Having article-by-article summaries seems useful here. And since none of us have read most of these articles, this might be a good use case for a Google Doc, so different people can improve on summaries if they spot an error.
Some people might also prefer the Google Doc format for critiquing particular articles, and not just summarizing? Whether in the Doc or on LW, I want to encourage people to critique specific articles or arguments if something catches their eye, so we don’t stay at too high a level of generality to notice subtle errors or biases, disagreements with other LWers, etc.
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My own responses to aphyer’s summaries:
1. Argues in favor of more bioenhancement and against refusing to do bioenhancement for reasons of ‘egalitarianism’, though in a somewhat wishy-washy way ‘we endorse a cautious proposal’.
This and the other bioenhancement paper were written by Julian Savulescu, who studied under Peter Singer and co-edited a book with Nick Bostrom.
3. Argues in favor of ‘nudging’ patients to obtain consent for treatments.
Also argues that informed consent is based on “social conventions” rather than on theories of autonomy.
4. Argues that if you favor assisted suicide when doctors do it, you should also favor it when for-profit entities do it.
Treats it as obvious that commercially assisted suicide is a terrible idea; therefore physician-assisted suicide is bad too.
6. Tells the story of a patient who demanded his doctors do something really stupid and refused to budge. Unclear what moral, if any, they want to draw.
I revisited the paper itself to find the main morals it draws:
(1) Even though paternalism is theoretically a bad idea when a patient “has been judged competent to make his or her own decisions”, this example shows that there can be practical, case-by-case reasons to be unusually pushy in trying to change patients’ minds.
(2) Normally, doctors and patients are basically strangers. The “ethics consulation process” provides an opportunity to build a higher-trust relationship and/or build a mutual understanding allowing for this kind of useful paternalism.
7. A weirdly meta paper that evaluates methods for evaluating ethics. I have no idea what this means.
From a part of the paper that wasn’t excerpted: “This project was undertaken in response to a growing concern both within and outside the field of clinical ethics that CE consultants who interact with patients, families, and health care professionals need to demonstrate competency to respond effectively to ethics consultation requests (Fox 2014, Dubler et al. 2009). Responding ‘effectively’ raises the question of what constitutes ‘quality’ in ethics consultation. While there has been historic value in the field placed on preserving a diversity of approaches to ethics consultation, diversity should not preclude evaluation of quality. Clinical ethics must continue to embrace diversity of approaches while sharpening our commitment to measurement of quality.”
The proposal is to assess quality by evaluating a portfolio consisting of the candidate’s eductional background, “a written summary of the candidate’s philosophy” of clinical ethics consulation, letters of recommendation, and the “centerpiece of the portfolio”: “six in-depth, detailed case discussions in which the candidate led or co-led the ethics consulation”. Since there are a lot of open questions and disagreements in bioethics, “presentation of arguments regarding controversies was given credit as long as they were argued clearly and coherently”.
9. I have no idea what this paper is about. It tells the story of a kid called James, but I don’t know what it wants to draw from it.
A hospital has insufficient staffing over the weekends, forcing them to switch a patient to a worse therapy. The paper argues that this is ethically unacceptable, and the hospital should have foreseen this possibility and sent the patient to a better-staffed hospital at the outset.
On an unrelated side-note, the paper asks whether the “worse therapy” is actually worse, noting that there’s disagreement/ambiguity in the medical literature.
10. Argues against ‘nudging’ people to register as organ donors.
Also argues for “mandated active choice,” which “presents people with the choice of registering as an organ donor or not, and requires them to make a decision, for example, by making the renewal of their driver’s license conditional on them stating their donation preference.”
12. Argues that bioethicists should pay attention to neuroscience?
And that they should do less theoretical work, and engage more with real-world specifics and stakeholders’ views.
E.g. (from the paper itself): “since deep brain stimulation (DBS) trials for treating motor disorders such as Parkinson’s disease and other neuropsychiatric disorders began almost 25 years ago, there have been hundreds of theoretical papers about numerous possible ethical challenges (e.g., dehumanization, loss of autonomy, changes to personal identity, authenticity of affective states, how to obtain meaningful informed consent, therapeutic misconception, human enhancement). However, in 25 years of work on DBS there is a surprisingly small amount of empirical literature about the perspectives and experiences of stakeholders (e.g., patient-participants, caregivers, clinical trial or treatment decliners, clinicians, researchers) regarding these neuroethics issues and whether and how these issues are manifested.”
16. Talks about ‘right-to-try’ trials where terminally ill patients try untested drugs. Some waffling, I’m unclear if they approve or not.
The paper is opposed to right-to-try, and warns that “the use of investigational drugs may gradually turn into fantasy therapy”.
20. Proposes a different standard for how to evaluate parent’s decisions re. medical care for their children. Unclear how it differs.
The “best interest standard” says that a parental decision should be respected if “a reasonable argument [can] be offered that the decision is best for the child, all things considered”, and if the decision does not expose the child to obvious risk of harm.
The paper objects that (a) a lot of terrible practices can be ‘reasonably argued for’ if you start with trash assumptions (e.g., religion); and (b) some harms are worth the benefits.
The paper instead recommends the “reasonable subject standard”, which says “parents should decide for their child as the child would if she were a moral agent trying to act prudently within the constraints of morality”.
28. Talks about how to handle decision-making for unrepresented patients. Unclear what they think you should do.
Argues that “the multi-stakeholder process is ethically superior to solo decision making”: “solo decisions about what is in a patient’s best interest run a serious risk of being arbitrary or biased, even if both the physician and the surrogate make their respective decisions after careful consideration”.
30. Argues that the HEC-C program (again!) should be more diverse—what they seem to mean by this is not the standard concept of ‘diversity’ but that it should cover a more diverse set of medical situations.
Specific objections include:
The paper authors haven’t taken the HEC-C examination, but they’re worried it might have similar flaws to a more standard examination, USMLE, where “questions do not depict complex ethical situations to critically think through and resolve, the content is often based on federal laws and regulations rather than ethical rules, students are prompted to either choose the ‘next best step’ or the most plausible answer that tests students’ reading comprehension more than their ethical knowledge, and correct answers often contradict the reality of patient care in clinical settings.”
Worries that curriculum standardization “restricts diversity of shared ideas and experiences”, that HEC-C focuses too much on inpatient settings, and that the $650 fee for taking the test is too high.
They want less reliance on multiple-choice questions. They support “introducing short answer questions on the HEC-C examination, and we strongly recommend a standardized patient or mock consultation component by which communication skills, including empathic responses, are assessed, as well as, how well participants are able to ‘read the environment’ and the overall context of the presented ethical issue.”
31. Argues that informed consent is ‘nonsense’ because people sometimes believe multiple different things.
Rather, the author thinks it’s nonsense because people have different social roles and relationships, and because goodness is about what serves the group, not about what the individual wants or consents to.
More from the paper: “Everything I do is affected by and affects others—for good or for ill. And if this conclusion is philosophically or politically uncomfortable, well, tough: we are all members of society; we’ve all put our signature to some form of social contract. [… B]ecause of the kinds of animals humans are, the good of society will also be the good of the individual. [… P]art of the job of ethics and law is to help a person’s subjective conception of the good coincide with the objective good. That is best achieved by facilitating recognition of the fact that the individual patient’s good is the wider good. This accords well with what we know empirically about the roots of human happiness. Altruism and relationality make people happy. Selfishness makes them miserable. (Foster and Herring 2015). That’s what one would expect if the relational model of human beings is correct.”
Having article-by-article summaries seems useful here. And since none of us have read most of these articles, this might be a good use case for a Google Doc, so different people can improve on summaries if they spot an error.
Here’s a Google Doc that starts with aphyer’s summaries and allows for article-specific follow-ups: https://docs.google.com/document/d/1tmrrTlWLxseSfudS7IWPMEFUWrLoSewFXOjj2ilwFPA/edit. If you add something to the Google Doc, I encourage mentioning it in this comment section so others can be notified.
I’ll also add a link to the Google Doc in the OP.
Some people might also prefer the Google Doc format for critiquing particular articles, and not just summarizing? Whether in the Doc or on LW, I want to encourage people to critique specific articles or arguments if something catches their eye, so we don’t stay at too high a level of generality to notice subtle errors or biases, disagreements with other LWers, etc.
_________________________
My own responses to aphyer’s summaries:
This and the other bioenhancement paper were written by Julian Savulescu, who studied under Peter Singer and co-edited a book with Nick Bostrom.
Also argues that informed consent is based on “social conventions” rather than on theories of autonomy.
Treats it as obvious that commercially assisted suicide is a terrible idea; therefore physician-assisted suicide is bad too.
I revisited the paper itself to find the main morals it draws:
(1) Even though paternalism is theoretically a bad idea when a patient “has been judged competent to make his or her own decisions”, this example shows that there can be practical, case-by-case reasons to be unusually pushy in trying to change patients’ minds.
(2) Normally, doctors and patients are basically strangers. The “ethics consulation process” provides an opportunity to build a higher-trust relationship and/or build a mutual understanding allowing for this kind of useful paternalism.
From a part of the paper that wasn’t excerpted: “This project was undertaken in response to a growing concern both within and outside the field of clinical ethics that CE consultants who interact with patients, families, and health care professionals need to demonstrate competency to respond effectively to ethics consultation requests (Fox 2014, Dubler et al. 2009). Responding ‘effectively’ raises the question of what constitutes ‘quality’ in ethics consultation. While there has been historic value in the field placed on preserving a diversity of approaches to ethics consultation, diversity should not preclude evaluation of quality. Clinical ethics must continue to embrace diversity of approaches while sharpening our commitment to measurement of quality.”
The proposal is to assess quality by evaluating a portfolio consisting of the candidate’s eductional background, “a written summary of the candidate’s philosophy” of clinical ethics consulation, letters of recommendation, and the “centerpiece of the portfolio”: “six in-depth, detailed case discussions in which the candidate led or co-led the ethics consulation”. Since there are a lot of open questions and disagreements in bioethics, “presentation of arguments regarding controversies was given credit as long as they were argued clearly and coherently”.
A hospital has insufficient staffing over the weekends, forcing them to switch a patient to a worse therapy. The paper argues that this is ethically unacceptable, and the hospital should have foreseen this possibility and sent the patient to a better-staffed hospital at the outset.
On an unrelated side-note, the paper asks whether the “worse therapy” is actually worse, noting that there’s disagreement/ambiguity in the medical literature.
Also argues for “mandated active choice,” which “presents people with the choice of registering as an organ donor or not, and requires them to make a decision, for example, by making the renewal of their driver’s license conditional on them stating their donation preference.”
And that they should do less theoretical work, and engage more with real-world specifics and stakeholders’ views.
E.g. (from the paper itself): “since deep brain stimulation (DBS) trials for treating motor disorders such as Parkinson’s disease and other neuropsychiatric disorders began almost 25 years ago, there have been hundreds of theoretical papers about numerous possible ethical challenges (e.g., dehumanization, loss of autonomy, changes to personal identity, authenticity of affective states, how to obtain meaningful informed consent, therapeutic misconception, human enhancement). However, in 25 years of work on DBS there is a surprisingly small amount of empirical literature about the perspectives and experiences of stakeholders (e.g., patient-participants, caregivers, clinical trial or treatment decliners, clinicians, researchers) regarding these neuroethics issues and whether and how these issues are manifested.”
The paper is opposed to right-to-try, and warns that “the use of investigational drugs may gradually turn into fantasy therapy”.
The “best interest standard” says that a parental decision should be respected if “a reasonable argument [can] be offered that the decision is best for the child, all things considered”, and if the decision does not expose the child to obvious risk of harm.
The paper objects that (a) a lot of terrible practices can be ‘reasonably argued for’ if you start with trash assumptions (e.g., religion); and (b) some harms are worth the benefits.
The paper instead recommends the “reasonable subject standard”, which says “parents should decide for their child as the child would if she were a moral agent trying to act prudently within the constraints of morality”.
Argues that “the multi-stakeholder process is ethically superior to solo decision making”: “solo decisions about what is in a patient’s best interest run a serious risk of being arbitrary or biased, even if both the physician and the surrogate make their respective decisions after careful consideration”.
Specific objections include:
The paper authors haven’t taken the HEC-C examination, but they’re worried it might have similar flaws to a more standard examination, USMLE, where “questions do not depict complex ethical situations to critically think through and resolve, the content is often based on federal laws and regulations rather than ethical rules, students are prompted to either choose the ‘next best step’ or the most plausible answer that tests students’ reading comprehension more than their ethical knowledge, and correct answers often contradict the reality of patient care in clinical settings.”
Worries that curriculum standardization “restricts diversity of shared ideas and experiences”, that HEC-C focuses too much on inpatient settings, and that the $650 fee for taking the test is too high.
They want less reliance on multiple-choice questions. They support “introducing short answer questions on the HEC-C examination, and we strongly recommend a standardized patient or mock consultation component by which communication skills, including empathic responses, are assessed, as well as, how well participants are able to ‘read the environment’ and the overall context of the presented ethical issue.”
Rather, the author thinks it’s nonsense because people have different social roles and relationships, and because goodness is about what serves the group, not about what the individual wants or consents to.
More from the paper: “Everything I do is affected by and affects others—for good or for ill. And if this conclusion is philosophically or politically uncomfortable, well, tough: we are all members of society; we’ve all put our signature to some form of social contract. [… B]ecause of the kinds of animals humans are, the good of society will also be the good of the individual. [… P]art of the job of ethics and law is to help a person’s subjective conception of the good coincide with the objective good. That is best achieved by facilitating recognition of the fact that the individual patient’s good is the wider good. This accords well with what we know empirically about the roots of human happiness. Altruism and relationality make people happy. Selfishness makes them miserable. (Foster and Herring 2015). That’s what one would expect if the relational model of human beings is correct.”
Your hyperlink currently includes a period at the end of the link URL and so doesn’t work right.
Thanks, fixed.