Tuesday, December 29, 2009

New York, New York

I am currently attending the American Philosophical Association's Eastern Division's meeting in New York. I am not exactly what you'd call an avid conference goer, so - believe it or not - this is my first philosophy conference. We got an unwieldy conference program (a book of some 200pp). The variety of what's on offer is truly impressive. To my surprise, more than a fair number of contributors to our recent volume 50 Voices of Disbelief are presenting here, including Philip Kitcher and John Schellenberg. I went to a panel yesterday, chaired by my good friend Rosamond Rhodes, on health care reform in the US and heard Norm Daniels as well as the Hastings Center's Daniel Callahan speak. Impressive people. Daniels, in response to a question from an audience member, replied that the health care reform package should not be permitted to fail over the troublesome exclusion of abortion related medical services. I wondered about this very same question. Clearly what happened there is appalling, but within the political constraints of the votes available to progressive agendas in the US Senate, what's currently on the table probably is the best that can be done. To argue that it's better not to achieve small progress in order to avoid the political sell-out on the abortion front, seems short-sighted. Daniels called that one right, I think. Callahan wrote a thoughtful, critical commentary recently on the Hastings Center's website that is quite critical of the liberal embrace of stem cell research. Check it out if you feel like. I also attended a meeting with fellow journal editors, primarily aimed at an exchange of views. I was pleased to learn that Hypatia, the feminist philosophy journal moved over to Wiley-Blackwell, the publisher of two journals that I jointly edit. Last but not least I had a congenial lunch with Jeff Dean, the commissioning editor for Wiley-Blackwell's philosophy books. All that done in a day. It's worth attending conferences after all, if yesterday's outcome is anything to go by. Well, I better get my own acts together for my talk tomorrow morning. I also need to get going to be able to catch up this morning with Mary C Rawlinson, the Editor of The International Journal on Feminist Approaches to Bioethics. Not that you likely care, but it's the coldest day in New York City this winter, and stormy weather at that. Bummer.

Tuesday, December 22, 2009

Brief hiatus

I am traveling to the American Philosophical Association's Eastern meeting in New York tomorrow. Will be blogging likely from NYC, but who knows. Don't be too surprised if there's a week's silence :). In case you happen to be there, too, give me a shout!

Udo

Friday, December 18, 2009

And the weekend good news: Manto Tshabalala-Msimang is dead

I like the hypocrisy of people insisting that we must never speak bad of the dead. Why not? If the dead were bad people, what's wrong with wishing them good riddance. A case in point is Manto Tshabalala-Msimang (better known as Dr Beetroot), the former South African health minister. Her policies and that of her boss Thabo ('I don't know anybody who died on AIDS in South Africa.') Mbeki led to about 300,000 preventable deaths among infected people. Beetroot insisted that it ain't clear that HIV causes AIDS, and claimed that anti-retrovirals for Africans were an evil scheme by the CIA and the pharmaceutical industry to poison Africans. Those suffering from, and dying on AIDS she offered, well, you guessed it, beetroot, lemon juice and garlic. Moron that she was she thought nothing of it to jump the waiting list for organ transplantations in order to grab a liver when her old failed as a result of her marriage to alcohol. Excuses were found for why this woman, in her 60s at the time, was deserving of the liver (ie public sector clinicians, working for her, colluded in lies about her legitimate rank on the waiting list). During the time it became public knowledge that as a hospital doctor in Botswana she was convicted of stealing patients' property while they were in surgery. It didn't occur to the ANC and its senior officials to fire Dr Beetroot. Well, I was elated when I found out that the transplant liver crapped up on her, and the system refused to offer her yet another one. Good riddance Dr Beetroot. Thabo, we're waiting for you to join her. After all, you also like your booze and there's some 300,000 people who are dead today because of you. Why don't you also call it a day?

On a slightly more analytical (as opposed to purely angry) level (even though my anger about these two South African politicians' murderous policies knows few boundaries, I have admit): What is of interest is that there's a pattern of colonial mentalities in play in South Africa as well as in Uganda. In South Africa, black nationalist politicians happily ganged up with Western crank scientists against their own people, because they were suspicious of mainstream Western science and knowledge. White Westerners taught them stuff that translated into genocidal policies costing about 300,000 predominantly black people's lives in that country alone. The attempted political emancipation drove these black nationalists straight into the hands of crackpots, that's how substantial their concern was that hooking their people onto life saving medicines was just another ruse by the West to poison and keep Africans down and dependent on the West. Incomprehensible. As good nationalists are wont to do, they insisted on 'local solutions', hence beetroot, garlic and lemon juice. African scientists and medical doctors standing up to them were fired and bullied sufficiently that Stalin could have taken a page from that book (Beetroot managed this without actually killing the scientists, she simple removed them from jobs and funding).

Uganda is another example. It has become clear by now, that draconian anti-gay legislation, threatening gays with the death penalty, was inspired by US evangelicals, white US evangelicals. How ironic that Africans, busily trying to assert themselves against 'evil Western values', are being goaded by other Westerners (crazy ones) to implement seriously civil rights violating policies against their own people ... bizarre stuff. The only good news is that they're being opposed frequently by younger generations of Africans who won't stand for that sort of crap.

Anyhow, Manto is gone, let's go and drink to her demise :).

Thursday, December 17, 2009

Solidarity with BA cabin staff

UNITE, the union of the BA cabin staff have called a strike, lasting from December 22 to January 02. Hey, let me declare a conflict of interest. I am scheduled to fly on BA on December 23 from LHR to JFK. I was looking forward to catching up with secular friends in New York to get over the painful sickening sweetness that comes with Xmas. I was also looking forward to giving a talk on December 30 at the APA Eastern meeting in New York, and to a lively discussion about my paper (the joys of the academy).

Well, I may or may not get to New York, who knows. I can't rebook my flight, because it's a return leg, so in a sense I am on the road and can't easily change horses in the middle of the race (or so my booking agent, AA, told me - I had some hope they'd help me, being gold member [pun intended] and all). So, I am likely to be well and truly stuck in London unless BA and UNITE reach an agreement, or unless the UK Supreme Court forces UNITE to back down for the time being. I shall see.

What irks me about the public debate on this is the nasty response by the wider traveling (even the not traveling) public. There we hear stories about priests not being able to return to Africa (to do what, propagate the death penalty for gays in Uganda as they're wont to do? surely they're not doing anything really useful there anyway!), married couples not being able to go on a honeymoon in Florida (at least you won't be eaten by the crocs that are everywhere in that state), and so on and so forth. Some of the stories are truly sad, BUT, surely the point of a strike is to put pressure on your employer. What's the point of striking if nobody notices (us academics faces this problem just about all the time, especially in the context of strikes :-)? So, here's my first point: you can't blame cabin staff for striking at peak season, because this is the best time of the year to go on strike, from a strategic perspective.

BA and the sorry British public opinion on this matter also go on about their cabin staff being paid better than anywhere else in the industry. The company churns out press releases using their (arguably overpaid) inflight directors' long-haul salaries to show how well paid their cabin staff are. Of course, starting salaries for current flight attendants they're proposing now are a fraction of those directors' salaries! They're barely a living wage. Bizarrely the published opinion on the matter points out that Virgin Atlantic cabin staff already are being paid these miserable salaries for the hard work they're doing. What kind of argument is that? Since when has the lowest salary in the industry established what is reasonable? I kid you not, this is the level of public debate in this country!

Then there is people going on how miserable BA's service is. Well, for better or worse, I like the company's economy and premium economy better than that of many other carriers. Compared to Air Canada, for instance, BA's performance is way better. Admittedly, BA's long-haul business class is a bit of a joke (the in-flight service, not the seats). I would not ever fork out my own hard-earned cash for a seat in the far front of their planes, sorry to say.

Either way, good success to their cabin staff, don't let published public opinion in papers like the Daily (Hate) Mail drag you down! You're right to fight for better working conditions (or at least to prevent a further deterioration). I for one don't go on Virgin Atlantic anylonger because I know that their arguably superior service is paid for by greedy ol Richard Branson's miserable pay conditions for his staff.

Sunday, December 13, 2009

Open Letter to UN High Commissioner for Human Rights on Uganda

I am reproducing an open letter my colleague John-Stewart Gordon has written to the UN High Commissioner for Human Rights on the dismal situation of gays in Uganda.

Dear High Commissioner Navanethem Pillay:

my name is John-Stewart Gordon (Germany) and I am currently visiting
professor at Queen's University Kingston, Canada, conducting
a research project on human rights in bioethics.

Even though you are certainly aware of the current situation
concerning gay rights in Uganda (and other countries in Africa:
http://www.guardian.co.uk/world/2009/dec/13/death-penalty-uganda-homosexuals?CMP=AFCYAH),
I wonder whether there is anything
what you can do about this serious human rights violation.

I am not gay but I do care for other people and I am a professional
philosopher who notice when serious changes in communities effect the
lives of innocent people. You can certainly call this a "sex-related
genocide" that has to be stopped immediately. The situation is grim,
the social climate is poisoned and hatred crimes happen on a daily
basis. I am deeply concerned about this situation and I want you to
take any possible action in order to end this humiliating tragedy.
This seems to be only the beginning of a cultural change
concerning minorities in Africa and in other countries etc. Once
again, I urge you to act now or to contact the relevant human rights
bodies that might be of any help. Please, use all your authority to
end this "war against gay people".

If I can be of any help, please, let me know and I will be there for
your assistance.

Sincerely
Professor Dr. John-Stewart Gordon

John-Stewart Gordon, Ph.D.
Visiting Professor

Area-Editor of The Internet Encyclopedia of Philosophy

Queen's University Kingston
Department of Philosophy
Kingston, Ontario K7L 3N6
Canada
http://www.queensu.ca/philosophy/faculty.html

http://www.johnstewartgordon.com/index.html
http://www.amazon.de/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-de&field-author=John-Stewart%20Gordon
http://www.amazon.de/Morality-Justice-John-Stewart-Gordon/dp/0739122991/ref=sr_1_3?ie=UTF8&s=books-intl-de&qid=1240667047&sr=1-3

The Internet Encyclopedia of Philosophy (IEP) is currently looking for
authors with (great) proficiency in the field of Bioethics.
Please, have a look at the following topics, at:
http://www.johnstewartgordon.com/iep.html

Friday, December 11, 2009

'Where there is smoke, there is Pfizer'

I took this header from the hugely recommended and informative site my colleagues at noveltechethics.ca have put together. You might recall that it has been decided to appoint a Pfizer VP to the governing board of the Canadian Institutes of Health Research. The CIHR is a public agency funding biomedical research in the country. I have already pointed out elsewhere why such an appointment is untenable. It is untenable for one fundamental and one slightly more contingent reason. The fundamental reason is that the Pfizer VP has a fiduciary responsibility to the shareholders of his company to maximise profits. He is by necessity unable to prioritise the public interest over the profit interest over his employer, hence he has a continuing conflict of interest that makes him eminently unsuitable for accepting such a post. Just to be clear, maximising the profits of his publicly listed employer in its own right is not objectionable, what is objectionable is that someone representing such interests should serve on the board of a funding agency aimed at maximising the public good. The second reason is that Pfizer has a dismal record in terms of its business ethics. As noveltech documents on its site, the company has been paying out billions of dollars to extricate itself from ethics failings and violations of the law. Sweet irony that the CIHR's ethics chap should be supportive of the appointment...

The Canadian government is keen to have someone with a background in product development (commercialisation in the widest sense) on the CIHR governing council to ensure that more of the biomedical research undertaken in Canada, that is funded by taxpayers, is subsequently commercially exploited. In its own right this isn't a bad idea, even though the immediate worry would be that commercial organisations (Pfizer comes to mind) would try to exploit taxpayer funded research as a shortcut to product development, with a pittance flowing back to the publicly funded research and the public being bilked for what it's worth by Pfizer for a drug that we paid already for as taxpayers who fund the CIHR.

Francoise Baylis at Dalhousie University has written a letter to Harvey Chochinov, the ethics member of the CIHR governing council. Chochinov has made himself a name by way of writing about something he calls dignity enhancing end-of-life care. His trivial insight is essentially that we should meet dying patients' needs better and that that would reduce the number of such patients who ask for assisted dying. He is, of course, right on both counts. Google him for fun to see how often he has published that very same insight in an avalanche of similar papers.

Anyway, I digress, Baylis asked Chochinov why he has supported the Pfizer appointment. To the crucial conflict of interest charge Chochinov replies: 'GC members are not there to promote their own vested interests or those associated with their specific geographic, financial, disciplinary or pillar based affiliations. [...] Rather, GC members are expected to place those personal agendas aside, and promote the best interests of CIHR, the broad research community and health related concerns of Canadians.' The trouble is that the Pfizer employee could not act in this manner due to his contractual obligations to his employer. He could not put his employer's commercial agenda aside even if he wanted to. So, Chochinov fails fully to address the issue at hand. In his reply to Baylies he argues that 'Members of the ethics committee have taught over the years that it is possible for people to reach different conclusions, in spite of following ethically sound processes. I believe the process of ethical debate in this instance has been sound, in spite not reaching consensus.' This statement is sufficiently bizarre that I tried to find his CV online in order to ascertain whether the CIHR's Chair of the Standing Committee on Ethics has any qualifications in ethics at all or whether we have here another physician with an urge to go on about ethics who has no formal training in ethics. I have got to be honest, despite trying for some time to trace his academic CV, I was unable to find it. He may or may not have had ethics training, I do not know. I am doubtful at the very least. His statement to Baylis constitutes a petitio principii. He is well and truly begging the substantive question by saying that reasonable people can legitimately disagree in matter of ethics. That's true, but surely only after the issues at hand have been addressed. His explanation for why the Pfizer VP would not face conflicts of interest is plain wrong. So, if on that basis he supports the appointment, the fact that some process was followed does not make his stance any more right. Ethics is not that relative! It's not a matter of having a chat and then it's a free-for-all.

Monday, December 07, 2009

Locker Room Etiquette

I know, I know, there is the climate thing in Copenhagen (even the man who walks on water is expected to say his HOPEful prayers and deliver suitably little, just before returning with his entourage, a squadron of vehicles and probably a few planes to where he came from). Goodness, what can I say, things are pretty obvious, I have little to add. I love the climate change denialists. Remarkable coalition of rightwingers and the usual rabble of fringe scientists. All quite funny, and boy, am I glad that I at least haven't bred. No kid to worry about too deeply when things go downhill. And I don't even drive or own a car... so I'm probably in the good books.

Now that that's out of the way, onto something slightly more serious. Gym locker rooms. No you gay guys, not that kind of locker room, go and rent your own video... - I mean real gym locker rooms. I went to the gym tonight, ran my 10k's, did weights, the lot. After about 2 hours I finally returned to the locker room, went to the locker, fiddled around with the combination lock and opened the locker. When I buy those combination locks each time I join a gym, I truly can't be bothered figuring out how to change the pre-set numbers. So, mine is always 000. Well, there I opened 'my' locker tonight. I ended up rumaging for awhile thru sort-of-interesting men's clothes, alas after awhile I realized that they were not mine at all. The number was right, the clothes were not. So, I ended up in another bloke's locker who obviously also couldn't be bothered changing his number. Being in a bit of a bind I tried to recall where I left my clothes this particular evening and settled for another locker. Same thing happened. Interesting clothes (lovely wallet, nice watch...), just not my stuff. Thankfully I got third-time lucky. I finally found my own stuff.

I was always suspicious about how many people can really be bothered to change those pre-set numbers, and by chance I discovered today that possibly not too many do. I am sure that what happened to me tonight happened to other folks, too (did you like my clothes by any chance? leave a note next time you accidentally drop in :).

So, how come that in all those many years I have not once had any of my property stolen in the gym. I had things stolen just about everywhere else, at home, from the hotel room, even in front of police stations, but never in the gym. Is it possible that folks who do the gym regularly and keep fit are nicer people? Are they in the average more ethical than folks doing no sport? Questions, and more questions, anyone up for a research project?

Friday, December 04, 2009

Open Letter to Canadian Health MInister

Dear Ms Leona Aglukkaq:

I am currently on a research assignment in Britain, hence I missed the uproar in Canada about the appointment of a Pfizer VP to the governing council of the CIHR. This open letter is in response to this growing scandal.

I am appalled that anyone should have considered appointing a representative of the pharmaceutical industry to such a position of influence, let alone a representative of Pfizer.

As to the former: Continuing conflicts of interest between the role the Pfizer VP would have to play in order to avoid breaching the fiduciary relationship the company and its employees have to its shareholders, and the public interest are inevitable. His role is to represent the interests of Pfizer and its shareholders, while the CIHR agenda surely is in the Canadian public's interest. There is no reason at all to assume that Pfizer's interests and those of the Canadian public necessarily are identical.

As to the second: Pfizer as a pharmaceutical company is probably the most egregious of the companies involved in terms of continuing breaches of ethics regulations. The company routinely and repeatedly pays out large sums to extricate itself from breaches of ethical guidelines, and frequently the law. I am flabbergasted that, of all companies available, a Pfizer representative should have ever been considered. Are you or your advisers unaware of any of this?

I urge you to intervene before it is too late. The CIHR is at great risk of losing credibility as a biomedical research funder by appointments such as these.

Sincerely,
udo schuklenk

Thursday, December 03, 2009

Atheist bioethicists?

As most readers of this blog will know, I am an atheist. I am also a bioethicist (everyone needs a job, so don't hold that one against me), and a journal editor. I came across a semi-interesting blog entry where someone was critical of Russell Blackford and myself for 'coming out' as atheists in our book 50 Voices of Disbelief: Why We Are Atheists. The gist of the blog entry (written, I hope I'm not getting the minutiae wrong, by a woman who once was a Reverend of sorts and quit her Reverend day job because she realised that the admission of women to Reverend jobs is mistaken) was that it's a bad idea for bioethicists to admit to being non-religious. The reason given was that this would give bioethics a bad name in the USA where people don't like non-religious folks and where many have become suspicious of non-God based bioethicists anyway. My good mate, the creationist Discovery Institutes propaganda chief on bioethics, Wesley J Smith could probably take some credit for this, assuming the empirical claims made are correct to begin with. Of course, our ex-Reverend has no evidence for her claim one way or another. She may or may not be right about US Americans' attitudes to bioethicists. It's probably fair to assume that among conservative religious people like herself that view might be somewhat more prevalent. You know, the types of people who refer to married gay couples as 'family' in inverted commas, who really really really hate hate crimes legislation, and who tend to subscribe to the view that abortion is akin to the Holocaust in Nazi Germany.

The question though is not unreasonable to ask: Should bioethicists who happen to be non-religious try to hide that view in order to avoid putting off creationists? Or even just putting off people who are vaguely religious? You can also turn that question around and ask whether bioethicists who happen to be religious should try to hide that view in order to placate non-religious people who can't handle any more 'God' business? So, if they submit an article to the journal that I edit, should they hide their views in order to make what they conclude palatable to me?

In Bioethics (one of the journals that I edit), kindly and rightly identified as a leading journal in said critical blog entry, we had articles by openly religious people arguing their case. Even stuff on a thomistic understanding of personhood (ie what someone who believes St Thomas Aquinas is a brilliant guy makes of modern notions of personhood in the context of that thinker's theology). Basically, as a journal editor you try to ensure that you're fair to content submitted to your journal. Surely that wouldn't be achieved by sending a piece that's situated in the context of Catholic moral theology to the atheist Russell Blackford for review. But that's about as far as it goes.

It's unclear though, why I as editor of the journal should not be entitled to hold my own views on the God question and why I should not be permitted to publish those views. Strategic views about the status of bioethics among evangelic Christians in the USA notwithstanding, the objective of any paper surely should be to make the strongest possible argument for one's case. Ideally you'd try to persuade both those who come from an ideological basis similar to yours, as well as those who com an entirely different angle of your views.

So, to sum up: Journal editors are entitled to hold strong views on matters affecting their field. They must not permit those views to prejudice fair process for submitted content that is in conflict with their strongly held opinions. Concerns about how that goes down with a particularly partisan section of the wider public are irrelevant.

Monday, November 30, 2009

50 Voices of Disbelief on 2009 Tree of Knowledge :)

Just saw this on facebook :). Nice.

Members of the Freethought Society of Greater Philadelphia erect the third annual Tree of Knowledge on the south lawn of the Chester County Courthouse.

Thursday, November 26, 2009

Farewell Borders

The bookseller Borders went into administration in the UK today (I assume its operations in other countries are not - yet - affected). I truly regret that this happened. I loved their stores. When they came onto the scene (outside the US that is), I lived in Melbourne. There was a big outcry by the literati and the snobbish published opinion that is alive and kicking in that city. Their big stores would kill small independent booksellers and all that. To be honest, I don't know whether small independent booksellers didn't make it as a result of Borders creating their massive store in Melbourne. I'm not sure I care a great deal, especially given that Borders served customer needs more efficiently. The store was fantastic. The first bookstore I had ever seen that had a coffee shop (yes, sadly Starbucks, but hey). So you'd browse books before deciding whether you'd buy them (try that on Amazon). They organised readings by great authors. Most importantly, they had a breathtaking selection of magazines and newspapers, both Australian as well as international. If you were interested in progressive politics, probably Borders was the only place offering you a huge selection of magazines and papers, both mainstream as well as distinctly warped stuff that I never saw in any other newsagent... I loved the place!

When I went to Glasgow some years later (work again), to my delight I found a superb Borders shop on the high street. Again, a lovely coffee shop inside (mind you, at the time the competition had realised that this brings customers into shops, so they all had them, too), the usual magnificent selection of magazines. The particular Glasgow store was price winning, the building was stunning... it seems it all was too expensive. The photo I include with this blog entry shows the back entrance of the Glasgow store. The idea behind Borders was brilliant to my mind.

RIP Borders.

Wednesday, November 25, 2009

Preserve the planet, eat fewer animals says... the UK government

Here's a not so new take on the animal ethics debate. What makes it newsworthy is that it is underwritten by the UK government. In a nutshell, the argument is that we should reduce the number of animals we produce in the context of generating food for us. The UK government experts conclude that a 30% reduction should have a significant positive impact on global warming. Here's the gist of the study as reported in today's Evening Standard:

'Scientists behind the report also hope the move will mean a dramatic reduction in the beef, lamb and pork consumed in households across Britain. It is aimed at helping to cut the UK's carbon emissions by 50 per cent by 2030, in line with current targets.

Recent UN figures suggest that meat production is responsible for about 18 per cent of global carbon emissions, including the destruction of forest land for cattle ranching and the production of animal feeds such as soy.

On average, a British person currently eats 50g of protein derived from meat each day - the equivalent of a chicken breast or a lamb chop.

The report, entitled Health and Climate Change and which will be published in The Lancet today, says: "If [a 30 per cent reduction in livestock] translates into reduced meat consumption, the amount of saturated fat consumed would drop sharply, which would have positive effects on health through reductions in heart disease."'

So, even if you don't buy into the argument that we should not force sentient beings (such as higher mammals) unnecessarily (we can live healthier without eating them), there's an argument from environmental necessity and from moral responsibility to leave a livable planet behind for future generations.

In unrelated news, religious folks in Nepal - Hindus, I'm told - have begun their traditional animal massacre whereby about 250,000 (!!!) animals including sheep, goats, cows etc are being slaughtered in a major bloodbath for the purpose of ... well, something with Gods and blablabla.

More Science by Press Release - the wrongly diagnosed PVS patient

I'm sure you've seen it on TV. A man was reportedly misdiagnosed as being in persistent vegetative state (PVS) and ones a brilliant scientist discovered that he wasn't he began communicating with the folks around him. The thing is though, according to the very same media reports he's unable to speak, or move any part of his body (and that includes then, of course, his arm, fingers etc). Well, if you watched the same reporting that I saw you will have seen him writing the story of being trapped in his motionless body on a touchscreen computer. His motionless body (in this case a finger) was kindly guided by a woman who held his hand and tipped the letters on the screen.

Really? How did she know which letter to tip? If the facts that have been reported in the papers and on TV are correct, he would not have been in a position to actually tell the woman in any way which letter to touch on the computer touch screen. Despite this glaring question-mark, swallowed whole by gullible journalists, serious questions remain about the misdiagnosis of patients believed to be in PVS. The doctor who claims to have discovered this misdiagnosis has not actually published any details about the case, so we need to take him on his word as opposed to scientific evidence - hence science by press release. This all matters, because the story in question gains much of its power from the patient's reported recollection (typed kindly by someone else's helping hand) of how life was for his mind trapped but fully conscious in his body.

It goes without saying that the Christian ethics crowd has happily exploited this case for its own agenda. Wesley J Smith who can be relied on to twist facts according to whatever it is that suits his employer's (neocon 'non-partisan' yet happily creationist 'think tank' Discovery Institute) ideological agenda declared that training permitted the patient to begin typing - well, according to the same evidence that he and I have access to, this is patently untrue. Catholic bioethics writers were all too happy to accept the story at face value because it suited their ideological interests. The less said the better.

Science by press release (and family video, in this case) is not a good thing, no matter what ideological side you happen to be on!

Monday, November 16, 2009

Civilisation: 1 - Jamaica: 0 - Beenie Man concerts cancelled

Latest result in the ongoing match between Jamaica and civilisation. We won, Jamaica lost. Here from a circular Peter Tatchell just posted:

Beenie Man concerts axed in Australia & NZ

Big Day Out organisers faced storm of protest

Tour cancellation sends warning to all murder music singers

Beenie Man incited the murder of lesbians and gays

London, UK - 16 November 2009

All of Beenie Man's Australian and New Zealand concert dates have been cancelled. This follows protests by gay rights groups, including the Australian Coalition for Equality. It also follows representations to the tour organisers by Peter Tatchell of OutRage!, acting on behalf of the international Stop Murder Music campaign.

"These concert cancellations will hit Beenie Man hard in the pocket. He has lost tens of thousands of dollars. The success of this campaign sends a warning message to all murder music artists: inciting homophobic violence will cost you money. You will lose out big time," said Mr Tatchell.

Beenie Man had been scheduled to perform in January 2010 at Big Day Out concerts in the Australian cities of Sydney, Melbourne, Adelaide and Perth and in the New Zealand city of Auckland.

The organisers have now confirmed that he will not be in the concert line-up:
http://www.bigdayout.com/news/pressreleases.php?PressReleaseId=52

For more information about the concert cancellations in Australia, contact Big Day Out organiser, Susan Forrester, in Melbourne: 00 613 9820 4677 and susan@bigdayout.com

Ms Forrester contacted Peter Tatchell of the gay rights group OutRage! seeking his advice on whether to go ahead with the Beenie Man booking.

Mr Tatchell replied to her, urging Big Day Out to cancel Beenie Man's concerts. He wrote to Ms Forrester as follows:

"Beenie Man is clearly unrepentant. He has never apologised for urging the killing of gay people. In fact, he put out a statement and hit song called 'I no apologise'. You would not consider hosting Beenie Man if he was a white racist singer who had called for the murder of black people. You would dump him. There should be no double standards when it comes to singers who incite homophobic violence," wrote Mr Tatchell.

"Beenie Man is one of Jamaica's leading reggae stars. He has had hit tunes which incite the murder of lesbians and gay men. It is a tragedy that he has not used his undoubted musical talent to promote the true reggae message of justice, harmony, peace and love.

"Although Beenie Man made an agreement to cease his murder music, he has since reneged and denounced the agreement. He went on to release a song: 'I no apologise,'" confirmed Mr Tatchell.

In his hit tune Damn, Beenie Man sings: "I'm dreaming of a new Jamaica, come to execute all the queers."

Another of his popular recordings, Bad Man Chi Chi Man (Bad Man Queer Man), instructs listeners to kill gay DJs and boasts that people would gladly go to jail for killing a queer:

"If yuh nuh chi chi (queer) man wave yuh right hand and (NO!!!) / If yuh nuh lesbian wave yuh right hand and (NO!!!) / Some bwoy will go a jail fi kill man tun bad man chi chi man!!! / Tell mi, sumfest it should a be a showdown / Yuh seem to run off a stage like a clown (Kill Dem DJ!!!)".

Chi Chi Man is a very offensive Jamaican patois homophobic slang insult, equivalent to the insulting words queer, poof and faggot.

Sunday, November 15, 2009

Promises, promises, promises - when will Rupert Murdoch DO as opposed to promise

Rupert Murdoch, proprietor of right-wing propaganda outlets such as the SUN and New York Post newspapers, and not to forget Fox 'News' promised the world that he would remove content from these and his other media from google. I think that's excellent news.

There is always the risk that accidentally I click a link found on google news and suddenly find myself on a New International site, thereby being inadvertently subjected to News Corp propaganda as opposed to actual news. If Rupert was to remove this challenge in order to charge (laughter) for access to his agitprop, he would do the world a BIG favour. Please Rupert, go for it...

Thursday, November 12, 2009

Pfizer is at it again

I am reproducing a news wire from AP that I came across today. Watch out for the publication of the analysis in the New England Journal of Medicine. As ever Pfizer is the culprit. No wonder they are busy sponsoring ever more bioethics positions... unsurprisingly there are also happy takers among universities. I sometimes wonder whether there is any kind of cash that they would not take! Interesting that Pfizer's spin doctors would describe the peer reviewed publication in the leading medical journal as unable to pass the threshold of 'credible scientific research'. Clearly the reviewers and lawyers the journal employed to determine the value of the report thought differently.

First, here are the findings from the abstract of the report: 'We examined reporting practices for trials of gabapentin funded by Pfizer and Warner-Lambert's subsidiary, Parke-Davis (hereafter referred to as Pfizer and Parke-Davis) for off-label indications (prophylaxis against migraine and treatment of bipolar disorders, neuropathic pain, and nociceptive pain), comparing internal company documents with published reports. Results We identified 20 clinical trials for which internal documents were available from Pfizer and Parke-Davis; of these trials, 12 were reported in publications. For 8 of the 12 reported trials, the primary outcome defined in the published report differed from that described in the protocol. Sources of disagreement included the introduction of a new primary outcome (in the case of 6 trials), failure to distinguish between primary and secondary outcomes (2 trials), relegation of primary outcomes to secondary outcomes (2 trials), and failure to report one or more protocol-defined primary outcomes (5 trials). Trials that presented findings that were not significant (P≥0.05) for the protocol-defined primary outcome in the internal documents either were not reported in full or were reported with a changed primary outcome. The primary outcome was changed in the case of 5 of 8 published trials for which statistically significant differences favoring gabapentin were reported. Of the 21 primary outcomes described in the protocols of the published trials, 6 were not reported at all and 4 were reported as secondary outcomes. Of 28 primary outcomes described in the published reports, 12 were newly introduced.'

Here the AP summary as well as the usual talking head one-liners toward the end, exasperation and all...

'Analysis of a dozen published studies testing possible new uses for a Pfizer Inc. epilepsy drug found that reporting of the results was often misleading, indicating the medicine worked better than internal company documents showed.

According to the report, when a company-funded study's primary finding wasn't favorable, that result was usually buried and something else positive was highlighted, without disclosing the switch.

The documents used in the review were obtained by lawyers suing Pfizer for refunds on prescriptions paid for by insurers and consumers. The lawyers, who are seeking class action status for the cases, claim Pfizer concealed evidence the epilepsy drug Neurontin didn't work for those unapproved uses, including nerve pain, migraines and bipolar disorder.

One of the report's authors is an expert witness for the plaintiffs; another has received fees from the lawyers.

Pfizer disputes the report's conclusions, saying the company never "attempted to mislead the medical community about the effectiveness" of the drug for certain uses.

"We believe the review suffers from significant bias, insufficient data, poor methodology, and cannot pass the threshold of credible scientific research," Pfizer said in a statement.

The report, by researchers at the University of California at San Francisco and the Johns Hopkins Bloomberg School of Public Health, comes two months after Pfizer was fined a record $2.3 billion — including an unprecedented $1.2 billion criminal fine — for illegally marketing other blockbuster drugs.

The report appears in Thursday's New England Journal of Medicine.

Dr. Sidney Wolfe, head of health research at consumer group Public Citizen, called it the first comprehensive look "at studies in which a company and people working for it so maliciously manipulated the data to make a drug look more effective than it actually was."

"In every instance, the published article made the drug look better than it would have," said Wolfe, a member of the Food and Drug Administration's drug safety advisory committee. "This results in harm."

Neurontin was approved by the FDA a decade ago for treating seizures and later for pain caused by shingles — but not for other conditions. Its potential side effects include suicidal tendencies and depression.

While doctors can prescribe drugs for unapproved, or off-label uses, drug companies are legally barred from promoting their products for such uses. Drugmakers often test drugs for additional conditions and publicize the results. But they don't always seek approval for those new uses, particularly if the new findings aren't convincing.

Experts believe most Neurontin sales were for off-label uses — the ones in the reviewed studies. Sales peaked at $2.7 billion in 2004, when Pfizer paid $430 million in government fines to settle allegations it improperly marketed the epilepsy drug for unapproved uses. By last year, Neurontin sales fell to $387 million due to cheaper generic versions sold as gabapentin.

For the new review, the researchers examined 20 patient studies funded by New York-based Pfizer and its Parke-Davis unit on use of Neurontin for preventing migraines or treating nerve pain or bipolar disorder. The studies were published in medical journals or presented at conferences, mostly over the last decade.

In eight of the 12 published studies, the main outcome listed in internal documents differs from the one later given in the published report. In half the cases, a new primary outcome was substituted and in others, the original main outcome was instead reported as a secondary measure or wasn't disclosed at all.

The authors cited some limitations to their review, including not knowing who made the changes.

"We cannot be certain that selective reporting was a decision made by employees of Pfizer and Parke-Davis, since the authors of the published reports included nonemployees," the researchers wrote.

Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics, called the report "one of the most ethically disturbing papers I've read in some time" and "an indication that people have been playing fast and loose with studies," particularly industry ones.

Caplan said the FDA should have the power to audit industry drug studies. Wolfe said there should be bigger fines and jail terms for manipulating study data, plus tougher rules for studies being published in journals.

Medical journals in recent years have required that studies be listed on a federal Web site, http://www.clinicaltrials.gov, to be eligible for publication. That move was made partly to make it harder for industry to hide studies on products that don't pan out and only publish those with good results. The study descriptions also list their primary and secondary outcomes.

Pfizer said it now has 1,245 company-sponsored studies listed on the Web site.


Friday, November 06, 2009

something light for the weekend


courtesy of the huffington post

Stand up, stand up, against Jesus

Civility has its uses, but we should not be afraid of satire and mockery as weapons against religious power

The question: Is there an atheist schism?

Religious teachings promise us much — eternal life, spiritual salvation, moral direction, and a deeper understanding of reality. It all sounds good, but these teachings are also onerous in their demands. If they can't deliver on what they promise, it would be well to clear that up. Put bluntly, are the teachings of any religion actually true or not? Do they have any rational support? It's hard to see what questions could be more important. Surely the claims of religion — of all religions — merit scrutiny from every angle, whether historical, philosophical, scientific, or any other.

Contrary to many expectations in the 1970s, or even the 1990s, religion has not faded away, even in the Western democracies, and we still see intense activism from religious lobbies. Even now, one religion or another opposes abortion rights, most contraceptive technologies, and therapeutic cloning research. Various churches and sects condemn many harmless, pleasurable sexual activities that adults can reasonably enjoy. As a result, these are frowned upon, if not prohibited outright, in many parts of the world, indeed people lose their lives because of them. Most religious organisations reject dying patients' requests to end their lives as they see fit. Even in relatively secular countries, such as the UK, Canada, and Australia, governments pander blatantly to Christian moral concerns as the protection of religiously motivated refusals to provide medical professional services demonstrates.

In a different world, the merits, or otherwise, of religious teachings might be discussed more dispassionately. In that world, some of us who criticise religion itself might be content to argue that the church (and the mosque, and all the other religious architecture that sprouts across the landscape) should be kept separate from the state. Unfortunately, however, we don't live in that world.

When religion claims authority in the political sphere, it is unsurprising — and totally justifiable — that atheists and skeptics question the source of this authority. If religious organisations or their leaders claim to speak on behalf of a god, it is fair to ask whether the god concerned really makes the claims that are communicated on its behalf. Does this god even exist? Where is the evidence? And even if this being does exist, why, exactly, should its wishes be translated into law?

In many situations, it is better to be civil, as Paul Kurtz has pointed out, but satire and mockery have traditionally had a legitimate place whenever absurd ideas are joined to power and privilege. Enlightenment thinkers such as Voltaire often used mockery to show the absurdity of ideological stances — including religious ones — that were considered sacrosanct. Mockery is one way of saying that a view does not deserve to be taken seriously. Religious views are fair game if one can also show, on a more serious level, why the view in question does indeed not deserve serious respect.

Perhaps some rationalist or humanist organisations, such as Kurtz's venerable Center for Inquiry, do have good reason to maintain a scholarly and dignified brand image. But there is also room for the younger, brasher atheists whom Kurtz inaccurately brands as "fundamentalists", and, in any event, there is a world of difference between appropriate civility and keeping quiet.
In the US, unfortunately, some atheists appear to have concluded that even civil and thoughtful criticism of supposedly "moderate" religion (i.e., almost anything that does not dispute evolutionary theory) should be discouraged.

These "accommodationist" atheists tend to be focused on science advocacy, particularly the teaching of evolution in public schools. In seeking public support for their positions, they think it prudent to take the various American demographics as they are. Since they want to sell evolutionary science to very large numbers of pious Americans, the last thing they want is to see it linked with atheism.

Once you think in that way, from a kind of marketing perspective, it can take over your approach to what you think you ought to say. Sincerity goes out the window, and everything must be "framed" to please the audience. We doubt that this strategy can work.

Religion cannot be eradicated — that is not a realistic goal — but the many problems with religious dogma can and should be highlighted. As atheists, we should state clearly that no religion has any rational warrant, and that many churches and sects promote cruelty, ignorance, and civil rights abuses.

There are harmful consequences to real people in the real world if the views of churches and sects are enshrined in law or given undue social deference - the acceptance even in liberal secular societies of conscientious objection as a legitimate reason for health care professionals and even civil servants to refuse to provide professional services to certain citizens is a case in point. For these reasons it is important that we should speak out and publicly contest the special authority that is accorded, all too often, to pontiffs, imams, priests, and presbyters. Religious leaders are not our moral leaders, much as they clamour to be, and however much the politicians flatter them. These spiritual emperors have no clothes, and we shouldn't flinch from saying so.

Sunday, November 01, 2009

Bizarre commentary by Jamaican literature prof on violent lyrics

I'm sure many of you have heard about how homophobic Jamaica is, all the way up to the murder of gays and lesbians. Part of the responsibility for this, it has been suggested by some, are antigay violent lyrics by local artists calling in their songs for the murder of gays and lesbians. Here's the take of a local academic arguing that gays and lesbians who call for such artists' concerts to be canceled and boycotted are 'pathological'. Check out her take on the issue first, and then read my commentary below. Turns out to be the case that she attended the latest CD launch of the artist who called in past lyrics for the murder of gay people. I sent the below reply to the newspaper that published her OpEd; realistically you won't see my riposte there, though. Jamaican public debate is sufficiently incestuous to prevent that from happening. -

To whom it may concern:

Professor Cooper's editorial, well-intentioned and unusually considerate (by Jamaican standards) doesn't add up. She complains essentially that a Jamaican singer whose repertoire included a song calling for the killing of gay people is still subjected to boycott campaigns by gays and lesbians in other countries. She calls such campaigns 'perverse'. Cooper considers the offending song's lyrics 'infamous', however anyone not wanting the singer to perform in their neighbourhood is acting under a 'particularly perverse pathology'. Really, is my attempt at keeping such artists out of my country sick, Professor Cooper? So, our Jamaican artist sings infamous songs, while those who would be at the receiving end of his murderous art are sick (aka pathological). Nice touch professor, truly a well-balanced statement. You should be safe in homophobic Jamaica (whatever that means these days).

What reasons has Professor Cooper on offer for her take on the issue?

Well, for starters, she points out that our artist hero hasn't sung the song in question for awhile and launched recently a CD hoping it would be bought by amongst others gays, lesbians, and - guess what - even slim people. Let me just say that to the best of my knowledge, he has not yet apologized and retracted the song in question. That a more market savvy performer tries to increase market share is understandable, but surely shouldn't be seen as evidence for a changed mind set.

Comes the professor's next reason: the US based ACLU is defending the artist's 'right' to perform. The ACLU, of course, also defends the KKK's right to propagate its racist views in public. It's the result of a particularly silly bit of US Constitution that puts virtually no limits on speech acts, unlike any other country in the world. You could not make such statements anywhere in Europe (neither the Jamaican artist's 'lyrics' nor the KKKs racist rabble-rousing). The result is that such societies are more cohesive and peaceful than the USA.

And another lost-case type argument from our literary professor. She claims, citing an unsubstantiated statement from an ACLU activist, that there is no causal evidence that hate speech calling for violence against minority groups leads to such violence. There is an obvious reason for this: actions usually have multiple causes, some conscious, others unconscious. We do know that propaganda works; why it shouldn't work in a pathologically homophobic place such as Jamaica remains a mystery to me. Gay people have experienced time and again spikes in anti-gay violence following high-profile homophobic statements by artists or politicians and the like. Equally, many minority ethnic people in Britain were deeply incensed when the BBC permitted recently the BNP leader Nick Griffin to speak on a program. They pointed out that the mainstreaming of racism will undoubtedly lead to an increase in racist violence. I wonder whether Professor Cooper fully appreciates the implications of her feeble attempt at denying the link between homophobic statements calling for violence against gays and lesbians and the occurrence of such violence.

Her last unsubstantiated claim is that fans potentially engaging in homophobic violence would not do so after dancing to artists' tunes encouraging them to kills gays and lesbians. Is she seriously suggesting that there might be people out there who were considering killing gays and lesbians and then these folks get prevented from doing this because they attend a concert with an artists calling on them to go through with their tentative plans? What can I say, this surely is a breathtaking empirical claim without any basis in fact.

So, there you go, now you know why us folks outside your island go out of our way to have your violence and art kept where it belongs, namely on your island - as your problem, not ours. Let Buju apologize for this song and we will welcome him with open arms.

Monday, October 26, 2009

Royal Society of Canada End-of-Life Decision-Making Panel

RSC: The Academies of Arts, Humanities and Sciences of Canada (the Royal Society of Canada) will announce “End-of-Life Decision Making”, an expert panel commissioned at its own initiative. The press release follows.

RSC/SRC Expert Panel on End-of-Life Decision Making

October 26, 2009

Among the many public-service roles of national academies around the world, one of the most important is the preparation of expert assessments on critical issues of public policy. The national academies in the United States are the most active in this regard, but the senior academies in other nations, notably in England, France, and other European countries, have been very active on this front for many years. Such reports are designed to be balanced, thorough, independent, free from conflict of interest, and based on a deep knowledge of all of the published research that is pertinent to the questions that have been posed.

The Royal Society of Canada (RSC) also has a long record of issuing definitive reports of this kind, either on its own initiative, or in response to specific requests from governments or other parties. The project being announced today, “End-of-Life Decision Making,” is one of a new series that the Society has commissioned, at its own initiative, on issues of significant public interest and importance at the present time. Announcements on the other projects will follow over the course of the coming months.

The Society relies on the advice of one of its senior committees, The Committee on Expert Panels (CEP), in formulating new projects of its own and in responding to requests for panel projects from external parties. In addition, the members of the Society’s CEP are responsible for selecting the membership of panels, including the chair; overseeing the conduct of panel activities; managing the peer review of the draft final report; and assisting the panel members with any difficulties that arise during the conduct of their work.

Over the course of the past year, the CEP has brought forward suggestions on a new series of expert panel reports for consideration by the Society’s governing board. The board has approved a number of these suggestions, including the project on “End-of-Life Decision Making.” The additional information, below, identifies the members of the panel who have agreed to write this report, as well as the preliminary terms of reference for this project.

Questions about this project may be directed to:

Professor Udo Schuklenk (panel chair), Queen’s University:

udo.schuklenk@gmail.com

Telephone: Office 613-217-8659

Professor Daniel Weinstock, Université de Montréal:

daniel.marc.weinstock@umontreal.ca

Telephone: Office 514-343-7345

Members of the RSC/SRC Expert Panel

(6 Panel Members)

Chair: Udo Schuklenk, PhD:

· Professor of Philosophy and Ontario Research Chair in Bioethics, Queen’s University

· http://www.udo-schuklenk.org/

· Publications: http://www.udo-schuklenk.org/researchs.htm

Before coming to Canada he worked at Australian, British, German, and South African universities, including Monash University’s Centre for Human Bioethics and at the University of Central Lancashire’s Centre for Professional Ethics. He is currently Joint Editor in Chief of Bioethics and founding editor of Developing World Bioethics. Both journals are listed in major indices including MedLine.

Members:

1. Johannes J. M. van Delden, MD, PhD:

Julius Center for Health Sciences, University Medical Center, Utrecht University, Utrecht, The Netherlands; Chair, Ethical Commission of the Medical Council of the Royal Netherlands Academy of Arts and Sciences (KNAW)

http://people.juliuscentrum.nl/profile.aspx?id=10959

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1331141

http://jme.bmj.com/cgi/content/extract/33/4/187

2. Jocelyn Downie, S.J.D.:

Canada Research Chair in Health Law and Policy
Professor, Faculties of Law and Medicine, Dalhousie University

http://law.dal.ca/Faculty/Full_Time_Faculty/Bios/Jocelyn_Downie/index.php

3. Sheila McLean, PhD, LLD, LLD, FRSE, FRCGP, FRSA:

First holder of the International Bar Association Chair of Law and Ethics in Medicine at Glasgow University and Director of the Institute of Law and Ethics in Medicine at Glasgow University.

http://www.gla.ac.uk/departments/schooloflaw/staff/academic/mcleans/

4. Ross Upshur, MD, MSC:

Canada Research Chair in Primary Care Research and Associate Professor, Departments of Family and Community Medicine and Public Health Sciences, University of Toronto; Director, University of Toronto Joint Centre for Bioethics

http://www.sunnybrook.ca/team/member.asp?t=13&page=1199&m=175

http://www.jointcentreforbioethics.ca/people/upshur.shtml

5. Daniel Weinstock, PhD:

Canada Research Chair in Ethics and Philosophy, University of Montreal

Professeur titulaire, Département de Philosophie, and Directeur du Centre de recherche en éthique de l'Université de Montréal (CREUM)

http://www.philo.umontreal.ca/prof/daniel.marc.weinstock.html

End-of-Life Decision Making

Context and Preliminary Terms of Reference (June 18, 2009)

Introduction

The purpose of these preliminary terms of reference is to indicate some of the main boundaries of the project description. At its initial meetings the panel will do a careful review of this preliminary statement and will indicate more precisely the ultimate scope and focus of the project, which is expected to be more limited than what is presented here. The final terms of reference will be released by RSC at that time.

Objectives

This is one the most serious social and ethical issues facing all advanced countries. The many and varied perspectives relevant to the issue are rarely presented to the public in a balanced, thorough, and informed way. A RSC expert panel report could make a significant contribution to the public policy debate on this issue.

1. There is a large body of medical science evidence that, if summarized for the public, would be helpful to their consideration of the issue.

2. The public could also benefit from a presentation of evidence about actual experience from the various jurisdictions that permit physician-assisted death.

3. The public would also benefit greatly from having a careful, balanced review of various pros and cons of decriminalization of physician-assisted death from well-reasoned ethical and legal standpoints.

4. Many medical personnel would also benefit from having all the issues laid out in a comprehensive and sensitive way.

5. The panel should consider proposing policy recommendations for public consideration that are the results of its review.

Questions that may be considered by the panel

1. Is either physician-assisted suicide [PAS] or voluntary euthanasia [VE] ever morally justifiable and should either be decriminalized under certain carefully defined conditions? If so, under what conditions?

2. Is there a morally significant difference between withholding and withdrawing life-prolonging treatment, on the one hand, and hastening a patient’s death by VE or PAS, on the other?

3. Is “terminal sedation” (sometimes referred to as “palliative sedation”) a morally and legally preferable option to VE or PAS? Does the distinction between terminal sedation and life-shortening symptom relief make sense in practice? What is the situation with regard to the provision of potentially life-shortening symptom relief? It is a practice that is, to a certain extent, in the shadows. It has not been addressed explicitly and comprehensively in the law and leaves some wondering whether it is legal or not and therefore whether some people may not be getting adequate symptom management.

4. Is cessation of eating or drinking (or of artificial hydration and nutrition) a morally and legally preferable option to VE or PAS?

5. Is there evidence of abuse with respect to PAS and VE in jurisdictions in which PAS or VE have been decriminalized (particularly those with contexts comparable to Canada)? What types of data should be considered germane and persuasive to this question?

6. What, if any, safeguards could prevent abuse and exploitation of VE and PAS without erecting insuperable barriers for people who wish to access these forms of assisted dying?

7. Is the concept of human dignity a useful one for discussions of VE and PAS?

8. Is either VE or PAS consistent with traditional medical ethics? What has the Hippocratic Oath to say with regard to this? Would either be likely to undermine the bond of trust between doctor and patient? Would either be likely to enhance the bond of trust between doctor and patient?

9. Are Advance Directives reasonable, ethically and legally defensible instruments to express a formerly competent patient's wishes? What is the value (or lack thereof) of Advance Directives in this context? Is there a difference between positive and negative directives?

10. If it is determined that VE and PAS should be legally permitted, how should the issue of incompetent dying patients be approached?

11. What is the legal and ethical status of unilateral withholding and withdrawal of potentially life-sustaining treatment? (It is a hotly-contested area of end of life practice in Canada right now and is one that is causing significant moral distress for everyone involved.)

12. Why does consent (or refusal), which has the effect of legitimizing some behaviours, not seem to have the same effect in the case of PAS or VE?

13. How should we evaluate false positives and false negatives? Is it worse to have a system in place that allows for a lot of needless suffering and thwarting of individual autonomy, but never generates a single false positive, or is the converse true? (This makes a difference to how we calibrate the safeguards.)

Suggested approach to the topic

(a) Begin by asking: What is the state of current knowledge with respect to the following?

· What are the current states of practice with respect to end of life care in Canada (with respect to withholding and withdrawal, potentially life-shortening symptom relief, PAS, and VE)? What are the main variables in this area? Who are the main decision-makers? What are the default positions (what usually happens unless someone protests strongly)? What is the current state of the empirical evidence with regard to PAS and VE?

· How do families of patients, patients and health care providers feel about the current states of practice?

· What trajectory of development are we on in this area?

· How are providers, patients and families being educated?

· What is the law in this area in Canada? What are Canadians' beliefs about the law? What are Canadians' views about what the law should be like?

· What is driving current decision-making in this area – e. g., is it economics, shortages of providers, lack of training, normative stances, etc.?

(b) Then ask: What are the main value positions (normative stances) in play and to what extent are they actually motivating decisions?

(c) Then move on to the substantive normative questions in the light of the above. The panel's report should aim not to duplicate work already undertaken in other reports. Instead, the panel will undertake a review of such work prior to formulating its own analysis of the issues.

******************************************************

Bonjour,

Demain, la SRC : Les Académies des arts, des lettres et des sciences du Canada (la Société royale du Canada) annoncera un groupe d’experts commandé, de son propre chef, sur « La prise de décisions en fin de vie». Le communiqué suit.

Groupe d’experts de la SRC sur la prise de décisions en fin de vie

Le 26 octobre 2009

Parmi les nombreux rôles de service public que jouent les académies nationales dans le monde, l'un des plus importants est sans doute la production de rapports d'experts sur les enjeux importants de la politique gouvernementale. Les académies nationales des États-Unis sont les plus actives à cet égard, mais celles d'autres pays, notamment de l'Angleterre, de la France et d'autres nations européennes, sont aussi très actives sur ce front depuis de nombreuses années. Ces rapports doivent être équilibrés, exhaustifs, indépendants, libres de tout conflit d'intérêts et fondés sur une connaissance approfondie de la recherche publiée se rapportant aux questions qui ont été posées.

La Société royale du Canada (SRC) a également une longue feuille de route en matière de production de rapports définitifs de ce genre, qu'elle les produise de sa propre initiative ou en réponse à des demandes précises des gouvernements ou d'autres parties. Le projet annoncé aujourd'hui, « La prise de décisions en fin de vie » fait partie d'une nouvelle série de projets que la Société a commandés, de son propre chef, concernant des enjeux d'intérêt public d'une grande importance. Les autres projets seront annoncés au cours des prochains mois.

La Société se fie aux conseils d'un de ses principaux comités, le Comité sur les groupes d'experts, pour élaborer les nouveaux projets qu'elle met en œuvre de sa propre initiative ou en réponse à des demandes provenant de parties externes. Les membres de ce Comité sont également responsables de sélectionner les membres du groupe d'experts, y compris le président, de superviser les activités du groupe, de gérer l'examen par les pairs de la version préliminaire du rapport final et d'aider les membres du groupe d'experts si des difficultés surviennent durant leurs travaux.

Durant la dernière année, le Comité sur les groupes d'experts a suggéré au conseil d'administration de la Société une nouvelle série de rapports d'experts. Le conseil a approuvé un bon nombre des suggestions, y compris le projet sur les « La prise de décisions en fin de vie ». Les renseignements ci-dessous indiquent qui sont les membres du groupe d'experts, qui ont accepté de rédiger ce rapport, ainsi que le cadre de référence préliminaire de ce projet.

Les questions concernant ce projet peuvent être adressées à :

Professor Udo Schuklenk (panel chair), Queen’s University:

udo.schuklenk@gmail.com

Téléphone: 613-217-8659

Professor Daniel Weinstock, Université de Montréal:

daniel.marc.weinstock@umontreal.ca

Téléphone: 514-343-7345

Composition du groupe d'experts de la SRC

(six membres)

Président : Udo Schuklenk, Ph. D. :

· Professeur de philosophie et directeur de la chaire de recherche en bioéthique, Université Queen’s

· http://www.udo-schuklenk.org/

· Publications : http://www.udo-schuklenk.org/researchs.htm

Avant son arrivée au Canada, il a travaillé dans différentes universités en Australie, en Grande-Bretagne, en Allemagne et en Afrique du Sud, dont au Centre de bioéthique humaine de l’Université Monash et au Centre d’éthique professionnelle de l’Université du Central Lancashire. Il est actuellement corédacteur en chef de la revue Bioethics et rédacteur en chef fondateur de la revue Developing World Bioethics. Ces deux publications figurent dans les principaux index, y compris MedLine.

Membres :

1. Johannes J. M. van Delden, M.D., Ph. D. :

Centre Julius pour les soins de la santé, Centre médical universitaire, Université d’Utrecht, Pays‑Bas; chaire, commission d’éthique du Conseil médical de l’Académie royale des arts et des sciences néerlandaise (KNAW)

http://people.juliuscentrum.nl/profile.aspx?id=10959

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1331141

http://jme.bmj.com/cgi/content/extract/33/4/187

2. Jocelyn Downie, S.J.D. :

Chaire de recherche du Canada sur le droit et la politique de la santé

Professeure, facultés de droit et de médecine, Dalhousie University

http://law.dal.ca/Faculty/Full_Time_Faculty/Bios/Jocelyn_Downie/index.php

3. Sheila McLean, Ph. D., LL.D., FRSE, FRCGP, FRSA :

Première titulaire de la chaire de droit et d’éthique médicale de l’Association internationale du barreau et directrice de l’Institut de droit et d’éthique médicale, University of Glasgow

http://www.gla.ac.uk/departments/schooloflaw/staff/academic/mcleans/

4. Ross Upshur, M.D., M.SC. :

Chaire de recherche du Canada dans le domaine des soins primaires et professeur, départements de médecine familiale et communautaire et des sciences de la santé publique, University of Toronto; directeur, Centre conjoint de bioéthique du University of Toronto http://www.sunnybrook.ca/team/member.asp?t=13&page=1199&m=175

http://www.jointcentreforbioethics.ca/people/upshur.shtml

5. Daniel Weinstock, Ph. D. :

Chaire de recherche du Canada en éthique et en philosophie, Université de Montréal

Professeur titulaire, département de philosophie, et directeur du Centre de recherche en éthique de l'Université de Montréal (CREUM) http://www.philo.umontreal.ca/prof/daniel.marc.weinstock.html

Groupe d’experts de la SRC sur la prise de décisions en fin de vie

Principes généraux préliminaires (le 18 juin 2009)

Introduction

Ces principes généraux préliminaires ont pour but d’établir certaines balises essentielles en ce qui a trait à la description du projet. Au cours de ses premières réunions, le groupe d’experts examinera attentivement cette description préliminaire et précisera la portée et le but du projet, qui devraient être plus limités que ce que nous présentons ici. Les principes généraux finaux seront établis par la SRC à ce moment-là.

Objectifs

Cette question est celle qui, dans tous les pays avancés, pose les problèmes sociaux et éthiques les plus sérieux. Les très nombreux points de vue sur la question sont rarement présentés au grand public de façon objective, approfondie et éclairée. La publication d’un rapport par un groupe d’experts de la SRC pourrait contribuer de façon importante au débat public sur la question.

1. Il existe une volumineuse documentation médicale qui, résumée à l’intention du grand public, pourrait appuyer sa réflexion sur la question.

2. Le grand public pourrait également profiter de la présentation de documents sur l’expérience menée en différents endroits où l’euthanasie médicalement assistée est autorisée.

3. Le grand public pourrait aussi grandement profiter d’une revue approfondie et rigoureuse des pour et des contre de la décriminalisation de l’euthanasie médicalement assistée d’un point de vue éthique et juridique bien raisonné.

4. De nombreuses personnes exerçant dans le domaine médical auraient avantage à voir tous les enjeux exposés de façon claire et sensible.

5. À la suite de son étude, le groupe d’experts devrait envisager de soumettre des recommandations en matière de politique à l’intention du grand public.

Questions que le groupe d’experts pourrait examiner

1. Le suicide médicalement assisté et l’euthanasie volontaire sont-ils moralement justifiables et devraient-ils être décriminalisés dans certains cas bien définis? Si oui, quels seraient ces cas?

2. Y a-t-il une différence importante, sur le plan moral, entre le refus et le retrait d’un traitement de prolongation de la vie, d’une part, et l’accélération de la mort d’un patient par l’euthanasie volontaire ou le suicide médicalement assisté, d’autre part?

3. La « sédation terminale » (appelée parfois « sédation palliative ») est-elle préférable, sur le plan moral et juridique, à l’euthanasie volontaire ou au suicide médicalement assisté? Dans la pratique, y a-t-il une distinction entre sédation terminale et soulagement des symptômes susceptible d’abréger la vie? Où en est-on sur la question du soulagement des symptômes abrégeant la vie? C’est une pratique qui, dans une certaine mesure, se trouve dans une zone d’ombre. Elle n’a pas été examinée de façon explicite et exhaustive par les législateurs et l’on ignore encore si elle est conforme à la loi. Par ailleurs, dans le cas de certaines personnes, on peut se demander si la gestion des symptômes est adéquate.

4. Cesser d’alimenter le patient ou de lui donner à boire (ou cesser toute hydratation et alimentation artificielle) est-il préférable, sur le plan moral et juridique, à l’euthanasie volontaire ou au suicide médicalement assisté?

5. Y a-t-il des preuves d’abus en ce qui a trait au suicide médicalement assisté et à l’euthanasie volontaire là où ces pratiques ont été décriminalisées (particulièrement dans des contextes comparables à celui du Canada)? Sur quel type de données, pertinentes et convaincantes, pourrait-on s’appuyer pour répondre à la question?

6. Quelles mesures, le cas échéant, pourraient prévenir l’abus et l’exploitation de l’euthanasie volontaire et du suicide médicalement assisté sans ériger d’obstacles insurmontables pour les personnes qui souhaiteraient accéder à ces formes d’aide à la mort?

7. Le concept de dignité humaine est-il utile aux discussions sur l’euthanasie volontaire et le suicide médicalement assisté?

8. L’euthanasie volontaire et le suicide médicalement assisté sont-ils conformes à l’éthique médicale traditionnelle? Que dit le serment d’Hippocrate sur la question? Ces pratiques risquent-elles de compromettre le lien de confiance entre le médecin et le patient ou, au contraire, peuvent-elles le resserrer?

9. Les directives préalables sont-elles des outils raisonnables et justifiables sur le plan éthique et juridique pour formuler de façon adéquate les souhaits des patients qui avaient auparavant la capacité de décider? Quelle est la valeur (ou la non‑valeur) des directives préalables dans ce contexte? Y a-t-il une différence entre directives positives et directives négatives?

10. Si l’on établit que l’euthanasie volontaire et le suicide médicalement assisté devraient être légalement autorisés, comment doit-on approcher la question des patients mourants qui sont dans l'incapacité de décider?

11. Quel est le statut, du point de vue juridique et éthique, du refus ou du retrait unilatéraux d’un traitement susceptible de maintenir la personne en vie? (Cette question est vivement contestée au Canada et cause une grande détresse morale chez toutes les personnes concernées.)

12. Pourquoi le consentement (ou le refus), qui a pour effet de justifier certains comportements, n’a-t-il pas la même incidence dans le cas de l’euthanasie volontaire ou du suicide médicalement assisté?

13. Comment devrions-nous évaluer les faux positifs et les faux négatifs? Est-il plus grave d’avoir un système en place qui donne lieu à beaucoup de souffrance inutile et qui nie l’autonomie individuelle, mais ne génère jamais de faux positifs, que l’inverse? (Cela fait une différence sur la façon de calibrer les balises.)

Suggestion d’approche

(a) Demandez-vous d’abord : Quelle est l’état de nos connaissances en ce qui a trait à ce qui suit?

· Quelles sont les pratiques actuelles en matière de soins de fin de vie au Canada (relativement au refus ou au retrait des soins, au soulagement des symptômes susceptible d’abréger la vie, au suicide médicalement assisté et à l’euthanasie volontaire)? Quelles sont les principales variables dans ce domaine? Qui sont les principaux décideurs? Quelles sont les positions par défaut (ce qui se passe généralement, à moins que quelqu’un proteste fermement)? Quelles sont les connaissances empiriques actuelles en ce qui a trait au suicide médicalement assisté et à l’euthanasie volontaire?

· Que pensent les familles des patients, les patients et les fournisseurs de soins de santé des pratiques actuelles?

· Quelles sont les perspectives dans ce domaine?

· Comment les fournisseurs de soins de santé, les patients et les familles sont-ils informés?

· Quel est le contenu de la législation en la matière au Canada? Comment les Canadiens perçoivent-ils cette législation? Quel devrait être le contenu de la législation selon les Canadiens?

· Qu’est-ce qui sous-tend la prise de décisions dans ce domaine, p. ex., l’économie, l’insuffisance de fournisseurs, le manque de formation, les positions normatives, etc.?

(b) Demandez-vous ensuite : Quels sont les principaux énoncés de valeur (positions normatives) en jeu et dans quelle mesure influent-ils sur les décisions?

(c) Passez ensuite aux questions normatives essentielles, à la lumière de ce qui précède. Le groupe d’experts doit veiller à ne pas reproduire les travaux déjà effectués dans le cadre d’autres rapports. Il doit plutôt prendre connaissance de ces travaux avant d’entreprendre sa propre analyse de ces questions.