevitably imperfect.

    While we could explore and criticize the basis of many such decisions (and despite huge institutional pressures many criticisms of vaccine products lie within mainstream scientific debate, for instance issues regarding influenza vaccination, HPV, aluminum adjuvants, mercury preservatives etc.) we are simply not talking about a branch of science which admits of such certainties. Nor are we dealing with just a few products. The US mandated schedule has perhaps dozens of products already, with hundreds in the pipeline which depend for their commercial viability on being licensed and mandated in their turn. Brennan does not engage with the problem that is not about one or two instances (for instance MMR vaccine is often cited) but an indefinitely large number products which could become c...

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  • The libertarian case reconsidered

    Jason Brennan presents a justification for mandatory vaccination policy from a libertarian perspective. I reevaluate Brennan’s argument, focusing on the applicability and potential limit of the clean hands principle he proposed. I argue that the clean hands principle cannot tell us how to weight the degrees of risk of different collectively harmful activities; therefore, we could not distinguish the relative significance of coercive interventions that aim at stopping different kinds of collectively harmful activities. Using secondhand smoke prevention as an analogous policy example, I illustrate that many behaviors that suffice the five conditions could be qualified as collectively harmful activities. These activities are hence subject to coercive policies that are justified by the clean hands principle, including those obviously infringe individual rights and civil liberties and contradict with libertarianism. For libertarians, this implication of the clean hands principle might not be too comfortable to accept.

    Main Text
    Using David Gauthier’s strategy, Jason Brennan demonstrates that even starting with a theory “with strongly individualist and antigovernment premises” such as libertarianism, mandatory vaccination is justifiable (p.37).1 Drawing on one of his own works, Brennan argues that the clean hands principle requires a person not to participate in collectively harmful activities, and that libertarians should accept governments’ coercive...

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  • compromise

    Indeed FGA type 1 and 2 would not rob me and so many like me who want to follow our religious rights and adhere to harmless procedures as well which are surely less invasive than male circumcision. Its would not make me feel harrassed by western oppression of allowing the afflent consenting woman undertake the same procedure while condemning me of mine. Since FGA type 1 n 2 are harmless they are on the rise as cosmetic surgeries, so why should my choice of doing it for religious purpose become harmful to be banned. Yes severe forms shouldn't be allowed but surely type 1 or 2 as alternatives can reduce severe forms from happening. Medicalization and strict protocols can be framed to ensure safety from FGA type 1 n 2 procedures as well.