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<div class="moz-cite-prefix">On 2014-12-06 17:05, John Clark wrote:<br>
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<div dir="ltr">Anders Sandberg:
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<blockquote style="margin:0px 0px 0px 0.8ex;border-left:1px
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class="gmail_quote">> 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)<br>
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<div>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.<br>
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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...<br>
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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. <br>
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<blockquote style="margin:0px 0px 0px 0.8ex;border-left:1px
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class="gmail_quote">> Does the treatment in expectation
help the patient more than it causes risk?<br>
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<div>That is a scientific question not a moral one. <br>
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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. <br>
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<blockquote style="margin:0px 0px 0px 0.8ex;border-left:1px
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class="gmail_quote">> Does the treatment have some
risks of harm that are unacceptable?<br>
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<div>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.<br>
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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. <br>
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<blockquote style="margin:0px 0px 0px 0.8ex;border-left:1px
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class="gmail_quote"> > Can they be reduced? <br>
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<div>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?<br>
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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:<br>
<a class="moz-txt-link-freetext" href="http://www.scu.edu/ethics/publications/submitted/cirone/medical-ethics.html">http://www.scu.edu/ethics/publications/submitted/cirone/medical-ethics.html</a><br>
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<blockquote style="margin:0px 0px 0px 0.8ex;border-left:1px
solid rgb(204,204,204);padding-left:1ex"
class="gmail_quote">> 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. )<br>
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<div>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.</div>
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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. <br>
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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. <br>
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<pre class="moz-signature" cols="72">--
Dr Anders Sandberg
Future of Humanity Institute
Oxford Martin School
Oxford University
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