Bioethics, healthcare policy, and related issues.
There has been a flurry of attention recently to the notion of a “poverty of the stimulus” argument in moral development. Briefly, the “Argument from the Poverty of the Stimulus” (“APoS”) was advanced by Noam Chomsky in support of his theory regarding an innate (“nativist”), universal human grammar, on which children draw as they learn language. (The argument has a formal structure, but it basically consists in the observation that the specific grammar of the particular language the child is exposed to is underdetermined by the stimulus the child receives – the sentences the child hears from others. Given a limited set of inputs, a variety of possible grammatical structures capable of producing those sentences could be deduced, so the child cannot learn one particular language from that input; instead, the child learns the one language that is capable of generating the set of sentences it has heard and which is possible under the set of universal grammatical rules hardwired into its brain. When it has heard enough sentences, only one plausible grammatical structure will be available from within the universal grammar the child possesses, although many possible grammars could still have been deduced if that constraint were not present. The existence of the universal grammar is required to make accurate language acquisition possible in spite of the poverty of the stimulus, and therefore the fact that language is acquired at all is evidence for such a universal grammar and therefore the truth of the nativist theory of language.) The moral parallel is the idea that there is a universal, nativist moral sense. Just as the existence of hardwired language rules allows the child to generate new sentences, despite its exposure to impoverished language stimuli previously, so the nativist moral sense allows the child to make moral judgments regarding situations it has not already encountered. Just as the nativist language theory is a refutation of the empiricist school of language – holding that language skills are acquired essentially by behaviorist-style mimicry – the nativist moral theory is a refutation of the claim that moral judgments are culturally determined.
Adam Colber of Neuroethics & Law Blog has a good post, referencing an interesting recent journal article on the topic. Kyle Swan of Pea Soup had a more detailed discussion of the subject about 18 months ago (I just found the link after being “stimulated” by Colber’s post), which provides some excellent speculation and a very insightful comments thread. He also provides a useful bibliography, and links to a preceding series of posts on moral realism. There’s some excellent work going on over there at Pea Soup.
But what does this all cash out to?
Howdy!
God, I love looking at Sitemeter’s visitor stats, especially including the world-wide map with IP locations superimposed as colored dots.
Shoutout to my homies in Andalucia, yo! Not to mention 4 different Australian states (hey, Viv!), New Zealand, and a plucky contingent from Eastern Europe. (I may not know you, but I love you!) I’m strangely thrilled by visitors from England and Western European countries I’ve visited, though I don’t know why. And the search-phrase visitors are cool: “find a date” (? – whatever, man; I feel your pain). The nation-wide response from the good ‘ol US of A is very heartwarming.
Welcome, one and all!
A few special notes:
To you visitors from Raving Atheist – no, I don’t know what he’s talking about either, but welcome aboard and please take a look around. One of us is crazy, and I think you can tell who.
Other click-throughs from other blogs are also most welcome; I’m grateful for your interest and the support of the referring bloggers, in every case. Thanks, welcome, and please stick around.
New York bloggers and visitors: say hello! I’d like to get more hooked into the New York blogging scene, and especially with some of the really great New York ethics/policy bloggers (we all know who they are). Drop me a line! I’m down for meetups or events in Brooklyn or Manhattan especially.
Ethics bloggers: you too! I also want to connect with the professional ethicists/bioethicists online, and would really appreciate input and feedback from that community on what I’m doing (wrong) here and what you think about it. And, of course, substantive comments on the issues in the posts are highly desirable. I’d like to hear from you.
And a plea:
I’ve said it before, but have long since gotten past the point of “too proud to beg”, so I’ll say it again: use the comments section! It’s there for a reason! Now that I’ve got some stats tracking going, I know you’re out there, so say something! (A little link-love wouldn’t hurt neither, though it does hurt to say so out loud.)
I simply don’t know if I’m making a contribution people value. A while back I meta-posted on my plans for focusing and continuing the blog, explaining also why I tend to pursue long-form theoretical discussions rather than breaking-news links and commentary. That’s still largely my conception of this blog. But maybe, like Spinal Tap, I’m filling a much-needed void. Let me know what you think, and if there’s something here you find useful.
Thanks a lot! – especially for visiting and sharing your time and interest here. It’s very gratifying, and I hope we’ll have more opportunities.
UPDATE: Oy! I just discovered that I had my blog e-mail messed up for the last six months, and haven’t seen or responded to any e-mails sent me since about November 2005. Not only that, but the pileup of unseen mail (virtually all of it spam) hit my Inbox quota in January, so I don’t even have any e-mails for the last three months or more. If you’ve written to me directly (using the e-mail link on the sidebar) and I haven’t responded, that’s probably the reason. If you’ve written to me since the middle of January, I never got your e-mail and can’t respond at all. I’m sorry for this.
Certainly no offense was intended – I’m delighted to get e-mail through the blog, and wondered why it had stopped. (The reason is that I let somebody stupid handle the mail function – but when you’re a one-person operation, and the one person is me, that’s the only available option.) Again, I’m sorry – but the problem is now solved. Please keep writing, I’ll be glad to get back to you this time!
Elissa Ely has a fascinating and troubling case history at the New York Times Mental Health page: the patient’s horrendous tales of lifelong abuse seem to have been made up, but so also was his subsequent report of improvement. The care team cannot decide whether to challenge him on either of these issues.
The Spanish Socialist Workers’ Party (“PSOE”) has apparently signed on to the agenda of the “Great Ape Project” – namely, to establish legal and moral standing for most species of apes by virtue of what the Project perceives as their sufficient mental capacity for moral personhood. To my knowledge, this is the first time an organized political party of any consequence (including the Greens) has taken this stance.
The Spanish Socialist Party will introduce a bill in the Congress of Deputies calling for “the immediate inclusion of (simians) in the category of persons, and that they be given the moral and legal protection that currently are only enjoyed by human beings.” The PSOE’s justification is that humans share 98.4% of our genes with chimpanzees, 97.7% with gorillas, and 96.4% with orangutans.
Note that the citation of genetic closeness is both a somewhat contentious issue and not directly morally relevant. The Great Ape Project itself refers to mental capacity, not genetic consanguinity. This is still an interesting development, however.
Laurie Edwards, of ChronicBabe – an interesting support blog for young women with chronic disease – relates the similarities between finding her future husband and finding her ideal doctor.
Turns out, the world of dating and the world of doctors have a lot more in common than I’d considered. After all, who else has such access to the most intimate physical details of our lives?
I’m not on the animal-rights bandwagon (though I think there are interesting questions to be asked about intelligence in some primates). I generally have no strong objections to those who are, though I think they’re on the wrong track. I am offended by irresponsible groups like ALF and PETA, and think their illegal acts should be strongly punished, and I am equally offended by false accusations often raised against animal experimenters (though I also agree there have been lapses that should themselves be corrected and punished). In general, I think that the animal-rights activist community is as believable, mature, and responsible as the anti-choice activist community – which is sad, because in many ways their issues and arguments are in fact better grounded.
However, I’m always amused by and contemptuous of the labels on “green” foods and products self-righteously proclaiming that “this product was not tested on animals”. (Today I tried some shaving cream, from a cosmetics company run by two gay men, which was reassuringly labeled “tested only on boyfriends, not animals”. Great product, by the way.) There are only two things that can mean, and they both are predicated on the assumption that you’re an idiot.
Many had (somewhat) higher hopes than in the past when Dr. Edmund Pellegrino was recently named to take over the chair of the President’s Council on Bioethics from the execrable Leon Kass. And early returns suggested a freer sense of intellectualism within that body: more-open dissent, in distinction to the persecution dissenters faced under Kass, and a broader range of opinion flowing out of the Council under Pellegrino. But it was too much to expect that the overwhelmingly conservative membership would now incline to any higher sense of purpose, or more-inclusive understanding of what bioethics should be, than in the past. Today, Council member Robert P. George has disgraced himself – while acting in his personal capacity, not within the Council, it should be noted – by not merely endorsing but campaigning for anti-gay discrimination in company with conservative religious bigots.
George, I emphasize again, was acting outside the Council, in a private capacity. And the position he takes – for a Constitutional amendment prohibiting civil rights (marriage) for gay citizens nationwide – is not outside the range of common opinion in these degraded times, though it is certainly an ugly and shameful one. His conduct does not strictly reflect upon the Council, and certainly not its Chair, who, to his credit, has reversed the policy of retaliation upon holders of unapproved opinions that had been pursued by Kass. As a mere exercise of the right of opinion, or of personal political prerogative, George’s action is immune to reproach. So I am not arguing that the Council is implicated in this action, or that George’s endorsement of official discrimination directly incriminates anyone but himself. However, I cannot overlook what this says about the kind and quality of Council membership, and its ramifications for public bioethics in what it is increasingly hard to regard as a liberal democracy.
The Vatican appears to have launched an offensive against condom use to prevent AIDS, based on grossly distorted claims (and apparent ignorance of facts) regarding their efficacy against HIV transmission. The degree of falsity is so breath-taking, and the stakes so high, that the official Brazilian National Program on HIV/AIDS labeled it a “crime against humanity“. On the bright side, one highly-placed church official has shown a tiny bit of sanity on the matter.
Dawn Eden, an anti-sex writer with a widely-read blog and a thin skin, has had some sort of obsessive antagonism to Planned Parenthood for some time, and is a leading voice in an orchestrated campaign to cripple reproductive healthcare in America by crippling the single largest provider of reproductive care services, and the overwhelming provider of service to poor women.
Eden is confused on the issues, however, and breathlessly over-excited – and not a little ill-informed – by perfectly ordinary sex-related facts – all characteristic of her approach to the subject.
“Generations for Life” – “The Youth Outreach of the Pro-Life Action League” (a group of mid-twenties bloggers, 2/3 of them men, attempting to provide “outreach to [the] new pro-life generation”), has a lot of growing up to do. More specifically, they’ve got a lot of ill thinking and deep-seated confusion to overcome.
A recent post by GFL Director Annie Casselman proposes a series of “twists” on the theme of a woman with an unwanted pregnancy, and asks in each case whether she should be permitted to have the abortion she wants. Casselman imagines that that right is somehow weakened by being pregnant in “unusual” circumstances – she does not even bother to raise the usual anti-choice objections to abortion in general, but somehow seems to think that, even if a “typical” abortion is permissible, there are cases in which third parties can lay claim to a woman’s body simply by asserting one. If nothing else, she demonstrates how absolutely unable anti-choicers of whatever generation are to imagine that a woman’s bodily autonomy actually means anything.
Just saw the film Hard Candy, directed by David Slade (who has done almost nothing but music videos previously), and starring Patrick Wilson and a remarkable Ellen Page, who comprise almost the entire cast. Rated R for no good reason. The story revolves around the relationship between a precociously intelligent 14-year-old girl and a somewhat creepy early-30s photographer who pursues her online and then in person. When they meet, she suspects he is a pedophile responsible for the disappearance of another teenage girl – and then turns the tables on him in an act of revenge or vigilante justice.
The movie is somewhat unevenly paced – the first half hour is a tour-de-force of acting from both main characters, as they alternately engage in an exploratory flirtation and then each retreat to more age-appropriate demeanors; the moment when the plot takes its definitive twist and goes off in a new direction is also the moment when the director seemingly forgot what the movie was about, however. The second half is less a psychological intrigue than a straightforward vengeance tale. The result is a weird mashup of Lolita and Death and the Maiden, as directed by David Cronenberg. However, leaving aside the inconsistency, there are some provocative things in it, and some questions raised about how we are to understand young sexuality, our revulsion by pedophilia (and our protective impulses toward young girls especially), and our common impulses toward destructive retribution in response.
The castration scene was notable, too.
In order to discuss the moral/philosophical issues raised by the film, it is necessary to discuss the plot content. The material below the jump contains plot spoilers. Please come back after you’ve seen the film, if you prefer not to have the plot revealed.
A theme running through many of my posts is the patient-centered ethic of care: patient autonomy as the pre-eminent ethical principle, and patients’ values as definitive of the ends and goals of medical practice. This conflicts with a paternalistic notion of care, of course (and in doing so is hardly unique in today’s ethical climate). But it also conflicts with any “exceptionalist” medical ethic, that is, any claim that the ethics of medicine somehow take precedence over individuals’ rights or values because medicine, as a unique and traditional profession, has an “internal ethic” that trumps the ethical claims of mere patients, or of society. I am not the only person to hold such positions, though my views on them are probably further out on a limb than most people’s. However, I also believe these views impinge on a proper understanding of the factual ground of medical practice as well.
Obviously, medical science just is what it is – moral principles do not change the facts of the case (even if they influence which facts are sought by researchers, or acted on by clinicians). But medical practice, even more than most technological practices, operates on a highly value-laden vision of scientific fact, and nowhere more so than in the concept of the “definition of disease”. To traditionalists, nothing could be simpler: disease is whatever conflicts with “health”, and “health” can be identified in some sort of “I-know-it-when-I-see-it” natural law fashion. (More recently, the notion of “normal species functioning” has emerged as a “scientific” definition of health.) To critics, the “obvious” conception of health and disease is fraught with imposed meanings: not merely what kind and range of conditions or functions we take to be “normal”, but even what conditions are recognized at all. (The history of women’s depression, ADHD, and homosexuality are cases in point. “Drapetomania” – the pathological inclination of American slaves to run away – is a tragically hilarious example of socially-constructed disease, and likewise Tris Engelhardt’s celebrated paper on “the disease of masturbation” is a classic on the subject.)
For the most part, this debate has been a conceptually important, but in practice marginal, bywater of bioethics. It matters a great deal what diseases are recognized as candidates for treatment, but, with the exception of certain controversial psychiatric conditions (notably homosexuality), those determinations have been imposed by insurance companies, not derived by philosophers of medicine. The issue is coming to the fore today, however, in high-profile ethical controversies with distinct practical impact.
The Center for Reproductive Rights has a comprehensive, and very worrisome, report on the extent of legal barriers to women’s reproductive healthcare. An obvious problem is laws in heavily Catholic countries that are so absurdly restrictive they prohibit surgical evacuation of a dead fetus, or abortion when a woman’s health is not merely threatened but she is in fact actually going blind, measurably and progressively, from side effects of the pregnancy. Beyond this, though, there is also the systematic efforts of the Catholic Church in Europe to evade local laws on reproductive healthcare rights by convincing governments to sign “concordats” stipulating restrictions on, or the right to impose restrictions on, healthcare rights and especially women’s reproductive autonomy, entirely outside the existing legal framework of the EU or the individual nation. Luckily, the EU has been taking a look at these developments, and there are some encouraging signs.
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Bioethics Discussion Blog has a very nice post on the subject of the relationship between ethics and law. It’s couched in general terms, but is intended to apply specifically to bioethical issues. I think the principle he relates is very insightful; it’s close to the position I have always held and would like to see more widely appreciated. Sadly, in these times, there seems to be little sense of restraint or appropriate boundaries on legal meddling with others’ behavior. Perhaps BDL, and his source, respected bioethicist Dr. Eric Loewy, are on the right track.
The UK Guardian reports on a special issue of PloS Medicine (an online peer-reviewed journal) on “disease mongering” – the practice of pharmaceutical companies’ deliberately increasing fear over – or in cases entirely inventing – diseases to increase public demand for drugs that, conveniently, can only be provided by the pharma companies that created that fear in the first place. Like “halitosis” – the imaginary “disease” of bad breath, invented by Listerine and now standard medical terminology – pharmas have created or exploited ambiguous medical terms like “mild cognitive impairment” (to expand the range of uses for medications for Alzheimer disease), “female sexual dysfunction” (to justify prescribing Viagra for women), “erectile dysfunction” (redefined from true organic impotence to any degree of dissatisfaction with erection, to expand the market for Viagra to include all men regardless of health status), and “restless leg syndrome” (vague feelings in the legs, which supposedly are symptomatic of a neurological condition). They have also actively worked to redefine or blur the definitions of recognized conditions so as to justify diagnosing them in more patients, thus increasing the potential market for their products, and have publicly advertised their products for conditions which affect small proportions of the population in order to create demand for medication for conditions – especially ones affecting children – that the public fears but does not understand, such as ADHD (by publicizing controversial treatments to parents and teachers) and bipolar disorder (through advertising literally intended to convince women that they are crazier than they or their psychiatrists believe).
More and more, “educational” advertising is intended to convince consumers they are sick, not to alert them to treatments if they are sick.
There’s an odd disconnect many “pro-lifers” seem to exhibit between their ideology and their personal understanding of the difficult decisions they, too, sometimes face. One thinks of the more-than-a-few Republicans who are part of the “fetus-fetish” community but who support embryonic stem cell research because a family member or someone they know has a debilitating disease, or the more-than-infrequent anecdotal reports of anti-choice activists seeking abortions – often at the same clinics they themselves had been picketing! – because their situations were somehow “different”. From Jeanette at the blog “Oh, How I Love Jesus Because He First Loved Me” (yes, really) comes another example, moving in its own way, but strangely indifferent to the idea that others might have similar thoughts.
I previously posted on controversial remarks by UT biologist Eric Pianka regarding the advisability of a global pandemic that could kill up to 90% of the human species. Relying on an article written by respected amateur scientist and writer Forest M. Mims III, based on his notes of the public address, I accepted Mims’s report that Pianka had openly advocated the deliberate release of Ebola virus for the purpose of accomplishing this mass killing, on grounds that it was necessary to drastically reduce the human population to ensure the ecological stability of the planet. There are a few problems with this scenario, however.
First, Mims appears to be the only witness who believes that is what Pianka was saying that day. Pianka himself denies it, and others present give a different version of his message. Second, Mims’s article has been picked up by the right-wing blogosphere, with predictable results: Pianka has received death threats against himself and his family; many members of the Texas Academy of Science who had nothing whatsoever to do with Pianka or his beliefs have received illiterate, but angry and harrassing, messages, in one case filled with misspellings and all-caps references to the Nazis and, for some reason, the movie Soylent Green; there have been calls for disciplinary action by the university (which to its credit is standing firmly on academic freedom, with the exception of a few board members); and right-wing ideologue and “Intelligent Design” guru William Dembski has reported Pianka to the Department of Homeland Security as a terrorist. The Director of Mims’s parent organization, the Society for Amateur Scientists, has also published an inane and scientifically garbled essay claiming psychological insights into Pianka’s mental health, based on his reading of a second-hand paraphrasal of Pianka’s lecture (“I can only conclude that years ago Eric Pianka must have lost touch with his essential humanity, that is, a strong emotional need for his own kind. Now, perhaps driven by that terrible depression that can occur in old men, he seems to have lost touch with reality. I offer this under the touchstone of Ockham’s razor: I think that depression provides the least remarkable explanation for Pianka’s mental descent. . . . [D]epression can be a side effect of aging, especially in men. Moreover, men often express their depression by becoming angry at the world . . . elderly depressed men often become fixated on death. . . . If this explanation is the right one, then he needs to be treated by a psychopharmacologist with expertise in depression. Until he does receive the necessary care, we must think of him as a person in pain . . .”).
In other words, an ordinary display of scholarly debate from the right wing.
I previously blogged on the question “how much freedom of inquiry is too much?“, specifically regarding controversial or outrageous policy proposals by respected scholars. Dr. Autumn Fiester of the UPenn Center for Bioethics approaches the same question from the perspective of outrageous or frivolous research. She particularly notes the development of a genetically-engineered pig clone containing an enzyme that converts omega-6 fatty acid to the more healthy omega-3, arguing that this is a pure waste of money:
First: the omega-3 pig represents the worst type of “research waste:” precious scientific resources of time, mental energy, and money that could be used to tackle serious human and environmental threats are being devoted to frivolous causes. The list of devastating problems begging for a scientific solution include: chronic, genetic, and infectious diseases, famine, food and water safety, global warming, the destruction of ecosystems – the list goes on and on…
Second: the one problem we don’t have is a shortage of omega-3. Not only is it found naturally in readily available foods like walnuts and fish, but it can be found in supplements and nutritionally supplemented foods like Smart Balance Peanut Butter. We certainly do have a very serious problem of obesity and nutrition in this country, but neither are problems science needs to solve. We are fat because we eat too much, and we are unhealthy because we choose to eat the wrong foods. . . . Offering us genetically modified pork to provide us with a plentiful nutrient is an obvious attempt to drum up a need that justifies the science.
How much freedom of inquiry is too much? How outrageous do someone’s remarks have to be to call down censure? And what should the reaction of the scholarly community be to someone who seems clearly off the deep end on questions of policy, but is otherwise a respectable scholar?
Some on the right wing are taking perhaps-understandable exception to reported remarks of Dr. Eric Pianka, a herpetologist at UT Austin. Pianka was recently awarded the Texas Academy of Science’s Distinguished Scientist of 2006 award – and to all accounts deservedly, on the basis of his biological research. Pianka, however, is apparently kind of a “character”, and he offered remarks at the same session at which he received that award advocating a program of deliberate biological warfare with the goal of mass genocide of 90% of the human species. Which seems a bit extreme.
