Monday, October 20, 2014

Cultural relativism and misguided respect for deadly parental 'care' decisions

A remarkable story is currently occurring in Canada - again. An aboriginal child is suffering from life-threatening cancer. The type of cancer: leukemia. The odds of success if chemotherapy is instituted in a timely fashion: > 90%. The child in question: an 11 year old girl. The girl dropped out of treatment and left hospital. A second child, also 11 years old, also removed from her parents from hospital under similar circumstances has since experienced a relapse.

In both cases the child in question is an aboriginal child. In both cases the parents decided to take it to some holistic healing center in Florida. To date there is zero empirical evidence that the approach taken by this treatment center treats childhood leukemia successfully.

The hospital in question asked a court to direct the local Children's Aid Society to intervene. Remarkably, the Society, represented by a lawyer, took this stance:

"Handleman, the lawyer for the society, said that appropriate steps were taken and after an investigation it was determined the girl was not a child in need of protection. Handleman also stated that her mother was not refusing treatment for her daughter, but simply chose treatment the doctors disagreed with."

Simple, isn't it? There is an eleven year old child suffering from leukemia, the odds of successful treatment with the gold standard of clinical care under those circumstances: 90%, parents remove child for unproven holistic something, Children's Aid Society doesn't quite see what the fuzz is all about. After all, the parents were willing to provide some sort of treatment to daughter, just not the gold standard of care. Problem solved. It's all relative and truly in the air. There is no discernable difference to the Society between the professional opinion of specialists and the parents.

To put it in the word's of the hospital CEO where the child was treated,

"Obviously our main concern is with the well-being of this child.… This child has a life-threatening illness [and] without standard treatment will not survive, so our sole focus is trying to bring this child into treatment so we have an opportunity to provide her with a long, healthy life."

That apparently is of no concern to the local Children's Aid Society. Not in a case where an aboriginal parent has other ideas about treatment. Indeed, the mother stresses

"'This was not a frivolous decision I made."

Alas, there is zero evidence that the course of action she is currently following has succeeded, ever!

Remarkably, the judge in the case seems to be buying in the postmodern relativism that drives the argument of the Children's Aid Society. Here's what the National Post reports from the trial

"But Justice Gethin Edward of the Ontario Court of Justice suggested physicians essentially want to “impose our world view on First Nation culture.” The idea of a cancer treatment being judged on the basis of statistics that quantify patients’ five-year survival rate is “completely foreign” to aboriginal ways, he said.
“Even if we say there is not one child who has been cured of acute lymphoblastic leukemia by traditional methods, is that a reason to invoke child protection?” asked Justice Edward, noting that the girl’s mother believes she is doing what is best for her daughter.
“Are we to second guess her and say ‘You know what, we don’t care?’ … Maybe First Nations culture doesn’t require every child to be treated with chemotherapy and to survive for that culture to have value.”

This sounds almost farcical. The judge apparently doesn't think child survival is what's at stake, but the value of aboriginal society. A nice sentiment so long as you aren't a vulnerable child desperately needing proven medical care. To be fair, the judge is asking these questions. I hope he'll come to his senses and not judge along those lines. - Surely, the essential question here is this: Should we, as a society override parental care decisions for their children in cases where there is overwhelming evidence that they're harming their children irreversibly, or, as in our case, where the children would die almost certainly?

The long and short of it is that we have always done this. The children's (objective) best (survival) interests trump parental best intentions, parental ignorance, parental fanaticism, parental scepticism with regard to mainstream medicine etc etc. Hospitals routinely override parental decisions by Jehova's Witnesses that refuse life-preserving blood transfusions for their children. And they are right to do so. There is no parental right to kill their children, not even with the best of intentions. Anyone recall the cases of children who died because their parents thought prayers would do the trick?

What is not known is whether these two cases (same hospital) are a result of a communications break-down between the health care professionals and the parents. But even if this was the case, it remains shocking that the Children's Aid Society could possibly justify its inaction with the view that the parents were just trying something different. Since when has the life of a child become so cheap that we leave it to misguided parents who wish to do as they see fit, evidence be damned?

Oh, right, I forgot, it's an aboriginal child. If this is a case of trying to make-up for past injustice, let me just say that this isn't quite a sensible way to go about this matter.

Thursday, October 16, 2014

Is it that difficult to get your questions right, Globe and Mail?

The Globe and Mail newspaper has done a pretty sterling job covering the ongoing proceedings on end-of-life matters in Canada. Reporting has been well-informed and its editorialising has been supportive of the decriminalisation of assisted dying in the country.

Yesterday though, the paper flunked it. It tried to have yet another for-and-against on the subject matter. I don't blame the paper, the issue is currently heard by the Supreme Court of Canada, it's a big issue (right next to that non-issue, Ebola scare in Belleville). The for and against asked Margaret Somerville (mysteriously introduced as one of Canada's best-known experts on the subject) and Arthur Schafer to address the question of whether doctors should be permitted to accede to patient requests for assisted dying. Not unexpectedly, the two contenders had nothing new to say, but nonetheless their comments were the starting point for a lively debate among Globe and Mail readers.

What I found shocking is that the paper didn't manage to phrase the question correctly. It asked: 'Should patients be allowed to request suicide?' Well, obviously, this isn't the question at all.

Canadians are legally permitted to ask this question of anyone at any time. Nobody is questioning Canadians' right to request assisted dying (it's about assisted suicide/voluntary euthanasia, btw, not about suicide, dear Globe and Mail). The real issue is whether health care professionals should be permitted to accede to such requests. That the paper didn't quite get to asking its 'best-known experts'. Bit disappointing.

Supreme Court of Canada heard arguments in Charter challenge to assisted dying criminalisation

An exciting day yesterday. I listened all day via live audio-video link to the Supreme Court of Canada hearing on the Charter challenge to Canada's criminalisation of assisted dying. Commentators in the national media are broadly in agreement that the Attorney General of Canada made a hash of it, and that the judges' questioning a least appeared hostile to the government's defense of the status quo. I share that view, being not a lawyer and all. I was pleased to see that the Royal Society of Canada Report I had a hand in producing got a mention in various presentations. One of my colleagues on the expert panel, Jocelyn Downie, live tweeted the event from the SCC. I looked at the list of interveners in the case. There's a whole bunch of them, virtually all of whom are Christian activist groups, some more fundamentalist than others. Their presentations were by and large predictable. There was much hand-wringing about threats to vulnerable disabled people. We know today from jurisdictions that have decriminalised that these threats are entirely imaginary. We also know that these hand-wringers cannot even claim to represent the majority of disabled people in this matter. I wonder how genuine these arguments really are. I suspect they are a last ditch attempt at keeping the SCC from declaring the part of the Criminal Code that criminalises assisted dying unconstitutional. The God folks also served other arguments such as the sanctity-of-life argument. One judge asked a youngish evangelical lawyer what this would imply for a possible future introduction of the death penalty into Canada's legal system. Being a conservative the lawyer couldn't quite bring himself to say that the death penalty would also be wrong. Then there was a lawyer representing groups called the Faith and Freedom Alliance and the Protection of Conscience Project. He didn't address the actual challenge but asked that the Court direct parliament to ensure that health care professionals would not be forced to assist in dying if they had conscientious objections. That, of course, is the case already today in matters such as abortion. However, this lawyer wanted to extend conscience based protections. Today health care professionals are legally required to pass the help-seeking patient on to a health care professional willing to provide the requested service. The lawyer wanted to strike out such an obligation. I am not a fan of conscientious objection rights anyway, so I hope the Court will ignore this. - So, all in all, a nice day of theatre on the stage of the SCC. I remain hopeful that we will soon learn that the criminalisation of assisted dying is unconstitutional in Canada. Fingers crossed, with a hopefully upcoming change in federal government, this could actually result in progressive Canadian legislation on this going forward.

Monday, September 29, 2014

Brian Leiter and the PGR - the quality problem in academic philosophy

Blog visitors outside philosophy (the discipline) will be forgiven if they haven't heard of the Philosophical Gourmet Report and/or Brian Leiter. Leiter is a professor at the University of Chicago, but that's neither here nor there really. I have read and do like some of his work. Leiter seems to be a belligerent kinda guy who sends nasty, over-the-top emails to people who criticise him.

He also publishes a gossip document (aka said Philosophical Gourmet Report) that ranks philosophy departments according to 'quality'. What determines quality? One would hope straightforward testable criteria such as publication records of faculty members, job placement and the like would be binding criteria to be used by evaluators. One would also assume that it's comprehensive and that it covers all doctoral degree granting philosophy programs. You could not be more mistaken. There's a pre-selection of 'top programs' which were somehow chosen, if you trust the Report's explanation of 'method'. It seems the Report picks faculty members from ranked programs and asks them to evaluate faculty lists. To take away the marketing effect of prestigious university labels the faculty lists do not include university affiliation. So, that would probably mean that if I received a list including Jeff McMahan I wouldn't think Oxford U. Fun approach that. Still, at least an effort is made to reduce bias based on institutional affiliation. That's kinda tricky as that is pretty much all that philosophers typically go by.

Well, what criteria are the evaluators given? They read like this: '"Faculty quality" should be taken to encompass the quality of philosophical work and talent represented by the faculty and the range of areas they cover, with the two weighted as you think appropriate. Since the rankings are used by prospective students, about to embark on a multi-year course of study, you may also take in to account, as you see fit, considerations like the status (full-time, part-time) of the faculty; the age of the faculty (as a somewhat tenuous guide to prospective availability, not quality); and the quality of training the faculty provide, to the extent you have information about this.'

Pretty obvious that this approach stays remarkably clear of measurable faculty outputs. Instead people affiliated with pre-selected programs evaluate the quality of people in pre-selected programs based on ... well, apparently, whatever criteria they choose to evaluate quality. Yep, that's how this works. This probably gels well with standard approaches of academic philosophers telling you that philosophy journals, usually old ones, that demonstrably nobody reads or cites, are top journals, simply because people from - you guessed it - top programs populate their editorial boards, and people from - you guessed it - top programs publish in them. Another sign of quality are typically inefficient review processes. The longer it takes the better it must be. Philosophical logic when it comes to evaluating philosophical quality is somewhat... well, unbeatable.

Anyhow, so that's this Report. Not once in my academic career did I bother looking it up. To be fair, it supposedly serves to assist in helping graduate students make sensible choices regarding graduate programs. Because it is used by lots of graduate students and apparently departments when they make hiring decisions, it has become a self-fulfilling prophecy. The beauty of academic philosophy. Never ceases to amaze me.

Well, Leiter also hosts a lively blog that I would probably be interested in if the above mentioned academic discipline and its shenanigans were of deep interest to me. There's on and off content posted there, often by Leiter himself, that's relevant to me (he does a bit of work that's of interest to secularists and academic freedom folks). I don't think I check-in more than once a month for a couple of minutes.

Anyhow, some philosophers think that Leiter is way too influential and ... well, a bully. So they try to have him removed from the PGR. A petition is circulating asking that folks sign it. Essentially it repeats that Leiter is a bully and that the signatories won't participate in reviewing for the PGR. Among the signatories are a whole bunch of very well-respected people, including personal friends of mine. I don't think I will sign the removal demand, because, frankly, the story is fairly convoluted and I can't quite make sense of it. Each side seems to represent a somewhat jaded (and incomplete) account of what it is that has transpired between the protagonists. Here's the Chronicle of Higher Education's take on the saga. Leiter doesn't seem to be a particular pleasant correspondent if he thinks you've crossed him, and some of his language is out of line by most standards. He does seem to do a decent job with the PGR, by philosophers' standards (whatever they might be). I suspect he might not be entirely mistaken if he assumes that the current kerfuffle is both sour grapes by programs not crowned by his philosophical gossip report as well as personal vendettas by folks he crossed in the past (and, no doubt, there will be legions by now).

Grab your popcorn, sit back and enjoy the latest philosophical fireworks, or, get a life.

Saturday, September 13, 2014

Great new review of 50 Great Myths About Atheism

From the current issues of the Journal of Contemporary Religion 2014; 29(3): 572-574.

50 Great Myths about Atheism
Chichester, West Sussex: Wiley-Blackwell
274 pp., £50.00, US$84.95 (hb), £14.99, US$24.95 (pb)
ISBN 978–0–470–67404–8 (hb), ISBN 978–0–470–67405–5 (pb), ISBN 978–1–118–
60781–7 (eb)

In 50 Great Myths about Atheism, Russell Blackford, Conjoint Lecturer in the
School of Humanities and Social Science at the University of Newcastle,
Australia, and Udo Schu¨klenk, Professor of Philosophy at Queen’s University,
Canada, explore 50 ideas about atheists that they consider to be often
wrongfully upheld. The authors, who also wrote 50 Voices of Disbelief: Why We
Are Atheists, tackle each ‘myth’ in succession throughout the book, giving their
reasons for considering the notion invalid or at least unfair.

The material in the present volume is presented according to themes. After
an introductory chapter, in which the authors explain the structure of the book
and define the main concepts, myths are addressed related to (in sequential
order) the meaning of atheism, the style of living of atheists, ethics and the
soul of atheists, name calling, the unpleasantness of atheists, faith and reason,
religion and science, and the future of atheisms. For all the myths, the authors
typically first introduce the source of the myth and then offer a rebuttal of the
statement. The last chapter of the book, entitled “The Rise of Modern
Atheism”, covers a coherent discussion of the history of atheism as well as
arguments against some classic theistic lines of reasoning and arguments
against the notion that religion and science are compatible.

Blackford and Schu¨ klenk have done an admirable job in refuting the claims
they deem unjustly attributed to atheism. Overall, the authors’ arguments are
convincing and well supported by citations and examples. For instance, in the
case of myth 38, “Atheists Don’t Understand the Nature of Faith”, different
definitions of faith as advanced by various religious writers are cited and
discussed, after which the authors persuasively explain how none of these
definitions precludes atheists from understanding what faith means. Inevitably,
however, with so many different sub-sections, some myths are more
compellingly refuted than others. In the myth just mentioned, the philosophical
claim is supplemented by the empirical finding that, in the United States,
atheists generally know more about religion than those who self-identify as
religious. There are more sections where rational arguments are supplemented
by empirical data, for example, myth 17, “Atheists Fear Death (More than
Others)” and myth 22, “Atheists Don’t Give to Charity”. The book is
predominantly philosophical, however, so that no empirical data are provided
for many other myths. Understandably, data are in many cases not available
and in other cases not necessary. However, certain myths suggest demographic
and/or attitudinal claims about atheists and in these cases it is arguable that
the absence of empirical data renders the refutation somewhat less conclusive.
Assertions such as “Atheists See No Good in Religion” (myth 7) and “Atheists
Want to Strip People of their Beliefs” (myth 33) are refuted by Blackford and
Schu¨ klenk; they state, for example, that “atheists are not necessarily hostile to
all religion” (28) and that “there is nothing in the mere concept of atheism that
could justify the use of force or other forms of coercion as legitimate means of
transforming religious people into fellow atheists” (110). It remains a mystery,
however, to what extent the attitudes addressed by the myths are in reality
represented in the non-religious population. Logical arguments, in that sense,
can only provide part of the answer. In fact, it is not impossible that sometimes
philosophy and empiricism could provide different answers to the same
question. A clear example is myth 5, “Atheists Hate or are Angry with God”.
The authors propose that atheists cannot be angry be with God because they do
not believe that God exists. Philosophically, of course, this argument is solid.
Psychological research has shown, however, that people who self-identify as
atheists and agnostics can and do report anger towards God at times (Exline
et al.; Exline, Yali and Lobel). Whether those who report anger towards God
may be called atheists is a separate discussion and this does, of course, not
mean that the myth itself, namely that all (or most) atheists are angry with God,
is true. However, it does at least qualify the philosophical claim that atheists
cannot be angry with God.

Not all myths discussed in 50 Great Myths about Atheism are claims of
demographics or attitudes of atheists. In fact, many statements can be and are
well refuted, with the refutation based solely on philosophical arguments, such
as myth 20, “Without God there is no Morality”. Moreover, even in the
discussions that do leave space for empirical support, many interesting and
thought-provoking arguments are brought forward by the authors that should
trigger the reader to at least (re-)consider the truthfulness of the particular
claim about atheists. As the book is broken up into small sections, it is highly
accessible and allows readers to pick and choose the items they find most

Overall, Blackford and Schu¨klenk’s work is a valuable contribution to the
debate between believers and non-believers. One hopes that the comics of
Jesus and Mo, which are dispersed throughout the book, in order, one
assumes, to amuse most non-religious readers, will not discourage religious
readers to pick up this book and consider the well debated ‘other side’ of
some of the beliefs about atheists they may hold.

University of Cambridge, Cambridge, UK
© 2014 Suzanne Brink

Blackford, Russell, and Udo Schu¨klenk, eds. 50 Voices of Disbelief: Why We Are Atheists. Chichester,
West Sussex: Wiley-Blackwell, 2009.
Exline, Julie J., Crystal L. Park, Joshua M. Smyth, and Michael P. Carey. “Anger toward God:
Social-cognitive Predictors, Prevalence, and Links with Adjustment to Bereavement and
Cancer.” Journal of Social and Personality Psychology 100 (2011): 129–48.
Exline, Julie J., Ann M. Yali, and Marci Lobel. “When God Disappoints: Difficulty Forgiving God
and its Role in Negative Emotion. Journal of Health Psychology 4 (1999): 365–79.

Friday, September 12, 2014

Endless fraud of fee-for-up-load Open Access 'publishing'

So, for your enjoyment, here's the latest instalment of the fee-for-upload 'open access' publishing industry. I received this just now. Make sure to read beyond the invitation-to-submit reproduced below. It gets more interesting.

"Dear Dr. Udo Schüklenk,
Greetings from the Journal Palliative Medicine and Nursing: Open Access (PMNOA).
We would like to introduce Aperito Online Publishing which is dedicated to the scientific community. Our motto is to provide the easily accessible research information worldwide.
For this we have chosen the selective scientists who have enormously contributed to the scientific community to have their work published in our Journal. You are requested to send any type of articles (Research; Review; Case Report; Mini Review; Short communication; Opinion; Letter to Editors, etc) to the Journal to increase the visibility of our Journal.
You can submit your article by sending an email to The article submission date is 09 October 2014. The articles which will be submitted on or before 27 September 2014 will be waived 50% & the articles which will be submitted on or before 04 October 2014 will be provided 25% off over publication fee. The Publication fees are as follows.
Country TypeResearch/Review ArticlesCase ReportsMini Review/Letters to EditorsShort Communications
High Income$909$549$500$400
Middle Income$729$459$400$300
Low Income$549$369$360$200

Note: If required we can also extend the date of submission as per your convenience.

You are requested to send an email for the confirmation within 48 hrs.

Best Regards
Sophia Elena
Aperito Online Publishing
1999 S. Bascom Avenue,
Suite 700, Campbell, California, 95008

So, I'm selective scientist (I'm not a scientist, I'm a philosopher), and if I submit before September 27 (!!!) I will get my up-load (aka Open Access fee) reduced (aka waived) by 50%. The motto of this fee-for-upload publication is 'easily accessible research information worldwide'. Cool. Why should I bother? Right, the journal wants my fee-for-upload 'publication', so that it can increase its own 'visibility'. Gotcha.

Remarkably, this SPAM outfit boasts two University of Toronto academics on its Editorial Board. I wonder whether they are aware of the nature of the publication that they're listed on the Editorial Board on: Peter C Coyte, Vincent Maida. Other academics are listed without the academic institution even being mentioned. The usual. A hastily copy-pasted-together 'journal' website aiming to get suckers to send their articles and credit card details…  Why do academics support these kinds of outfits - well, do they? I'm not so sure even about that. Oh, in case you want to know where this prestigious academic journal is supposedly or really physically located, this is what a quick address search offers, an insurance broker, probably fully unaware of the fact that they're sharing an office address with this prestigious Open Access journal. Ein Schelm war bosses dabei dent.

Oh, and in case you wonder, of course there are academics that fall for such fraudsters, as this 'publication' in one of its journals demonstrates.

Monday, September 08, 2014

Bioethics and the Ebola Crisis

As I write this the global north’s media hype about the Ebola outbreak in various West African nations is at its peak. Amidst wild speculations about the number of infected people there are also confirmed facts, such as about 3700 confirmed cases and about 1800 deaths.[1] No doubt numbers will increase. These cases occurred overwhelmingly in Liberia, Sierra Leone, Guinea and most recently Nigeria. It goes without saying that many more people have died of other preventable or treatable diseases in that same period of time in those same countries, yet the world’s gaze was transfixed on Ebola. Just for a reality check, in Nigeria about 215.000 people die per year entirely preventable deaths related to HIV/AIDS and another 300.000 die of Malaria.[2] Having said that, Ebola is a pretty terrible disease, even by the usual unpleasant standards of life-threatening diseases.

As can be expected of some mysterious disease emanating from the ‘dark continent’, a lot of attention seeking theatre accompanies the deadly performance of the actual virus. The actors are a mixed bunch of Christian missionaries busily trying to get their hands on the last available experimental agents while on private medical jet flights out of West Africa. As you would expect, toward the end of their performance they thanked their respective gods for their survival as opposed to state of the art medical care. Who else performed in the mass media’s bright lights? International organisations tried to grab the limelight. There were serious performers such as Doctors without Borders. They have treated patients in Ebola outbreaks for many years, without ever losing personnel in the process. Doctors without Borders provided us with sensible explanations for the ‘why now’ of the outbreak and the ‘why here’ with regard to where the outbreak is occurring. Essentially the outbreak is occurring in failing states with barely existing health care systems. Patients and their families – often with good reason – do not trust foreign or local medical staff. Quite understandably they are suspicious because mostly body bags leave government and other facilities tasked with attending to Ebola patients. Many of these people also don’t quite buy into the idea of viral causes of disease. Doctors without Borders asked for urgently needed specialist personnel from countries of the global north, staff able to undertake the necessary laboratory work, health care personnel for treatment, portable medical equipment necessary to isolate patients, and so on and so forth. That, of course, is so obvious, that it’s nearly boring. Theatre must be entertaining, and Doctors without Borders isn’t quite delivering on that front.

Steps in the WHO. After missing the outbreak for a fairly extensive period of time the world organisation responsible for global health decided that its first act after declaring this outbreak a pandemic, should be to host an expert meeting on experimental treatments and experimental preventative vaccines. It goes without saying that this haphazard meeting, convened within a week by WHO, and not really staffed by people who are experts on access to experimental agents, provided the necessary entertainment required by the media circuit. Endless media interviews were scheduled on the ethics of access to experimental agents all throughout August 2014, and it is here where the stage opened – finally – for bioethicists.

How did we perform? Did we stress that WHO’s choice of topic and the supposed urgency of its recommendation to provide access to experimental agents in Ebola regions amounted to pointless grandstanding in the face of a pandemic that requires a public health response, and not the tinkering with experimental agents? Some of us did, but it didn’t stop most of us from entertaining questions on the ethics of who should get experimental agents, whether it was ok that white religious activists with a health care background were prioritized over local dying health workers, and other reportedly important questions. In the rush to be seen to do something the WHO managed to convene said meeting without a single representative from a country affected directly by Ebola.

None of that mattered on the main stage of a pandemic veering out of control. Predictably riots broke out, patients ran away from hospitals or were violently freed out of isolation units by their worried families. Such on the ground mayhem would have also made for reasonably nice media theatre, alas, bioethicists decided to bring the full armament of analytical ethics to bear on crucial questions such as who should receive an experimental vaccine first. It is not that they were wrong in their concerns about the fact that these vaccines aren’t quite vaccines, they are chemicals that prevented infections in some monkeys. Even the drugs’ toxicity profiles were not established. So, in fairness there were ethical issues, but they were not the most pressing ethical issues. They were not particularly pressing because these vaccine candidates, even if they turned out to work, would not make a dent in the current pandemic. Did these issues occupy most of the mass media – bioethics collaborative performances? Sadly they did.

In supporting roles appeared health care professionals assembled by various nations, tasked with providing health care and laboratory services. They were doing the kind of work that Doctors without Borders has successfully undertaken for many years. Turns out our supporting actors are at the time of writing not quite ready for prime time, so as quickly as they drop in to West Africa, they are being airlifted due to some real or imaginary risk to them. The obvious point to be made here is perhaps this: Don’t send staff not up to the task, because the endless kerosene burned in private medical jets flying them forth and back is using up resources that could probably be put to better use. For instance, it could be used toward a down-payment for the creation of functioning primary care health care systems in the countries in question. Turns out, this allocation decision is an ethical decision, alas one not addressed by anyone currently pontificating on Ebola ethics.

What then are other relevant ethical questions to be addressed in the context of this pandemic? Here are a few that come to mind: What are the ethical obligations of citizens (and their representative governments) in the global north toward those affected now by this pandemic? Should they send health care personnel, possibly even military personnel, as the US President suggested in an interview? Or would it be sufficient to send a couple of experimental agents and wash their hands of the pandemic, as Canadian bioethicist Peter A. Singer seems to suggest in an interview. [3] Assuming that military or police force could assist in curbing the spread of the pandemic, under what circumstances and within which parameters should such deployments occur? What obligations of care do agencies have toward their staff? Do specialist technical public health workers in the global north have professional responsibilities to participate in Ebola related missions, given that they didn’t quite sign on for that sort of risk when they joined governmental agencies in the UK, Australia, Japan or elsewhere. What personal risks – if any – can they reasonably be expected to accept for themselves, both in terms of infection risk, but also in terms of violence that could occur if the local situation spins further out of control. Given that the existing health care infrastructure in the affected countries is disintegrating in front of our eyes, should others consider stepping in to provide the basic health services the local system was able to provide until – however insufficiently - the Ebola crisis hit?

There you go bioethics. Think of Ebola as primarily a public health challenge not a research ethics phenomenon and you might just be addressing questions that actually matter, ethically.

Udo Schuklenk

[1] Centers for Disease Control (U.S.). 2014. 2014 Ebola Outbreak in West Africa. (Accessed September 8, 2014)
[2] United States Embassy in Nigeria. Nigeria Malaria Fact Sheet.
[3] Hildebrandt, Amber. 2014. Why Canada must approach the Ebola outbreak as a natural disaster. CBC News Sept. 05. [Accessed September 8, 2014]

Saturday, August 16, 2014

Ebola epidemic reporting and bioethicists in the media limelight

There is a lot that is bizarre about the Ebola epidemic reporting. Journalists don't seem to be able to get the most basic facts of the matter right. Canada's CBC reported in its news program that Canada is sending a 'vital experimental vaccine' to West Africa. Well, obviously, you don't need to be a virologist or public health expert to figure out how nonsensical this claim is. There is nothing vital about an experimental agent that hasn't been tested on a single human soul.

Generally speaking, I am puzzled about the language that is being deployed widely to describe these experimental agents, by journalists, biomedical scientists and bioethicists alike. Why do we call something an 'experimental vaccine' or an 'experimental drug' (the latter I did unwittingly in my doctoral thesis - produced in another lifetime). The more I think about it, the less this makes sense to me. An experimental vaccine isn't a vaccine, an experimental drug isn't a drug. Both, at best, are chemicals hoped to be efficient with regard to a particular preventative or curative purpose. Until they are known to do that, it is manipulative to add the curative or preventative capacity to their name. Perhaps that's why princes are not kings (they're not called formally 'future king', they're called prince or princess, or whatever else, equally, caterpillars aren't called 'future butterfly' either). Yet when it comes to future may be drugs, we are less hesitant. I think this is a problem, because it leads to pseudo debates among the less well informed (i.e. most people). Framing effects are well known and if anything triggers them, this kind of misleading language does.

Example in point, I was unfortunate enough to have myself recruited for a BBC World program (I love the BBC, would never decline an invite from them). I was the 'ethics' guy on the program, there's an MSF operative, the President of Liberia, plus a 'political scientist' and African ex-pat in London whose role it was to berate the President, and a bunch of other folks. The hour-long program was moderated by one of those less well informed people. She tried to get the ethics debate off the ground by telling the world that two Americans received 'that vaccine', and what I thought of that. I was expected to go on about why not Africans etc etc. Instead I explained that the Americans received an experimental agent hoped to be therapeutic, and that today we have neither a vaccine nor a therapeutic drug. We don't even know whether the experimental agent assisted in their recovery, and we don't know whether the same agent was involved in the death of the Spanish missionary. She cut me off right there and moved on to the next panelist. At least I had fixed this minor issue of her coming into the studio not knowing the difference between a vaccine and a therapeutic drug and between experimental somethings and actual medicines.

Of course, I didn't actually get to talk about bioethical issues at all. So, was it my job to teach the basics here? I mean, it takes really half an hour on the web to get this stuff right, except the BBC staffer must have decided that that's why too much by way of preparation for an hour-long special program involving the President of Liberia! Wow.

Anyhow, bioethicists amongst my friends revelled on Facebook and other social media platforms in the number of interview requests they received, and naturally the pecking order of those media (i.e. were they important ones or so-so outfits).  To be fair, the issues raised by most of us were similar, the answers by and large in the same ballpark. It didn't take a genius to figure most of those questions out. I suspect the only disagreement we'd see come into the open would occur when it comes to deciding who should have priority when it comes to access to limited quantities of an actually working therapeutic drug. Anyhow, some got mortality figures somewhat wrong (it makes a different whether it's 55-60% or 80-90%), and so ended up in consequentialist evaluations that were somewhat off the mark due to their mistaken empirical assumptions.

Nobody questioned why this media ho-ha, and why now. One journalists from a Canadian TV news outfit (Bell owned - hint :) asked me what I thought sustained the media interest. I volunteered that 'you' are probably tired of Gaza, ISIS, and Ukraine, and so an exotic African disease ain't a bad deal during the summer lull in the news. That question didn't pop up during the interview :). Fair enough.

Very few of us questioned the utility (and jurisdiction) of the WHO 'ethics expert' panels missives on the use of experimental agents. It was very much a bioethics undergraduate output, nothing wrong with it, the tricky questions were postponed. To be filed and hopefully quickly forgotten under longish WHO URL and file-name. Mission accomplished. - In any case, it isn't within WHO's powers to 'approve' the use of investigational new drugs anywhere. None of their business. That hasn't stopped the crowd over at and most other mass media outlets from misrepresenting this lil bit of fact. It's probably the first time that such a motherhood-and-applepie product from a bunch of guys on WHO's rolodex was taken note of by the mass media. Kinda nice for bioethics, bad news that so few ethicists were involved in producing the document, and too bad that it was such an unnecessarily rushed output. Alta Charo among others noted that the panel chose to address the easy questions and managed to come up with obvious answers, while avoiding the difficult ones.

I do wonder to what extent bioethicists should contribute to maintaining media interest in a story that shouldn't be that big. More Africans have died of other diseases in the countries in question, apparently nobody cares about this. Should we in bioethics not focus on this during interviews to put the hype into perspective? Should we really entertain journalists trying hard to 'bring this back to Canada', including fantasies about an Ebola epidemic in the country? I don't think so.

*Steps of soapbox.*