Life as an Extreme Sport

Category: Bioethics

It’s about time I added a category for my field of study, eh?

Yet Another Person (Me) Wibbling About Kuhn, Paradigm Shifts, & Bioethics

Bioethics

Carl Elliott tweeted a link to a lovely retrospective/review of Thomas Kuhn’s absolutely essential book, The Structure of Scientific Revolutions, which as I noted on Twitter, in many ways sums up everything about my undergrad degree in the Comparative History of Ideas: if one is to understand Aristotelian science, one must know about the intellectual tradition within which Aristotle worked. A simple and elegant concept that completely revolutionized the way science — and the history of science — is taught.

Of course, it also dovetails with some other stuff I’ve been reading this week, and an idea I’ve been trying to work out. (Coming soon: talking about gun control because hey, we need more voices there!) Take a look, for example, at this week’s AAP/circumcision debate, the one that actually took down the Oxford servers this morning, so many people wanted to see what Practical Ethics had to say on the topic. As I mentioned in passing to Ananyo Bhattacharya (on Twitter), these conversations always contain so much more cultural baggage than anyone discusses; folks want to rely on science without looking at culture and history, which sets the scenario for endless debating around each other because even though the various “sides” of the debate are talking about the same subject, the language that they’re using to encode all the messages that they’re sending are extremely different.

And yet, it’s the top of the medical/science news cycle — and has been for a week. And this particular zombie horse will inevitably rise again and again for further kicking — why?

Iain Brassington makes some mention of it over on the Journal of Medical Ethics blog, and it ties back to Kuhn and the rabble rabble of potential paradigm shift: because it’s a sexy (okay, I realize the issue with using that to describe something about a penis, but look at it from a reporter point-of-view and don’t crucify me), generates simple snappy headlines, and plays in to the science news cycle, all of which generates the all-important click.

The problem is, at least within bioethics, is that we’re in that period of crisis of Kuhn’s cycle, where people are starting to act out against structural assumptions/dominant paradigm, but that the voice of “normal science” (or established bioethics/bioethicists, in this case) has been too loud. We’ve been seeing a critique of the shiny bioethics paradigm for years — the oldest one I can find it from 1986 (and I’m sure I’m just limited by my lack of university library access).

In the case of bioethics, the status quo is driven by more than just ideology — it’s driven by money. There’s a lot of money in the shiny, in biotechnology and stem cells and cloning and and and. These things are new and exciting and dramatic like a Hollywood movie — and if you play your cards right, you too can be on TV.

A few people have tried to force their perspective to becoming the expected revolutionary change in the field; they have (thankfully*) been unsuccessful. Which leaves us waiting for that something to tip us over into a new dominant paradigm, aware of the rabble rousers who are unhappily railing against the shiny tech money version of bioethics that dominates the field without having the out that, let’s be honest, the dominant paradigm of Kuhn’s work tells us that will happen.

All of which probably could have just been summed up as self-awareness is a bitch, but that’s a more interesting tweet than blog post, eh?

(* Why thankfully? A change in worldview for a field – the much abused “paradigm shift” – should be organic, not forced. Forced just plays in to the status quo of whomever has the power and ability to engineer the change.)

Pathologizing Pregnancy: Maria New & the Push to Gender Conformity

Bioethics

There’s that fabulous quote floating around about Ginger Rogers, saying that she “did everything that Fred Astaire did. She just did it backwards and in high heels.” I must have heard that at a pretty young age and internalized it, because for a very long time, I had the attitude that I could do anything I wanted – and I could do it in a skirt. Pants not required. (In fact, it was only ziplining in Costa Rica that broke what was something like a 10 year record of not wearing pants.)

I mention this just to illustrate that, at a glance, you would not mistake me for anything other than a very femme woman (and given my preference for dating men, a heterosexual one). I currently have my nails painted Iron Man red, I rarely go out of the house without at least a little bit of makeup on, I can be easily distracted by shiny sparkly pretty things, and for being goth-inclined, I have a pretty unhealthy preference for pink.

So, on the surface of things, I am a pretty stereotypically normal woman. Except for one thing: I don’t want children.
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Oh hello irony, nice to see you

...and everything else, Bioethics, life and living

For various reasons, I’m re-reading this post, from six very long years ago. This part, in particular, has me in that “am I laughing or crying” zone:

The idea of codes and oaths, and the idea of good being unbreakably linked to excellence is an interesting idea; that you cannot parse them individually. A good surgeon is a surgeon who does not remove the wrong organs. To then take this goodness and link to ethics, though, I wonder? Can you be ethical if you’re bad at it? Well, can’t you be ethical, but incompetent? To have the good intent, but the bad skill?

Oh. Oh the fucking painful irony.

Nazis & Structure: The Inherent Conflict-of-Interest in Bioethics?

Bioethics

This month’s free article from the Journal of Medical Ethics is a doozy: a medical student looks at Nazi physicians, moral luck, and the circumstances that conspire to create the situation where doctors feel that their participation in something as hindsight-reprehensible as the T4 euthanasia program is not only acceptable but morally sanctioned. It’s worth a read.

The interesting thing that stands out to me – aside from Colaianni’s excellent description of medical training that brings up impressions of systematic brainwashing (which may not be intentional but is there nonetheless) – is that it really impresses the need for watchdogs outside the system.

It’s perhaps fitting that I stumbled across this free access article when I was trying to get the feel for another debate raging across articles and commentaries: whether or not physicians needed to advocate for removal of end-of-life care in medically futile cases to the degree that they advocate for care in cases where the religious beliefs of parents conflict with best-accepted medical care. The argument, at least what I was able to glean from the abstracts available to folks without university affiliation or the ability to pay for a yearly subscription, seems to be that because of 11 cases (only five of which remain unresolved) of parents believing life support must be maintained until a miracle occurs, out of 203 total cases, physicians should advocate more strongly for legal recourse to end care. Why is it fitting? Because at least in my mind, that debate over religion and standards of care already started me thinking of the role of bio/medical ethicists in a hospital situation, and the concept I’ve been kicking around for a while: that by being situated within hospitals, embedded with physicians (if not physicians themselves), the ability of a bio/medical ethicist to do their job is compromised.

Colaianni writes that about hierarchy in medicine, and how the medical student reports to the intern reports to the resident reports to the chief resident and all the way up, Old MacDonald’s Farm style. Much like military structure, you’re taught to listen to those in charge and follow command structure; placing the ethicist within this doesn’t necessarily create an escape-valve, because the pressures that are on the physicians – loyalty to people, the institute, etc – aren’t alleviated by simply having another (different) title.

In particular, this quote stood out:

…three junior physicians marked brief questionnaires about mentally handicapped individuals with a red ‘+’ (for death) or a blue ‘—’ (for life). In this way murder was systematised, sanitised, ‘medicalised’ and sanctioned.

Ethicists are expected to function within the system, where things are systematized, sanitized, medicalized, and sanctioned. As any whistleblower knows, stepping outside of the institution that you function within is extremely hard – and can carry heavy penalties. Is it any wonder, then, that we hear of repeated scandals regarding ethics boards, hospitals, or even the public sector? In each case, the people who are expected to stand up and say “no, wait, hang on” are presented immediately with an extreme conflict-of-interest: standing up and speaking out against colleagues; friends; the system that supports their work and signs their paycheck.

What, then, is the solution? The obvious pie-in-the-sky one isn’t at all pragmatic: independent and transparent ethics committees. But money is the immediate issue there, so what if instead of trying to overhaul the entire system, we overhauled just one part of it? Instead of, say, the University of Minnesota bioethicists policing in-house research and medical practice, what if they policed Duke’s research and medicine? Duke’s bioethicists could then police UNC (as we wouldn’t want to create a system of reciprocity where UMinn would ignore Duke’s violations in exchange for Duke ignoring theirs). UNC could police Stanford who could police the University of Washington who could… and so on. While this would not remove issues (and in fact would create new ones), it would at least alleviate the immediate conflicts-of-multiple-interests issue. It is, in the very least, worth a consideration.

all you need is a rubber stamp to have an ethics committee

...and everything else, Bioethics

I’d like to leave a comment on Stuart Rennie’s latest interesting post over on his Global Bioethics blog, but he’s one of those Google-account-only for commenting, and Google and I parted ways a while ago. So, you should go read his post about the continuing side show of research ethics, and then my comment will make some sense.

Oh, and here is my comment:

I’ll be the first to argue that there are issues with informed consent, but it seems to me that if you cannot explain what you are doing in a way that your patient population can understand, then perhaps you need to go back to the drawing board.

More importantly, though, is whether or not an ethics review committee is really doing anything, if the results can be so thoroughly rejected in commentary. Yes, ethics tends to be plagued with philosophers who like nothing more than to sit around and pick arguments with each other, but at the same time, one really has to question the function of an ethics review committee if such seemingly unethical behaviour is going to be approved. If the committee is just there to rubber stamp a proposal, is it really doing what it’s supposed to do?