For many years, the medical journal The Lancet carried a short column called “In England Now”. It would contain a snapshot of some aspect of life. One memorable example – Dr No can’t trace the original – cut to the core of the difference between law and medicine. Law, it said, was easy – all legal problems are man made and can be dealt with at leisure. Medicine, on the other hand, was hard – it had to deal, in real time, with all-comers, some of which came from distinctly dark places.
Much of the same could be said about real-world medicine, and it’s ivory tower cousin, medical ethics, a discipline which manages to combine the clarity of dumplings with the utility of a rubber carving knife.
A Mr Iain Brassington, an FLK from Manchester’s School of Law, describes himself as a Lecturer in Bioethics, with special interests that include autonomy and euthanasia. He has recently posted on the BMJ’s Journal of Medical Ethics blog, and it makes interesting – in the Chinese sense that is – reading.
Mr B (note the use of the extra “i” in his first name, which is often a letter too far, even if one of the commentators on the blog lops off an “e”, which could be a letter too short) writes in a curious street-kid-cred style that is nonetheless injected with ballooning clouds of philosophical thoughts, unfortunately interrupted by words that are no doubt meant to be cool, but which somehow never quite hit the spot.
He kicks off with the title: “Can Saving a Life be the Wrong Thing to Do?” This is the kind of Important Question that bioethicists like to ask; and to which even medical students know the answer – as Dr No has said before, he was taught at medical school that his duty was to save life, but not to strive officiously to keep alive. There is a time for life; and a time for death.
The post is of course about KW, and the decision by the doctors caring for her to allow her to die. Mr B, who it would seem, from what he has said, has not spent much time with patients, let alone actively suicidal patients in casualty, but who has, no doubt, spent much time cloistered away in ivory towers, which might explain his complexion, nonetheless manages to display some pretty reckless thinking on the matter.
At one point he opines: “there’s no reason to think that, at the time, she was in any way incompetent or mentally ill”. Now, apart from the blatant disconnect from reality – KW was a woman with both depression and a personality disorder, and who had already made numerous attempts, some of them recent, on her life (so there was plenty of reason to suppose), this is a rather disingenuous way to present the argument.
The fact that there is no reason to think that she was incompetent does not mean she was competent and mentally well. It is merely an absence of evidence, and, as the saying goes, absence of evidence is not evidence of absence. The added twist – the fallacious argument at work here – is in the inversion of the burden of proof, and the effect is to produce a presumption of competence and mental wellness, and so capacity – despite the fact there is more than enough real evidence to raise serious questions about both capacity and mental wellness.
There are numerous other examples of linguistic trickery. Take, for example: “From an ethical point of view, I think that the doctors did the right thing in this case – but this is because it’d’ve been hard for them not to. Apart from a nasty dose of apostrophilia (an afflic’n Mr B seems somewhat prone to), what exactly does this mean?
It seems to be saying that they did the right thing because it would have been hard for them not to do so. If we take out the confusing quasi double negative “hard for them not to”, we end up with: they did the right thing because it would have been easy for them to do so a rather strange, even fallacious – by way of being a non-sequitur – ethical justification.
Mr B, who plans to write a paper on the end of medicine, and a proof that the argument that patriotism is a virtue is self-defeating, is also keen to smoke out any closet pro-lifers lurking round his post:
“I think that there’s an implicit pro-life stance in a lot of what you’re suggesting; I think I might feel another post coming on when I get the chance over the next few days…”
“By the pro-life point… well, part of the post I have planned involves unpacking that. Very loosely, though, I think that there is a cultural tendency to think that death is always a failure and something to be avoided: given a choice between life and death, life always comes up very strong. I’m just not sure what might back that supposition, though.”
Mr B, you will recall, has special interests in autonomy and euthanasia: so he probably would find life always coming up “very strong” rather tiresome. But if life wasn’t in the habit of coming up “very strong”, then his ancestors would most likely have fizzled out long ago…
The trouble with ethicists, just as with lawyers, is that they play with words, while doctors play with real life – and real death. Therein lies the problem – and why never the twain shall meet. But that’s OK. I can live with that, and so too, hopefully, can my patients.