[ExI] Medical power of attorney for cryonicsts

[Anders Sandberg]

On 2014-12-06 17:05, John Clark wrote:
> Anders Sandberg:
>
>     > Medical ethics at its simplest typically runs the issue past the
>     Beauchamp principles. Does the treatment respect the autonomy of
>     the patient? (this is where informed consent comes in, as well as
>     the right to withdraw for any reason)
>
>
> That one is pretty uncontroversial and pretty obvious; I don't have a 
> PhD in ethics but nevertheless I figured that one out all by myself.

Ha! Autonomy easy and uncontroversial? It is a nightmare. What about the 
autonomy of Pro Ana people to starve themselves to death? What about 
trepanationists who want a hole in their head? Suicides? When is an 
Alzheimer patient capable of making decisions, and when should we 
overrule them? What about forcing medication on incarcerated mentally 
ill people to become autonomous enough so they can be executed? What to 
do if the autonomy of one individual is in conflict with another 
individual? Or in abortion cases, one (or two?) autonomous individual 
and one preperson? What about unconscious people? What about people from 
cultures where consent is not individual, but done as a tribal thing? 
How do you do informed consent with mentally disabled people, or people 
who do not speak your language? What about parents right to do things 
with the bodies of kids (like circumcision or vaccination) when the kid 
is not yet fully autonomous? And so on...

Most of the time ethics is easy: don't be a dick. Ask before you do 
something to somebody. Stop if they ask you to stop. It is the 1% of the 
time when this doesn't work that keeps medical ethicists busy.

>
>     > Does the treatment in expectation help the patient more than it
>     causes risk?
>
>
> That is a scientific question not a moral one.

Sometimes. In enhancement ethics this is tricky, since benefits can be 
subjective (e.g. a new sense or body shape). But even in normal medicine 
it is not always straightforward what makes your life go better: do you 
amputate a really bad limb, or try to rehabilitate it? Is reduction of 
pain worth a health hazard? There are many apples and oranges to compare.

>
>     > Does the treatment have some risks of harm that are unacceptable?
>
>
> All treatments have risk and specifying how much risk is in the 
> scientific domain. And there is no one objective number that divides 
> acceptable risk from the unacceptable, it is entirely the patient's 
> decision not mine because it's his life not mine.

Science can in theory give you probability distributions for risk, yes. 
In practice this is often infeasible: we do not know the probability 
distribution of how *you* will respond to a drug, since we only have 
population data - data which we know is biased, often from small 
samples, and have unknown errors too. In a surprising number of 
situations we actually do not have proper data even from the start. Risk 
is also multidimensional: the risk of pain is not commensurate with the 
risk of disability which is not commensurate with the risk of death - 
they are different bad things. Reporting all this to a patient is very 
complex and often not welcomed at all: patients typically want the 
doctor to do the "best" thing, while the doctor is trying to tease out 
what "best" means without confusing the patient too much with statistics.


>
>      > Can they be reduced?
>
>
> Obviously if risks can be reduced they should be. But do we really 
> need to ask somebody with a PhD in ethics to get answers to these sort 
> of questions? Are they really that hard?
Yes. Try reading a few medical ethics cases and see if you think it is 
100% obvious to anybody with half a brain what should be done:
http://www.scu.edu/ethics/publications/submitted/cirone/medical-ethics.html

>
>     > Does the treatment cause injustice? (This is why I think
>     reporting is important: it spreads the benefit of the experiment
>     even if it doesn't work out. And this is also why super-expensive
>     treatments might be problematic. )
>
>
> This is where my opinion on morality differs from the opinion of 
> medical ethicists.  Apparently Mr. Beauchamp feels that if you can't 
> cure everybody you shouldn't cure anybody, I disagree.
Sorry, but you fail at ethics 101 here. You have presumably not read a 
word by Beauchamp, and yet jump to strong conclusions about what he 
thinks (and no, he doesn't think that). This is why it is actually 
useful to have somewhat thoughtful people around decisionmaking - in 
order to not to jump to stupid conclusions just because somebody 
forcefully thinks something is right.

In fact, medical ethicists have a lot of views on what is unjust: there 
are libertarian ethicists and there are communist ethicists (and even 
nuanced mainstream ethicists). But in order to argue for their point, 
they all need arguments and are obliged to respond to objections. Just 
saying "this is the way it is" is the hallmark of a layman, not an 
ethicist.

-- 
Dr Anders Sandberg
Future of Humanity Institute
Oxford Martin School
Oxford University

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