[ExI] Medical power of attorney for cryonicsts
anders at aleph.se
Sat Dec 6 20:18:52 UTC 2014
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:
> > 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
Dr Anders Sandberg
Future of Humanity Institute
Oxford Martin School
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