Final Post – Week 6

Computer screen with words on it saying: To blog or not to blog...

My thoughts on pht402:

  • Good variety of sources for course reading prep

  • Wonderfully diverse population of participants – both geographically and areas of speciality – fantastic to be able to interact with you all…

  • Writing a blog forced me to use a different style of presentation

  • New skills gained: using WordPress

  • Flexibility to do study at home, and at any time of day or night, including very short sessions eg. replying to a comment

  • Superb way of getting quick interaction and developing ideas

  • Provided challenges to my own thinking, both through comments & reading others’ posts

  • Fascinating to read about other people’s thought-processes in pondering these issues

  • More personal views stated than I’ve ever encountered before during a period of shared study – partly due to nature of the topics, partly, I feel, to the idiosyncrasies of the blogging medium

Altogether a great way to facilitate learning

A huge thank you to Michael for designing the course with such intriguing topics, and especially for throwing it open to therapists around the world

Many thanks to Rachael & Tony for administering the platform which enabled the participation of non-University of Western Cape therapists

Most of all, many thanks to my fellow MOOC participants for all your thought-provoking posts, for your honest introspection and self-examination,  for the interesting links to items related to the topics, for being kind enough to read and then make stimulating comments on my posts, and for causing me on several occasions to read your blogs late into the night when the rest of my household were asleep.

It’s been a great pleasure to interact with you all

My very best wishes to everyone for the future

And remember, your brain is a very greedy organ using 20% of your calories, so bear in mind that when studying or blogging you need nourishment:

Person at computer keyboard with coke and crisps being supplied by mechanical means while he types

Reflections on Euthanasia – Week 5

Both writing my own post, and reading other people’s posts made me consider that this particular subject is fraught with difficulties, and in many ways it would be easier just to stick to the clear moral path that Killing is Wrong and we should always strive to save lives and to enhance the quality of life.

Part of me would like to stay at that point and not have to address all the issues involved in this very difficult subject.

I really feel like “burying my head in the sand”

Figure with head buried in sand

But I truly believe that I would be a moral coward if I did that.

Umr starts off his post by stating that “ in order to address the topic as effectively as I need to, I find that I first have to look into where I stand on resources previously discussed, things such as equality, morality, torture?” and I totally agree. I had to revisit my thinking on previous topics, especially equality and morality, and also to give some consideration to my ideas on Freedom.

Lisa asks “Why does euthanasia carry such a strong social stigma today? Perhaps it has to do with the perceived mentality of “killing off the weakest and most dependent members in our society” or “killing those unworthy of life”.” This is a good question, and once we are advocating the right to a life of equality and freedom, it is difficult to argue for deliberate taking of life.  Difficult, but I firmly believe that it should be debated.

I felt it was important for me to spend some time trying to gain some insight into the lives of people in the unfortunate position of living with suffering and incapacity, and their views on this subject. I revisited some of the stories which have been in the news here in the UK, including Dianne Pretty who suffered from Motor Neurone Disease and fought unsuccessfully in the British courts to try and change the law so she could take her own life,  instead dying “in the way she always feared”.

The story of Brooke Hopkins, a University Professor in the USA whose wife happened to be a Medical Ethicist who specialised in end of life decisions, which Tony highlighted in his blog really demonstrates the many complexities and ambiguities in these cases, and once again I found myself thinking there is no easy answer.

Cecil writes about a very different, yet no less heart-wrenching, case of a French woman who suffers from intractable pain and also disfiguring facial deformity who also wants to be allowed to end her life.

I tried very hard to imagine what these individuals were going through, but in the end came to the conclusion which Jackie came to: that we will “never truly understand and empathize with somebody who legitimately requests for assisted suicide”.

I cannot know how I would feel in their situation; I can only guess at how I might react.

I find I keep coming back to the question I asked in my original post on this topic:

Does “right to life” mean “an obligation to live”?

To me, the answer to that question is No.

I still strongly believe that Locked-in Syndrome and terminal illness with intractable pain certainly diminish human dignity, and that it is harder morally to justify letting somebody die a slow and painful death than it is to justify helping them to avoid it.

I find myself thinking that in these very extreme cases then euthanasia should be considered; otherwise we’re potentially condemning the patient to a life of suffering.

Could condemning an individual to a life of suffering which they no longer want be called “passive torture”?

Euthanasia – a peaceful end at a time of my choosing..?

Road sign saying Choice, Exit now

I have been working as a physiotherapist for more than 30 years, and during this time I have been with a number patients as they lived the final weeks and months of their lives, knowing that in the near future they will die. A few lived their last few weeks with a nobility and joy which was inspiring to everyone around, a few fought bitterly against the hand that fate had given them, and some even lived their final weeks denying that life was coming to an end. Treating these patients was, on the whole, a rewarding experience, as everyone is grateful if you can ease their pain for even a while.

Equality and Freedom

Much of the debate around the topics in this Ethics MOOC have centred around 2 very basic concepts: equality and freedom. There seems to be a good consensus that equality for all is a Good Thing, and should be a moral absolute, and that each of us should have freedom to think and act as we wish, albeit with many limitations placed by the society we live in in order to ensure that one person’s free act does not rob another person of their life/health/freedom.

Freedom to choose the end…

So, looking at the last stages of a person’s life, does it make sense that they should be free to choose the manner of their death?

You or I certainly have that freedom right now: if I wanted to, I could end my life at a time of my choosing with a choice of several different methods, and I suppose I do consider this a freedom.

Now, a terminally ill patient suffering from the late stages of, for instance, Motor Neurone Disease, does not have the same freedom you and I do to end their life: they no longer have the physical ability to kill themselves. A person with Locked-in Syndrome similarly lacks that freedom.

This certainly seems to be unequal – I am allowed to end my own life, but simply because they are “disabled” they are not.

Is this not discrimination?

We might argue that life is unfair, and that their cruel disease has robbed them of many freedoms: to walk, talk, feed themselves, etc. and that it also robs them of the freedom to finish their life. However, we can also argue that the Law does not prevent them walking, talking or eating, yet the Law as it stands in the UK and in South Africa does prevent them ending their life.

Does “right to life” mean “an obligation to live”?

To my mind, Locked-in Sydrome and terminal illness with intractable pain certainly diminish human dignity, and it’s harder morally to justify letting somebody die a slow and painful death than it is to justify helping them to avoid it.

Euthanasia Legislation

I find myself thinking that in the context of the UK, on balance I believe that some form of euthanasia (perhaps similar to that currently practised in The Netherlands and Belgium) should be made legal.

I feel certain that I would be glad of it were I to be diagnosed with MND or something similar.

However, I do wonder whether in the context of South Africa legalising it might just bring certain problems which it wouldn’t in the UK.

Please forgive me: I know this sounds terribly prejudiced – it’s ok for me in my country but not ok for you in yours – but here are my reasons for being unsure:

Euthanasia is an extreme act used as a last resort when medical interventions are unable to provide a cure, and really needs to exist in a society where every person has access to very good medical care, especially palliative care services – I wonder whether this is the case at present in South Africa? I have no real knowledge of this, so I’m just asking the question.

I can imagine a scenario where a newly established – and maybe also as yet underfunded? – health care system might struggle to provide good care for terminally ill patients, due to lack of resources and experience; and in this case encouraging patients to undergo euthanasia might seem to be a good way of making sure that funds were saved to spend on patients with a better prospect of cure/recovery.

Please comment on this last section – do I have the right to make these sort of remarks about South Africa?

Picture of horse facing slaughter house, with a choice of taking left or right gate

The illusion of free choice

The whole euthanasia debate is certainly difficult.

But I believe that we are morally obliged at least to have the discussion…

Torture and Human Rights

Thought experiment:

A small wrong to prevent a large one?

And lots of shades of grey…

The Ticking Bomb

Cartoon of lit bomb

A terrorist is believed to have planted a bomb in an unknown location in a busy area of a major city.

Intelligence suggests that the aim is to kill a large number of people.

Is it morally justified for the terrorist to be physically tortured in the (admittedly probably small) chance that he/she will disclose information on the location so that the area can be evacuated?

Although we may argue that torture is morally wrong, in this case do we consider that a greater moral wrong (killing a large number of people) might be averted by the use of torture, thus using a small wrong to prevent a large one?

Even if we answer No to the above scenario, what if we changed the torture from physical to mental torture?

If we learn that the suspect has a fear of snakes, for instance, is putting him (or even just threatening to put him) into a room with snakes roaming/slithering around torture of the same degree as pulling out his fingernails?

Drawing of snake

Another drawing of snake

A new word: fear of snakes, according to Wikipedia, is known as Ophiophobia, from the Greek work “ophis” for snake.

It seems to me, as a person with no ophiophobia, that it is not as unethical, but to a true ophiophobe if given the choice perhaps he would chose the fingernail removal!

Would talking about the possibility of these 2 different methods of “persuasion” in front of the terrorist constitute mental torture?

What if we said we were holding his relative in custody and were going to to physically torture them – clearly this would be extremely unethical if we actually did it, but what if we didn’t really have them in custody and we had no intention of doing any such thing, is lying to him in this way wrong?

It is difficult to see how torture could be an absolute moral wrong, given that killing is morally worse than torture and yet we allow killing in self-defence.

So, given that torture is not the morally worst act that anyone could perform, maybe there will be some scenarios in which we might be forced to choose between two evils, the lesser one of which is torture.

 Scales of justice with gun on one side, legal gavel on the other

In the case of The Ticking Bomb, perhaps a one-off act of torture in this extreme emergency could be considered to be morally justifiable given that:

  1.  The authorities reasonably believe that torturing the suspect may result in saving the lives of many innocent people
  2. The authorities reasonably believe that torturing the suspect may result in saving the lives of many innocent people
  3. The threat to life is more or less imminent
  4. The lives to be saved are innocent, whereas the terrorist is not an innocent – he is known to have caused the threat, and he is refusing to cooperate in saving the lives.

And yet – the intentional infliction of severe physical suffering and pain is surely an Evil Act.

Torturing a human being takes away that individual’s autonomy, and given the moral importance of autonomy, torture is an Evil Act.

At present, I feel rather inclined to take a compromise stance on torture:

I consider it to be clearly very morally wrong, but wonder if on very, very rare occasions it could be argued to be morally the best action to perform. ie. it might be morally justifiable in certain one-off emergency situations.

However, despite saying all the above, I do strongly oppose any legalisation of torture, as I believe that:

In a liberal democratic country to legalise torture goes against the fundamental liberal values of individual autonomy and freedom

Drawing of head with cogs inside

By the way, if instead of “terrorist” I substitute the phrase “paranoid schizophrenic” – do you feel like giving the same answers?


Reflection on Week 3: Equality in South Africa

Through reading the posts from people living in South Africa, I have become aware how ignorant I am of what is happening in this country. As part of the course reading I had noted the relevant parts of the South African Constitution, and naively thought that this was a great statement, so surely the country was now well on the way to equality for all?

South African flag on map of South Africa

I now realise that it is a long, slow process to bring a society to a state of true equality for all races when there has been such profound inequality for so many generations.

Umr’s post  “Equality is Dead”  in particular, caused me to think long and hard, as he writes so powerfully about the changes he sees around him, stating that “South Africa has come a long way since its dark ages, but I feel that we have an even longer way to go before we earn the rights to really consider it a “rainbow” nation.”

Chantelle posted a link to a video which, as a non-South African, I found very helpful in explaining some of the issues. And she makes the point that “ there cannot be true equality, real fairness without freedom. You cannot sacrifice the one for the other” very coherently. She also points out measures to “force” equality can create divides and socio-economic problems.

On reading’s Cecil’s post I certainly agreed with his opening statement that “You probably can never understand the detriments and the legacy “Apartheid” left in our society, and how it has shaped and influenced our lives”, but I am glad to have the opportunity to learn more about this. He argues very persuasively that “a fair advantage is needed to equalise the injustices of the past”, and I can now see that without something as drastic as this, movement towards true equality would be very difficult to start.

However, in life things are seldom black and white, and just as I found myself starting to think that “Fair Discrimination” is the answer to the issue of previous inequalities in South Africa, Adam’s thoughtful post demonstrated to me the problems with this strategy. He puts it into historical context: “ I have never sat in a history class without hearing about discrimination” then describes the discrimination he has personally encountered on the Other Side of the fair discrimination rules.

Giving advantage to one racial group necessarily disadvantages another – what a dilemma!

Still, reading all the blogs by these young people in South Africa leaves me feeling that despite the present difficulties, surely a nation with such thoughtful, eloquent and brave young people will find a route to true equality.

To paraphrase Umr’s post title “Equality’s Dead”, may I suggest “Equality’s struggling to be born”?

And finally, Noam writes in her blog that although we are equal, we are not all the same, and I am reminded that part of the joy and wonder of being human is the enormous variety of ideas, opinions and ways of being we see around us.

A World without Diversity: No Spice of Life

Equality, prejudice and a confession…

To me, when compared to the previous two in our Professional Ethics course, this topic seems to be pretty straight forward.

Of course every person has equal worth, whatever their race, age, gender, social status, religion, sexual preferences, disability.

Although, In the words of the cartoonist below, maybe some improvements could still be made…

Perfect Gender Equality

And yet historically, of course, this has not been the case in many societies throughout most of history. We are fortunate to be living in current times, in a world where this ethos of equality is enshrined in Law and Constitution in many countries.

I  was saddened to read the article in our course study material about Uganda and its policy on homosexuality how a modern society can be proposing to pass an Anti-Homosexuality Bill.

To my mind, this attitude is simply wrong, and I find it hard to believe that people can argue for it.

However, I do not find it difficult to believe that people can think that: if we are making decisions about questions of equality based on our emotions, then I can see that someone who is strongly heterosexual might be utterly repelled by the mere idea of homosexual actions, and may construct their response based on instinctive emotion rather than reasoned intellectual thought.

That does not make their response right, of course… far from it.

But it did start me asking myself if I ever made important decisions about other people based on emotion, resulting in the following train of thought:

A Confession – please don’t judge me harshly!

Discrimination – identifying my personal triggers.

PrejudiceI need to know my own innate discrimination tendencies. What instinctive judgements might I make, before I even have time to think consciously about them?

For me, I realise that smell may play a part, as it is such a powerful sense in terms of changing our mood, etc.

Some years ago I came to recognise that I found it difficult to relate to, empathise with, people belonging to one particular ethnic group, and I was very aware  of the different smell associated with this group. (Talking of different smells, I have been told that to a Japanese person Europeans smell of milk, so I am not alone in noticing differences in body scent.)

Once I identified this trigger, it became relatively easy to challenge it intellectually and I was pleased to find that my emotions followed suit.

Does anyone else have any deep-seated irrational prejudice lurking  in their psyche?

My moral judgement in conflict with the Law

Although I have not encountered even a single instance of this sort of dilemma in my experience, I am strongly inclined to believe that the answer has to be: The Law comes first, and no matter how fervent my beliefs, I have to obey the law of the land.

Cartoon of judge

After all, if I chose to disobey it, then I must accept that anyone else may also ignore it, and thus I shouldn’t complain if they murder my friend or steal from me. If I want the protection that the law affords, allowing me to live in freedom, then I have to follow its rules myself – all of them, even if there are some I don’t agree with.

What is your view on this? Do you consider that I am just taking the easy path..?

Reflections on Week 2 Morality

Morality as a journey

In her post Kristin suggests that developing morality should be an ongoing journey, and I certainly agree with this view; in fact this MOOC has already caused me to revise my ideas on morality in terms of challenging religious dogma.

Signpost pointing to "right", "wrong", "good", "corrupt", "forbidden"It is my view that our moral values are not a final destination we arrive at aged 18 and never examine or question thereafter! An important dimension of being human is our drive to establish a set of rules we chose to live by, and each of us remakes moral decisions on a daily basis.

As intelligent, thinking beings, surely we should examine and re-evaluate these decisions throughout our lives, updating our views in response to our life experience?

Agnosticism and morality

Kristin also argues very eloquently for faith in God as a basis for moral decisions, and asks the question:  without God, how can we have any morality?

This really made me reconsider my standpoint as I struggled to answer this question with something more coherently argued than “go with what feels right”.

I suppose that as an agnostic (I don’t have enough conviction to call myself an atheist) I believe that the basis of my morality is to enable all people to live in freedom, and I am firmly of the opinion that morality is an essential part of being human, not a part of some supernatural realm. I believe that we can search deep within ourselves, and pay attention to the world around us, and then apply our skills of logic, reasoning and justice to build a valid moral framework.

Cartoon of Einstein

 I read that Albert Einstein once said: “A man’s ethical behaviour should be based effectually on sympathy, education and social ties and needs; no religious basis is necessary. Man would indeed be in a poor way if he had to be restrained by fear of punishment and hope of reward after death.”

Kim argues very eloquently for formulation of morality without recourse to religion, and gives an example of a medical dilemma (presented in a TV series, but such dilemmas certainly do occur in real life) where a child dies unnecessarily because the parents’ religious faith does not allow for the life-saving blood transplant the child requires. I found this problem particularly difficult to debate, but I am coming to the conclusion (for today, at least!) that if I had the power to make the medical decision, I would want to ignore the wishes of the parents and save the life of the child. In practice, though, were I in that position of power, I would do whatever the law of the land demanded of me…

But I think I’ll leave the final word to Noam who concluded her post with this superb statement:

“ I think we need to actively remind ourselves not to judge our patients, to remember to focus on our job  and be modest enough to remember our morality is not the only one out there.”