In defence of Dominic Cummings…

I never expected to write the above words as I don’t particularly hold Tory sympathies, but The Guardian did such a stupid disappointing mud-slinging job with this article that I feel I have no choice but to speak up.

https://www.theguardian.com/politics/2020/feb/19/sabisky-row-dominic-cummings-criticised-over-designer-babies-post

 

First of all, Cummings was thinking out loud. More people should do that as it’s very useful and it’s impossible to have good ideas if you don’t allow yourself to have bad ideas as well. He’d been to an event, in 2014, and he rambled on about what he had heard and what he thought. There is nothing wrong with that per se.

People object to (talking about) “designer babies” but nobody defines it.

I define a designer baby as any baby that is chosen over any other baby or embryo or zygote that would have been viable and would have been able to live into adulthood.

We’ve been making designer babies for decades!

In some countries, people with Down syndrome no longer occur because they’ve been eradicated from the population while they become city councillors and get degrees in other countries.

We used to lock people up and deprive them of normal life experiences because they were different (and we still do, in fact, also in the UK). That kind of treatment would hold anyone back.

“Treat people as if they were what they should be, and you help them become what they are capable of becoming,” Goethe is supposed to have said or, more likely, written a long time ago. Hold someone back and you condemn the person to a life of limitations.

We’ve also seen this happen for women. One of the two founders of the British-born philosophy of utilitarianism considered women “disabled” by society.

Not that long ago, women were not allowed to go to university and not allowed to do many other things, such as have a bank account, own property or run a business.

In March 2017, expert Wendy Savage (a gynaecologist and professor at Cambridge University) allegedly stated in an interview with the Daily Mail that a pregnant woman should always be told the sex of the fetus and should be allowed to abort the fetus if she does not like the baby’s sex.

That too is about designer babies, about picking the pink handbag, not the blue one.

The British celeb who flew to Cyprus because she could pick her baby’s sex (gender) there and was not allowed to do that in the UK, she wanted a designer baby on the basis of her mistaken belief that sex is an either/or switch.

There are several countries in the world in which male children are currently preferably allowed to come into the world at the expense of female children and it’s already changing these countries’ populations too. (That is how we know it is happening.)

Back to Cummings.

At one point in that blog post, he wrote very clearly that he did not have the required knowledge to be able to assess some of what he was writing about:

“There is a great deal of Hsu’s paper – and the subject of IQ and heritability generally – that I do not have the mathematical skills to understand.”

He wrote the word “egg” when he clearly meant “zygote” or “embryo”, and he did not mention that IQ is a relative measure.

But he did mention “junk DNA” which was once mistakenly believed to be just that. Useless junk.

And he also wrote:

“If the poor cannot do the same, then the rich could quickly embed advantages and society could become not only more unequal but also based on biological classes. One response is that if this sort of thing does become possible, then a national health system should fund everybody to do this. (I.e. It would not mandate such a process but it would give everybody a choice of whether to make use of it.)”

He did write:

“The latter will rightly make people deeply worried, given our history, and clearly require extremely serious public debate. One of the reasons I wrote my essay was to try to stimulate such debate on the biggest – and potentially most dangerous – scientific issues. By largely ignoring such issues, Westminster, Whitehall, and the political media are wasting the time we have to discuss them so technological breakthroughs will be unnecessarily  shocking when they come.”

I am sure that there is a lot about Cummings’ thinking that I don’t agree with, but neither am I pleased with this childish article in The Guardian.

All over the world, bioethicists are talking about these kinds of topics and you can’t do that effectively if you don’t consider all the angles.

The old eugenics is still continuing. The new eugenics has been with us for a while but is really accelerating now with CRISPR.

I participated in an EDX course by Harvard Law School professor Glenn Cohen who also heads the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, in which we all (about 200 of us) thought hard about these difficult matters.

I have a course on Udemy in which I also challenge people to come up with positive effects of doing something as well as negative effects, in terms of the new eugenics.

If you want an example of this kind of thinking exercise, then consider that eradicating all women from society would eradicate menstrual pain and the majority of breast cancers whereas others might say that women are defective humans anyway, hence that society doesn’t need women and if you couple the latter with continued technological progress, which would make even the biological requirement for having women drop away, you can see a world without women in the future.

If you find this upsetting, then maybe you should remind yourself that we have had no problem applying the same kind of logic with regard to for example people with Down syndrome.

We need to talk about this because we are all biased by definition and unless we are all willing to ponder and discuss these very difficult topics and from all possible angles and reach a consensus, a handful of highly biased people will make up our minds for us.

That could be people like Julian Savulescu at the Oxford Uehiro Centre for Practical Ethics, whose ideas may even be more extreme than those of Cummings (which sadly sometimes obscures the fact that Savulescu also occasionally has brilliant ideas that are much more in line with Michael Sandel’s take on these issues).

It’s why I wrote a book about this stuff. Not because I have all the answers but because I don’t.

Instead of criticizing Cummings over this post, people should follow the example of Cummings and start thinking about this stuff and weighing in.

NOTE: When I say that we need to reach a global consensus regarding the new eugenics, I don’t mean “this month” or even “this year, or decade” but am thinking longer term.

Sex versus death: why marriage equality provokes more heated debate than assisted dying

File 20171016 22280 wa2p98.jpg?ixlib=rb 1.1
While fear suppresses talk about dying, marriage equality involves sex.
AAP/Danny Casey

Julian Savulescu, University of Oxford

The Greek philosopher Epicurus wrote:

Death does not concern us, because as long as we exist, death is not here. And when it does come, we no longer exist.

We are in the midst of two great ethical debates: marriage equality and assisted dying. The results of the marriage equality postal survey will be announced on November 15; meanwhile, the Victorian parliament is this week debating a new law to allow doctor-assisted dying in the last year of life.

What is striking is the volume of the respective public debates. Everyone is talking about marriage equality; very few are discussing assisted dying.

Given that the ethics of assisted dying are more complex than marriage equality, and what happens in Victoria is likely to provide a template for other states, why is it receiving so much less attention?

How fear of death affects public debate

Public ethical debates are fuelled by emotion and psychological biases on both sides. In the case of assisted dying, most of us are not like Epicurus: we fear death. We hate talking about it.

Despite the fact that polls show that 73% of Australians favour assisted dying, it is not clear whether the legislation will pass, although the mood seems to be leaning slightly in favour: 40 out of 87 MPs in the Legislative Assembly told the Herald Sun they would vote yes.


Further reading: As Victorian MPs debate assisted dying, it is vital they examine the evidence, not just the rhetoric


So, there should be an enormous impetus to show MPs the level of public support. But it has been rather muted. Perhaps for similar reasons we post photos of weddings on Facebook, but not funerals: both are important, but only one makes good dinner party conversation.

Terror management theory, evolution and social signalling

Our fear of death might even be linked to our love of marriage, according to terror management theory (TMT). Neuroscientist Claudia Aguirre writes:

When we’re faced with the idea of death, people defensively turn to things they believe will shield them from death, literal or otherwise. Thinking about death also motivates people to indiscriminately uphold and defend their cultural world views, whatever those may be.

TMT has been linked to our development of regulation and rituals around sex.

In evolutionary terms, sex is more important than death, which is one of the reasons marriage equality provokes such heated debate.
Shutterstock

So, a fundamental commitment to marriage being between a man and a woman may be more of an immovable foundation on which group membership is based to guard against our shared fear of death than an ethical position that can be defended or rebutted on rational grounds.

While fear suppresses talk about dying, marriage equality involves sex. People are intensely interested in love and sex. And sex has been more important than death in evolutionary terms.

As evolved animals, we were only here to survive long enough to reproduce. Reproduction is evolution’s goal, and so practices around its rituals and norms are hugely important in evolutionary and religious terms.

Religions and societies seek to control reproduction. In the Judeo-Christian tradition, sex was to occur within marriage between one man and one woman. Death at an old age is of much less evolutionary significance.


Further reading: To Christians arguing ‘no’ on marriage equality: the Bible is not decisive


We are social animals, motivated to support our in-group and reject out-group members. Tribalism can help explain our devotion to football teams, for example. We have developed social signalling to show our group which side we are on and maintain trust.

Add to that a status quo bias, and public debates where the topic in question is seen to express something foundational about ourselves can become little more than cheering for our own team.

Anchoring

Anchoring is a psychological bias that means we evaluate how good or bad something is relative to the anchor of existing examples.

In the UK, the 2013 same-sex marriage legislation was fairly uncontroversial. One reason could be that civil partnerships – same-sex marriage in all but name – were created back in 2004. Each step in the UK’s progress towards marriage equality was a short step from the previous state of being.

In contrast, the Australian campaign against same-sex marriage portrays the choice as a paradigm shift in our culture, extending far beyond marriage. Former prime minister Tony Abbott linked the debate to political correctness, gender fluidity and even the date of Australia Day, saying:

This isn’t just about marriage … there are lots and lots of implications here and we’ve got to think them through before we take this big leap into … the dark.

A better approach

For assisted dying to be an appropriate activity for medicine, we should show that death can be an appropriate therapeutic end and in a patient’s best interests. That is, that their life is no longer worth living.

That is an extremely difficult case to prove, and I haven’t seen any good arguments for how to evaluate that. Why wouldn’t we just go on what a competent person says? If a suffering person believes they’re better off dead, they’re probably right.

But here is another way to think about it. The Victorian legislation will provide assistance only to those in the last year of life from a physical illness. They are effectively in the process of dying.

While palliative care may be able to control pain and suffering, it cannot do everything.
Shutterstock

One major objection to the assisted dying bill is that we don’t need it because good palliative care is sufficient. Relief of suffering is very important, and more should be spent on end-of-life planning and palliative care.

But this objection is complicated for several reasons. If palliative care is outstanding, people won’t request assistance in dying. So there is no need to ban it.

More importantly, while palliative care may be able to control pain and suffering, it cannot do everything.

Together with colleagues at Barwon Health and Oxford University, we surveyed 382 people from the general population and 100 attendees at an advance care planning clinic, where people think about and express their values relating to end-of-life care. We didn’t ask them about assisted dying, but we did ask them to rank four factors at the end of life: pain relief, dignity, independence and living as long as possible.

The highest proportion of both groups ranked the relief of pain and suffering as the most important value, followed by maintaining dignity and remaining independent.

Living as long as possible was ranked as most important by the lowest proportion of participants – only 4% of palliative care patients and 2.6% of the general population (30–35% regarded this as either not important or not very important).

People care not only about pain relief, but also about dignity and independence at the end of life. These are much more subjective and less amenable to control by palliative care. So while palliative care can address part of what people care about, it may not be able to address all their values.

Moreover, people can already shorten their lives by more than a year for any medical condition, or no medical condition at all, by refusing to eat and drink by mouth. It takes around ten days to die of thirst. Such people could be given palliative care to relieve their suffering during this period of suicide.

But surely the Victorian law offers a better way to die? As with the palliative care, this kind of death does not provide the dignified death, or the independence, that people value.

As distressing as public debate on heartfelt, emotive issues like assisted dying and marriage equality can be, it is an important collective exercise. Like many other people, I thought the marriage equality survey was a waste of money. But on reflection, this idea maybe misplaced. When the views of one part of the community are deemed politically incorrect and suppressed, they foment, then erupt in a Brexit or a Trump.

Debate is vitally important to democracy. What we should hope is that people engage in these debates with their heads, not their hearts. It will take considerable effort on both sides to overcome the psychological obstacles to finding the most fair and reasonable policy.

As Epicurus also said:

The ConversationThe art of living well and the art of dying well are one.

Julian Savulescu, Uehiro Chair in Practical Ethics, Visiting Professor in Biomedical Ethics, Murdoch Childrens Research Institute and Distinguished Visiting Professor in Law, Melbourne University, University of Oxford

This article was originally published on The Conversation. Read the original article.