Thursday, October 27, 2011

Magic Time!

I am fairly ethically naive I must confess. I do not think this is an indictment against me so much as a strength of mine. Consider by way of an anecdote having an argument with someone. To my mind, an argument is an argument is an argument and it should be evaluated in light of its premises, necessary implications, internal coherence, logical consistency and, of course, any datum that bears on it. In this way, in broad terms, an argument can be either good (sound and valid), or bad (unsound or invalid, or both) or indeterminate (I'll leave this one alone for now). I see no benefit that enhances an argument by appending to it the label 'philosophical'. Are these arguments somehow unlike other arguments? Do they not fail or succeed on all of the criteria I've laid out?

If so, then certainly no argument is improved by calling it philosophical. Indeed, an argument is frustrated because it should immediately be called into question for not having to observe the ordinary conditions of what makes an argument. If an argument is improved by adding philosophical to it, then in addition to all of these criteria is added that isn't available to 'regular' arguments? I fail to see any benefit at all in adding that label - except, perhaps, in the ego of some minds as setting out some esoteric bar that lesser intellects should take notice not to dare apply tension.  Of course, I don't find this a strength, but I am aware there are quarters in the world where obscurantism is a sign of enlightened thinking; I'm looking at you postmodernity.

Ethics seems to operate this way to my mind as well. Suppose for a moment that we have some ethical framework that seems to work in all but the strangest constellation of novel circumstances. For the moment, I am thinking of information and the exchange of ideas, knowledge, or even just raw information. I think an interesting discussion on states secrets would perhaps not be available to the general proposition that the free exchange of information should be encouraged (or at least not discouraged) in certain situations. Do we really want the Energy Department to disseminate the security protocols of the local nuclear facility to everyone on the web? I'd say not, but I am available to persuasion otherwise.

In the instant case, it is generally considered in a society that publicly educates its citizenry that the citizenry in response is available to hearing ideas, thoughts, opinions, recommendations and such like and then weighing all of the competing information to arrive at a decision. This is, after all, what is democracy, no? We take it to be a fundamental treachery of human dignity, reason, intellect, the Enlightenment, civic duty and so on to prohibit the ability of people to exchange information. We have a lot of words and noun phrases for this concept because it is important (so important in fact, that we're willing to wage war in its defense - that is to say that the concept of freedom of thought and speech is more important to us than whether or not some few--or even many--people might have to be slaughtered in armed conflict to make certain it persists).

Call this whatever you'd like, but this seems to my mind to fit squarely into the topic of 'ethics'. We also don't allow this to be modulated by group association: the blacks, say, can't be told they can't know something this week because the whites said so. Equality therefore seems to be now inexorably linked to this freedom of thought, speech and inquiry.  This is, to my mind again, an ethical proposition and a proper ethical framework.

Like with throwing philosophy in front of the word argument does no work in improving an argument, so too is there no improvement by throwing medical in front of ethics.  In fact, it would seem that medical ethics are inferior to just regular, garden variety ethics.

I am speaking, of course, about the HPV can now be given to little boys issue, on which Abbie yesterday wrote. I am, like most people, overjoyed that this is available to boys and men (even if not directly beneficial to either, though it is).  The health of society is contingent on the health of its population. In fact, one is a subset of the other. We are all bound up in this lot of our lives together, and it is therefore in my interest to see to it that as many members of my population are taken care of because their survival is my survival. Their health is my health. Their security is my security.

These are not novel ideas, and I am certainly not breaking any new frontiers in moral thinking.  But to question a statement asserting that it's unethical to give to boys the HPV vaccine in the context of how we distribute healthcare is to court controversy apparently.  The long and the short of it is this: if it is true that a physician may not offer to a patient some potential treatment which has some  indirect benefit to the patient through his (or her) membership in society even after (as required by law) making known to the patient the consequences of the treatment (up to and including death), then medical ethics are inferior to 'regular' ethics. Medical when preceding ethics seems to directly translate to 'inferior'.  This is denied to a potential patient as even an available option - deciding for him or her on his or her behalf. What a gracious offer that is to excuse me from my responsibility to do that pesky thinking thing for myself. 

Are patients expected to be unable to hear information, ask questions and then make a decision? Does this happen a lot? I am told that it happens often (a scandalous implication of our education system I note). Fair enough. So, the solution to that is therefore to have a class of elite ethical thinkers who can in advance determine what patients are allowed to be told, hear, evaluate and decide upon. To do their thinking for them - to act as a sieve through which it's determined when a patient (always selected by race, gender or gender identity I note, and even age) is a person deserving of being able to make his or her decisions for himself - or not.

I'll put this as Christopher Hitchens has earlier put it on an only-collaterally relevant point: how many of you here aren't grown up enough to hear information? Whom do you appoint to do your thinking for you, on your behalf? To whom do you delegate the task of reading the relevant information and deciding for you, relieving you of your responsibility of thinking for youself? Hands up, please. Who has a nominee?

Medical ethics boards and standards insist that such a person must exist.  "We" have decided that not only is there one person good and smart enough to relieve all of us of our duty to be responsible for our own lives, to think, read, analyze and decide matters of our own health and risk as it relates to the health of our society and fellow creatures, but rather there are tens of thousands of people who are just that good, just that smart, just that wise, just that prescient to determine in advance what any of us will think about an optional vaccine.  Well, so long as you have the right genitalia that is. Women - smart enough to think on their own. Men - on this issue, not allowed to even be informed, let alone determine whether it's an acceptable risk/benefit to them to take the vaccine. Well, that is, until all these people decided that you're now allowed to know about it from those medical professionals whom you pay to advise and treat you.

I've been here before and I do not like this circle.


madder said...

I think the claim isn't that it would be unethical to offer the vaccine to boys, but rather that it would be unethical to coerce them in some way to get it (e.g. requirement for school attendance, or otherwise causing them some inconvenience if they don't).  At least that's how I've always understood it; someone will correct me if I've gone astray.

Woden said...

@madder: That is my understanding as well. However, I have to say that I strongly disagree with this view in regards to infectious diseases. When effective, long-lasting vaccines are available, I think we are doing ourselves as a society a disservice to *not* make them mandatory. We're just setting ourselves up for outbreaks that were entirely preventable, which will cause large amounts of cost and quite likely large amounts of entirely preventable deaths... and not necessarily to the people who chose to avoid the vaccines. I don't see why I or my loved ones should have to suffer because Joe Blow figured he didn't need his vaccines, and spread his germs to me or mine.

The Justicar said...

I am of two minds on this, and what is keeping from coming along with you is is a horrible slippery slope argument. I realize that it's not exactly tight logic like one might expect of me, but my reasoning as to why this particular slippery slope is at least persuasive, if not outright compelling deals with calibration of a baseline of expected societal norms.

So, let's say we do that and make it mandatory for everyone. And a generation goes by such that everyone is just used to the powers that be coming in and forcing vaccinations. Whatever is the problem of that day has already an immediately universal resolution for the pondering:  make people do it.

But on the issue of a physician advocating one option over another on reliable data subject to rejection or acceptance by a patient, then I see no ethical problem at all.

Copyleft said...

Making these vaccines mandatory when they pose a (minor) risk to the patient and offer no benefit would, indeed, be ethically unacceptable in the absence of a public-health emergency such as an epidemic.

HOWEVER.... According to ERV's blog, there is evidence that the vaccine DOES provide a benefit to boys: it can reduce the risk of oral cancer too.

This changes the equation somewhat.

Epinephrine said...

The fact that you make an exception in the case of epidemic suggests that it is a matter of balancing risk/benefit, and that it is acceptable to accept some level of risk for a sufficiently large benefit.  This violates the notion that it is unacceptable (ethically) to give a shot to someone who will derive no benefit from the shot.  If it is, indeed, a matter of risk/benefit, then it's merely a matter of setting the threshold at which one considers it ethical to risk one person's health for the benefit of others.  In order to eradicate smallpox, many people were given smallpox shots that posed a considerable risk despite the fact that the risk of smallpox in their area had been reduced to the point that the risk from the shot may well have been higher.  This has doubtless saved many lives, as every future generation benefits from the elimination of smallpox. 
It is perfectly normal in our lives to suffer inconveniences for the benefit of others; I'd love to send peanut butter sandwiches in to school with my kids, but I might inadvertantly make another child very ill (possibly even causing death) if they came in contact with peanuts.  It's a minor inconvenience to a large number of people, protecting a small number of children from a much worse problem.  Vaccinating boys against HPV (without any benefit being derived) is similar; you cause a small issue for many (mostly soreness at the injection site) to protect a small number (girls who would have developed cancer) from something dreadful.