Autonomy and Toleration

 

In this posting I want to examine the relationship between autonomy and toleration. This examination will highlight the tension between respecting autonomous decisions and autonomous persons. I will argue that the concept of autonomy we adopt affects how tolerant we should be. Toleration will be defined as accepting choices we believe to be wrong and have the power to change, provided that these choices don’t harm others. John Stuart Mill famously argued that “the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.” (1) Mill was discussing liberty but the liberty to choose can be described as a primitive form of autonomy. Mill believed if we accept the above then we must also accept that “if all mankind minus one, were of one opinion, and only one person were of the contrary opinion, mankind would be no more justified in silencing that one person, than he, if he had the power, would be justified in silencing mankind. (2) It follows that if we equate autonomy with the liberty of Mill that toleration and autonomy are automatically linked and that we should tolerate any behaviour, which we disapprove of and have the power to change, provided that this behaviour doesn’t harm others.

It might be objected that it is overly simplistic to equate autonomy with liberty and that a more nuanced account of autonomy is needed. How then might we better define autonomy? Let us first consider autonomous decision making. Of course the freedom to choose is a necessary condition for autonomous decision making but it might not be a sufficient one. My objector might suggest that the simple freedom to choose is an insufficient condition for two reasons. Firstly she might suggest that for someone’s decision to be an autonomous one that it must accord with certain accepted norms in addition to the norm of not harming others. For instance if someone made decisions about what she should to do today based solely on her horoscope we might question if she was truly self-governing. My objector might then argue that our concept of autonomy must contain a substantive element and that that there is no meaningful content neutral account of autonomy. Secondly she might suggest that for someone’s decision to be autonomous he must accept Kant’s hypothetical imperative and always choose means that are likely to deliver the ends he seeks. For instance we might question whether someone was really self-governing if one of the ends he desired was increased learning and he sought to acquire this increase by prayer. In the light of my objector’s suggestions two arguments might now be advanced as to why autonomy and toleration need not be linked. Firstly if we accept a substantive account of autonomy which includes some accepted norms then we have no reason, based on respecting autonomous decisions, to accept those decisions which don’t concur with those norms and hence be tolerant.  Secondly it might be argued we have no reason based on respect for autonomy to respect, tolerate, those who choose means that are unlikely to achieve the ends they seek.

I have outlined a possible more nuanced definition of autonomous decision making. However we can respect autonomous decisions or autonomous people. Let us now turn our examination to respecting autonomous people. I will suggest that that respecting an autonomous person means accepting all of her decisions including ones that appear to have been made in a non-autonomous manner. My objector might argue that it is possible to respect someone as an autonomous person without respecting all of her decisions. In order to consider this objection I will first consider what sort of person is an autonomous person and how is she connected to autonomous decision making. It might be suggested that an autonomous person is simply one who always make autonomous decisions. If we accept this definition then we should have no problem in accepting all the decisions made by an autonomous person. However if we accept this suggestion it might be argued that it would be much simpler if we only respected autonomous decisions and ignored the concept of an autonomous person altogether. Moreover most people don’t always make decisions which conform to conditions outlined above for autonomous decision making, indeed it might be suggested that they rarely do so. It follows that if we accept the above that we are only going to respect an extremely small set of human beings as autonomous persons. In the light of the above should we simply respect human beings and forget about respecting autonomous people? I would suggest we shouldn’t. A three year old and an adult in the prime of her faculties differ in their capacities and intuitively the idea of self-control, self-government or autonomy seems central to this difference. Perhaps a better way to define an autonomous person would be to define her as a human being who has the capacity to make autonomous decisions. Such a definition would satisfy most adults because they want to be defined as the kind of creatures who can make their own decisions rather than simply being defined as human beings. Such a definition would also be useful because it defines a meaningful subset of human beings in contrast our previous definition which only defined a narrow subset. Lastly such a definition roughly concurs with Mill’s idea that liberty is “meant to apply to human beings in the maturity of their faculties”. If we accept this definition of an autonomous person then what does it mean to respect such a person? I have suggested above that this means accepting all her decisions which don’t harm others. Let us assume that we don’t respect all the decisions of someone who has the capacity to make autonomous decisions. Which of her decisions should we respect, only the one that are autonomous ones? However doing so means respecting an autonomous person is equivalent to respecting autonomous decisions and the concept of an autonomous person seems to do no work. Let us accept that if the concept of an autonomous person is to be a meaningful one that respecting someone as an autonomous person necessarily means accepting all of her decisions. This position seems to concur with that of Mill. It follows that respecting someone as an autonomous person means respecting, or at the very least accepting, her autonomous decisions. Acceptance of the above and the previously outlined definition of toleration means that we will be tolerant automatically. It means accepting choices we believe to be wrong and have the power to change, provided these choices don’t harm others.

It might be objected that it is difficult to ascertain whether someone has the capacity to make autonomous decisions. She might point out that if we respect autonomous persons and this means that we must respect non-autonomous decisions that this respect causes difficulties for the doctrine of informed consent. My objector might proceed to argue that because of this difficulty it would be much better to assess whether some specific decision was an autonomous one rather than whether the person making it had the capacity to make autonomous decisions. For this reason she might suggest that when we respect autonomy we should only respect autonomous decisions. She might point out that adopting her suggestion would mean that it would be easier to act beneficently towards someone who seems to be making a decision which runs counter to his best interests. If we accept that respecting autonomy means respecting autonomous decisions and accept a substantive account of autonomy then respect for autonomy and toleration aren’t automatically linked. There are no reason based on respect for autonomy as to why we should accept the decisions of others which conflict with our accepted norms. In a western democracy if the wearing of the hijab goes against our accepted norms then there is no reason to accept it based on respect for autonomy not to ban it; similarly in an Islamic state if not wearing the hijab goes against the accepted norms then again then there is no reason to accept not wearing it based on respect for autonomy. It follows that there is no reason based on respect for autonomy, as conceived above, as to why we should be tolerant, unless of course one of our accepted norms is to be tolerant.

It would seem if we believe respecting autonomy means respecting autonomous persons then we should be tolerant, if we accept a substantive account of autonomy and believe respecting autonomy means respecting autonomous decisions then we have no reason based on autonomy to be tolerant. I will now present two arguments as to why we shouldn’t accept that respecting autonomy means respecting substantive autonomous decisions. Firstly I would argue if we do so then we might be accused of epistemic arrogance. Let us accept that any autonomous decision must accord with the hypothetical imperative. Let us assume someone makes a decision using this imperative but that we don’t accept her decision as an autonomous one. It follows that our rejection is based on rejecting the beliefs or norms her decision is based upon. Let us also accept that our beliefs and desires help define us as persons. It follows if we don’t respect someone’s decisions that whilst we might be respecting her as a human being in a caring way but that we aren’t respecting her as a person. Autonomy and the concept of a person are of necessity connected. Most people don’t want to be only respected as a human being but as a person. It follows that if we only respect autonomous decisions we erode the concept of a person. Secondly I will argue that if we only accept a substantive account autonomous decisions that the concept of an autonomous decisions also loses its usefulness. If we only respect substantive autonomous decisions we only respect what we regard as good decisions. It follows if we only respect what we regard as good decisions the idea of autonomous making is doing no useful work and becomes redundant. It follows that that if he concept of autonomy is to remain a useful concept that we should reject a substantive account of autonomous decision making.

I have argued that we should reject a substantive account of autonomy. Most applied philosophers seem wedded to a substantive account of autonomy perhaps, this is because of an unconscious desire to justify their discipline for after all if something is a primitive concept then there is less of a need for applied philosophy. If we reject a substantive of autonomous decision making and still believe autonomy remains important then we must accept that respecting autonomy means respecting those people who have the capacity to make autonomous decisions. Respecting those people who perhaps aren’t as we educated as some are and rely on their emotions more than most people do. If we do so we must still be able to define an autonomous decision. Clearly not all decisions are autonomous. For instance random decisions, coerced decisions or decision made under some internal compulsion, such as a patient refusing consent because of fear, aren’t autonomous decisions. I have argued above that we should reject a substantive account of autonomous decision making because it erodes the idea of a particular person and reduces the need for autonomous decisions by equating them with good decisions. It follows that we should adopt a content neutral or primitive account of autonomous decision making. An autonomous decision is one which is freely made by someone which is based on her own beliefs and is instrumentally rational enough to serve those beliefs. Respecting this primitive concept of autonomy entails that we will be naturally tolerant. Respecting autonomy means accepting choices we believe to be wrong and have the power to change provided that these choices don’t harm others. Lastly if we accept that informed consent is based on respect for patient autonomy then adopting a primitive account of autonomy means a larger number of people should be competent to give consent compared to the number if we adopt a substantive account.

1. Mill J S. (1974) On Liberty and Other Essays. Oxford University Press (Oxfords Worlds Classics), introduction.
2. Mill J S, chapter 2

Abating Anger

A posting in peasoup by Antti Kauppinen suggests that rage might be a moral emotion. Rage is uncontrollable anger. This posting will, for the most part, be concerned with more moderate anger and whether such anger can be justified and when it can ever serve any useful purpose. I will argue that whilst anger is dangerous that nonetheless controlled anger can sometimes serve some useful purpose. 

To the Stoics anger was a harmful emotion. Seneca describes the mischief anger does as follows,

“no plague has cost the human race more dear: you will see slaughterings and poisonings, accusations and counter-accusations, sacking of cities, ruin of whole peoples, the persons of princes sold into slavery by auction, torches applied to roofs, and fires not merely confined within city-walls but making whole tracts of country glow with hostile flame. See the foundations of the most celebrated cities hardly now to be discerned; they were ruined by anger. See deserts extending for many miles without an inhabitant: they have been desolated.” Sophia-project, Anger book 1.

What sort of anger was Seneca talking about? There is uncontrolled anger and anger that has been tempered or abated some degree. I would suggest that Seneca was talking about uncontrolled anger which I believe could be better characterised as rage. I will consider whether rage might be regarded as a moral emotion as suggested by Kauppinen at the end of this posting. I now want to consider whether tempered or controlled anger can ever be a useful emotion. 

Let us accept that anger has evolutionary roots. It might be argued that because of these roots anger must retain some purpose. However such an argument seems to be unconvincing. Evolution has given us a taste for sweet and fatty things. Such a taste might have been an advantage to a hunter gatherer but is a disadvantage to anyone living in an affluent city. Similarly anger might of advantage to a hunter gatherer but might be a disadvantage to a city dweller. Human progress may now be too rapid for evolution to keep pace with. Let it be accepted that emotions in general are useful to us. Hume argued that reason is slave of the passions. Nonetheless as suggested above the specific emotion of anger might no longer remain useful to us. It might be argued that in practice we cannot simply eliminate a single emotion which has ceased to be useful to us, such as anger, without damaging our capacity to feel the emotions which remain useful to us. If we eliminate all anger then perhaps we will damage our capacity to feel empathy, see anger and empathy. I will now offer two examples which suggest that it might be wrong to eliminate anger in all circumstances. Each example will suggest further reasons as to why we shouldn’t eliminate all anger because our anger can be useful in some circumstances.

My first example concerns anger at Donald Trump’s policies on immigration, his lying together with his underlying racist and misogynist views. Should we simply transmute our anger into useful actions aimed at combatting these evils as suggested by Martha Nussbaum? (1) I would suggest that we shouldn’t because if we do so our actions might be interpreted as a sign of weakness, this is especially true in the case of Trump. Sometimes when faced by wrongdoing we must signal our determination to fight that wrongdoing and perhaps retaining some anger helps in this signalling. A further example might be provide by those who lived under apartheid in South Africa and were unjustly disenfranchised perhaps their anger signalled their determination to oppose the apartheid. However caution is needed as excessive anger can damage rationality and degenerate into hate. In spite of this need for caution I would suggest that when fighting injustice that retaining some controlled anger is useful in this fight by signalling our determination to continue in this fight.

My second example comes from the Vietnam War. In this war Hugh Thompson’s anger helped him, to courageously save others from being massacred at My Lai. Was Thompson’s anger was justified? Was his anger useful in helping stop the massacre? Might not a calm rational moral person also have helped to stop the massacre? Intuitively his anger seems both to have been justifiable and useful.  However our intuitions are not always reliable and I will now attempt to show his anger was useful. Some emotions such as sadness don’t seem to have a clear focus or target. Some might class such emotions as moods and moods are hard to justify. Other emotions such as anger are intentional and are focussed on some target. Let us accept that morality matters. I will now argue intentional emotions can be justified by moral concerns and my argument will focus on anger. Intentional emotions can be seen as sending a signal that something is wrong and needs attending to. If I see someone forcefully pushing into a queue I might feel angry at the perceived injustice. If this person is unjustly trying to displace other members of the queue then my anger is justified because my anger focusses my in attention on the injustice. However if this person is attempting to join her partner in the middle of the queue then no injustice is taking place and my anger is unjustified. Let us accept that anger can be justified by focussing our attention moral concerns. However when anger focusses our attention we must ensure that we focus accurately on those whose wrong actions are the cause of our anger. Hugh Thompson accurately focussed his anger on the wrong actions of the perpetrators of the massacre at My Lai. The perpetrators of the massacre were also angry but their focus on the cause their anger was inaccurate. The villagers massacred were mere bystanders and did nothing wrong, did not cause the situation which lead to the perpetrators anger. The perpetrators anger was inaccurately focussed, resulting in them unjustly targeting innocent women and children. Let us accept anger can be justified by alerting us to some moral wrong. Let us also accept that once anger has alerted us to some wrong that our anger should be translated into actions which alleviate the wrong when this is possible targeting those who cause the wrong. However does translating our anger into action mean our anger should cease completely or continue at some lower level?

I have argued that anger can be justified by alerting us to some moral wrong. At this point I want to compare my position to that of the stoics. Stoics argue that because the cause of someone’s anger is some event in the past and because the past cannot be changed anger is irrational. More generally the stoics argued that emotions are irrational and that we should seek to master them. What do stoics mean by mastering anger? I have argued above that anger isn’t irrational because it alerts us to some wrongdoing. Some stoics might be prepared to accept that anger sometimes alerts us that to the fact that something is wrong. After all if they refuse to accept the above, are they prepared to accept that anger simply occurs at random without any meaningful reference to the context in which it takes place? In response to the above a stoic might suggest that emotions such as anger and rationality occupy completely separate domains and that we should only pay attention to reason and seek eliminate our anger. Plato also believed emotions and reason occupied separate domains and used the example of a charioteer controlling unruly horses as a metaphor for reason controlling the emotions. My stoic might argue whilst hunter gatherers found anger useful in alerting them to wrongdoing in the tribe that nowadays reason alone can alert us to wrongdoing, anger has become a redundant emotion. Stoics believed in cultivating virtue, but if reason alone can detect wrongdoing stoics might also have made good deontologists. A stoic might proceed to argue that reason always alerts us to wrongdoing and does so more reliably than unreliable anger. In the light of the above she might suggest that we should try to eliminate any anger because reason offers a better way to alert us to wrongdoing and anger might interfere with our rationality. To her mastering anger means eliminating anger. One response to the above might to suggest that emotions and reason do not occupy completely distinct domains, I will not pursue this response further here. A second response is to point out that whilst we are no longer hunter gatherers we are human beings and human beings cannot simply eliminate emotions such as anger. My stoic might concede that we cannot simply eliminate anger but argue that when we experience anger we should move on using reason and try to suppress our anger with reason. Mastering our anger now means suppressing it. Such a position is similar to that of Martha Nussbaum who argues we should transmute our anger into useful actions. I have some sympathy for such a position. However it might be better if we sought to control our anger rather than simply suppress it. If we merely suppress our anger rather than control it then our anger might suddenly reappear, indeed it is feasible suppressed anger might fester and grow. When we eliminate or suppress our anger we do not experience anger, the same is not true of controlling anger. To control anger we must retain some anger. However we must stop simply being angry and realise we are angry. Once we stop simply being angry and become aware we are angry we can reflect on and monitor our anger. Is our anger justified? Is our anger excessive? Is it useful? I would argue mastering our anger should mean controlling our anger. It seems that my stoic would argue that we should try not to become angry and if we do become angry we should suppress it, Nussbaum would argue that once we have become angry we should transform our anger into useful actions aimed at correcting the injustice which caused it, whilst I would argue that once we have become angry we should control our anger and use it to enable us to carry out useful actions aimed at correcting the injustice. In the above I have considered eliminating, suppressing and controlling anger from a purely theoretical viewpoint, it is possible that empirical research might mean my views should be amended.  My stoic and Nussbaum believe maintaining anger is both counterproductive and wrong, I believe maintaining some limited form of anger is justified because doing so helps in controlling anger.

I now want to argue that we have a further reason to maintain some anger. What sort of signal is an emotion sending? It is sending a signal that something needs attending to. Emotions are somewhat analogous to alarms. According to Michael Brady emotions facilitate understanding. They do so by facilitating,

“reassessment through the capture and consumption of attention; emotions enable us to gain a “true and stable” evaluative judgement. (2)

I accept that anger requires that we should reassess the situation. However I would argue anger not only captures our attention but in some circumstances help us to retain our attention, helps us to retain our focus. Let us assume that someone is angry because she has been bypassed for promotion due to sexism. Perhaps if she attends to the circumstances of her being bypassed for promotion she finds that the person selected really was better qualified for the position than her. In this scenario her anger might be judged to be inappropriate and should cease.  However let us assume her anger was justified but her employer tackles the injustice. A stoic would argue all her anger should be abated. It seems to me that by simply suppressing her anger she deprives herself of a useful tool for focusing on the injustice of more general sexism. At My Lai Hugh Thompson’s anger helped him maintain his focus on stopping the massacre. Perhaps if he hadn’t maintained his anger his attention might have wandered and he would have considered the dangers to himself, his future or the damage making the public aware of the massacre would do to the US army. Blind anger is never useful, but it seems plausible that some form of controlled anger might be useful in maintaining our focus on some injustice.

I have argued that anger is a useful emotion when it is controlled. However there are dangers associated with the use of anger. It has been suggested that emotions are somewhat analogous to alarms. Alarms are meant to be attended to and switched off. Anger should be attended to and if unjustified should cease. However I have argued that if anger is justified it should be attended to and controlled rather than simply suppressed. Nonetheless if someone simply remains angry and does not reassess her situation on becoming angry then her anger serves no purpose and is damaging. I would suggest there is some mean to anger in much the same way as Aristotle suggested there was a mean to the virtues. Someone might be excessively prone to anger causing her to focus her attention on trivial matters. She might also be very slow to anger and this slowness might deprive her of a better understanding her situation.

 Lastly I want to return to my starting point and consider Kauppinen’s suggestion that rage might be a moral emotion. Kauppinen suggests rage is a negative feeling that is a cousin of anger and hate. He argues rage motivates you to destroy, to get physical, preferably destroying what you see as the obstacle to justice. I have suggested that rage is simply unabated anger. According to the Cambridge Dictionary rage is a period of extreme or violent anger. According to the Oxford Dictionary rage is violent anger, fury, usually manifested in looks, words, or action. It would seem that rage is not a cousin of anger but an uncontrolled form of anger. I am quite happy to agree with Kauppinen that rage might be justified in some circumstances. Rage against apartheid, Trump’s policies and the perpetrators of the My Lai massacre can be justified. However I am not so happy to believe such rage is a useful emotion. I have argued above that anger needs to be abated and controlled it follows that if rage is a form of uncontrolled anger that rage is unproductive. Anger helps someone reassess her situation and take action. If rage is simply uncontrolled anger then whilst rage may be justified it is not a useful emotion. Indeed rage may be counterproductive because the enraged simply rages and fails to reassess her situation.

1. MARTHA C. NUSSBAUM, 2015, Transitional Anger. Journal of the American Philosophical Association, page 53.
2. Michael Brady, 2013, Emotional Insight; The Epistemic Role of Emotional Experience, Oxford University Press, page147.

Ectogenesis and the Abortion Debate

Ectogenesis means the gestation of a foetus in an artificial environment outside the mother’s womb. Recent research with raising premature lambs in gestation bags means there is some possibility that ectogenesis might be feasible. Let us assume that ectogenesis becomes possible. It has been suggested that such a possibility might lead to the end of the debate about the permissibility of abortion, see bioedge. In this posting I will argue that whilst the realisation of this possibility might reframe the debate it will not end it.

One of the classic arguments for the permissibility of abortion is that of Judith Jarvis Thompson . Thompson asks us to imagine that someone wakes up to find herself in bed connected to a famous unconscious violinist suffering from a fatal kidney disease. Her thought experiment assumes that she is the only one with the right physiological features to save the violinist. Thompson assumes she has not consented to being connected to the violinist and that he will automatically recover in nine months. She suggests that it is morally permissible for her to demand to be disconnected from the violinist even if this leads to his premature death. She then argues by analogy that a pregnant mother has a right to an abortion. A woman has a right to be disconnected from her unborn child even though this will lead to the child dying. If ectogenesis becomes a possibility, then Thompson’s argument by analogy fails. In Thompson example it is not possible to disconnect the person connected to the violinist without the violinist dying. However, if ectogenesis becomes possible then it might be feasible for a mother to become disconnected from her unborn child without the child dying. The child is then gestated/incubated in an artificial womb.

It might appear that if ectogenesis becomes feasible then abortion will become unnecessary. Let us reimagine Thompson’s thought experiment. In this reimagined scenario someone is still connected to the violinist for nine months in order to save his life and at the end of this time she is disconnected. Unfortunately, the violinist’s illness has greatly weakened him meaning he needs care for the next fifteen years. Equally unfortunately because she are a close relation of the violinist it is suggested that she is the ideal person to carry out this caring. Someone in this scenario has two reasons for wanting not to be connected to the violinist. Firstly, she simply doesn’t want to be connected, secondly she wants be disconnected so she doesn’t have to care for the violinist later on even if this causes his death.

Let us further reimagine our thought experiment. The violinist’s doctors come along with some good news, they have discovered some new treatment which means it is unnecessary for someone to be connected for nine months. However, the violinist will be greatly weakened and still need care for the next fifteen years and that because of your close relationship you remain the best person to provide that care. You now have no reason to cause the violinist’s death because you wish to be disconnected but you still have some reason to cause his death because you don’t want to care for him for next fifteen. This scenario seems analogous to that of a pregnant women wanting an abortion if ectogenesis becomes feasible. She now has no reason to cause the foetus’ death because she can be disconnected, she might even never be connected in the first place, but she does have a reason this death because she doesn’t want to be a mother. It might be objected that I am not realistically representing the situation. My objector might suggest that others can care for the violinist, even if as not as well as a close relative, and that an unwanted baby can be cared by the state or adopted. I accept her objection. She might conclude that there is no need for abortion if ectogenesis becomes available and that the state provides childcare for abandoned children.

The soundness of my objector’s conclusion depends on two factors. Firstly, exactly how ectogenesis works and secondly the State’s willingness to finance ectogenesis and the extra childcare involved. Let us consider the process of ectogenesis. It seems conceivable that one day ectogenesis might be used by couples who conceive using IVF and that there might be no need for women to gestate the foetus involved in IVF at all, but these are not the women seeking abortions. The women seeking abortions are already carrying the foetus involved. Might the process in removing the foetus from a women’s womb be much more invasive than a simple abortion? If so might the women involved prefer an abortion? I will put this question to one side and deal with the importance of the preferences of a women carrying a foetus later. Let now consider the State’s obligations. The philosopher Rousseau sent all his five children to the Paris Foundling Hospital immediately upon birth. It might be argued that if a great many people acted in the same manner as Rousseau that the cost of ectogenesis together with that of childrearing might place too great a burden on the state. I find such an argument unpersuasive and in the era of safe contraception think it unlikely that the State would find the burden of financing ectogenesis and extra childcare excessively burdensome.

In spite of the above many people would feel uneasy about the ease with which Rousseau gave away his children. It might be possible for a potential mother to have a preference not to have a child and a preference not to abandon any child she had. Let us assume abortion ceases to be an option open to women due to ectgenesis and state childrearing. Let us consider a pregnant woman who would prefer not to be a mother and also prefer that if she did indeed become a mother not to abandon her child. In the above scenario she could not have an abortion and would find herself unable abandon the child she didn’t want. I would find her preference not to abandon her child commendable for two reasons. First, she displays a caring attitude towards her child. Secondly she has a sense of personal duty, she believes some duties shouldn’t be delegated to the state. She might believe she doesn’t have a duty to cause a child to exist but that if she does cause a child to exist then she has a duty to rear that child.

It is important to be clear about the relationship between her two preferences. Her primary preference is not to become a mother. If she cannot satisfy her primary preference, then she has a secondary preference not to abandon her child and become a mother. She doesn’t want to be in a position in which she satisfies her second preference. She has a mega preference that she should be able to satisfy her first preference rather than her second. Her position is analogous to that of a soldier. Most soldiers would prefer not go to war but if they must do so most would prefer to act courageously, they have a mega preference that there will be no need for them to act courageously in battle. If we can ask whether we should satisfy her mega preference means that the possibility of ectogenesis would not end the abortion debate, but merely reframe it.

Should we try to satisfy her mega preference? It might be argued that someone’s inability to abandon her child means that at a later period she might be glad she became a mother. It might then be further argued because she later affirms having the child she must also affirm the conditions necessary for that child to exist, she must become glad she was unable to have an abortion and that as a result we had no reason to satisfy her mega preference. This situation is analogous to Parfit’s fourteen-year-old girl who has a child and later in her life her love for that child means she must affirm her decision to become pregnant at fourteen was a good decision for her. For an excellent treatment of these issues can be found in Jay Wallace’s ‘The View from Here’ (1). I would feel uncomfortable in endorsing the fourteen-year-old’s decision as a good decision and likewise would feel uncomfortable in failing to endorse someone’s mega preference to have an abortion as a good for her because she might later come to love her child. I would suggest in cases such as these result in the feeling of a deep sense of ambivalence and do not give us reason to regard the fourteen-year-old girl’s decision as a good decision or the denial of abortion as justified. If we accept the above, then the possibility of ectogenesis and State childcare doesn’t give us reason to ban abortion. I don’t believe the idea of souls should play any part in determining the permissibility of abortion. I do believe it is permissible for a woman have an abortion before the foetus becomes conscious. However, if science can determine when consciousness emerges this might change the time at which abortions ceases to be permissible.

1. See chapter 2 of, Jay Wallace, 2013, The View from Here; On Affirmation, Attachment, and the Limits of Regret, Oxford University Press.

If a Lion could Speak

According to Wittgenstein, “if a lion could speak, we could not understand him.” (1) It is by no means clear what  Wittgenstein meant by this remark and I will suggest two possible explanations. Firstly, there might exist some languages which cannot be translated into any other. Secondly some minds might be so radically different from ours that the thoughts in those minds might be so radically different to our own that we couldn’t conceive them. It might appear that whilst the soundness of these propositions might be of academic interest it is of no practical importance. I would suggest that this appearance is mistaken. Suppose that some advanced AI, robots or even aliens could speak could we understand them? The answer to this question might help support or provide some evidence against Bostrom’s orthogonanlity thesis. Recently Facebook abandoned an experiment after two artificially intelligent programs appeared to be chatting to each other in a strange language only they understood, see the Independent . Stephen Hawking believes if we are ever contacted by aliens we should think very carefully before replying due to the dangers involved. I am extremely dubious about whether we will ever be contacted by aliens but the possibility exists as long as we are unsure of how life evolved in the universe. The first possible danger posed by our inability to communicate with aliens formed the subject matter of the 2016 film Arrival, might powerful minds with which we cannot communicate pose a threat to us? Besides the above possibility there also exists the possibility that alien minds might be so radically different from ours that they might consider us of no importance and even consider us as dangerous. This second possibility might also be posed by some advanced form of AI. On a more practical level if Wittgenstein is correct then Turing tests are pointless for we might be unable to converse with fully intelligent conscious entities.

Let us accept that language can be roughly defined as a system of communicating information. However, there is an important difference between language processors and language users. If language is simply a system of communication then ‘computer languages’ such as Java, C and Python are languages in much the same way as are English, Mandarin and Sign Languages used by the deaf. I would suggest that however fast a computer runs or however much information it can handle that if this is all it can do then it cannot be said to be a language user. What does it mean to be a language user? I would suggest that for some entity to be considered as a language user this entity must determine the use it puts language to.  At the present time computers, robots and AI don’t determine how the information they process is used and as a result aren’t language users. It follows that at the present time that any dangers posed by computers, robots or AI are due to our misuse or misunderstanding of them rather than some imagined purpose such entities might acquire. It might be objected by someone that accepting my suggestion means that because animals don’t determine the use the language they use that they also aren’t real language users. It would appear to follow that chimpanzees and clever crows which appear to communicate with us are really language processors in much the same way as computers rather than users. I would argue this objection is unsound. Animals might simply use language but the use of the language is put to, unlike the use of computers, is determined by the animals’ needs and wants. Accepting the above means accepting that certain animals are primitive language users. The rest of this posting will only be concerned with language used by language users as defined above.

 

Let us consider the possibility that we might be unable to understand the language of aliens or some advanced form of AI. It is possible that any AI, however advanced, must remain a language processor rather than a language user. Nonetheless because we are uncertain as to how we became language users the possibility of some advanced AI becoming a user cannot be completely ruled out. Let us now consider whether some language might be untranslatable into any other. By untranslatable I don’t mean some language which is difficult to translate but rather that some language is impossible to translate. Of course we may not capture all the nuances of some language in translation but is there any language that cannot translated at least to some degree? In order to answer this question, we must ask another what is meant by a language?  Let us accept that language is a system of communicating information among language users as defined above. Information about what? Information must include knowledge of things in the world shared by the language users. The world of language users must be a world of things. These things might include such things as, physical objects, descriptions of behaviour in the world and emotions among others. If any world was a completely undifferentiated one with no distinct things existing in it there could be no speech and no need for language users. Our original question might now be reframed. Is it possible for the users of one language to talk about a set of totally distinct things from the users of another language? This would only be possible if the world of one set of language users was totally separate from that of another set. This might be possible if language defines the world we live in, language could also help us make sense of the world we live in. Let us assume for the sake of argument that lions could talk. Would this talk define a lion’s world or help lions make sense of the world they live in? I would suggest language must touch the world rather than define it and that this world is shared by all of us to some degree. I don’t believe Wittgenstein would agree. It follows that if lions could talk they would talk about some things common to our world. For instance they might talk about being hot or cold, hunger or being content. It follows lions could speak that we should be able to understand them even if the translation proved to be difficult in practice and we couldn’t understand all the nuances of their language. However, would the same be true for some more fanciful language users such as advanced AI, robots or aliens? I would suggest the same argument can be applied and that all language users share the same universe to some degree and it is impossible for the users of one language to talk about a set of totally distinct things from the users of another language. Because language must touch the world any two sets of language users must talk about some of the same things. It follows we should be able to partly translate the language of any language users who share our world even if this might prove to be difficult in practice.

I have argued that we should be able to partly translate any language in our universe even if this might prove to be difficult in practice. This argument presumes that all language users share the same universe, share some common understandings. Lions and human beings all understand what is meant by trees, sleep and hunger but only humans understand what is meant by a galaxy. The above appears to suggest that there is a hierarchy of understanding and that some things can only be understood once a creature has understood some more basic things. The above also seems to suggest that there is a hierarchy of languages with simple ones only touching the more basic things in the world whilst more complex languages are able to touch a wider domain. In the light of the above it seems possible that aliens or some advanced AI might be able to talk about things we are unable to understand. Is it possible that our inability to fully understand the language of such entities might pose us with an existential threat?

Our failure to understand such entities means that we cannot completely discount the above possibility, however I will now suggest that we have some reasons to believe such a threat is unlikely to be posed to us by aliens. Language use is not simply a cognitive exercise. Any communication between entities that don’t have a will is not language use but language processing, language users must have a will. For something to have a will means it must care about something. If something cared about nothing, then it would have no basis on which to base decisions and all its decisions would be equally good meaning decisions could be made at random. The domain of our moral concern has expanded over time. Slavery is now unthinkable, women in the western world are considered of equal worth when compared to men and our moral concern extends to animals, all this is very different to ancient world. What has caused this increase in the domain of our moral concern? I would suggest this increase is due to an increase in our projective empathy. This increase is not simply driven by an increase in our ability to feel emotion. It is driven by our ability to see others as sharing with us some features of the world. Slaves can have a will even if the exercise of this will is restricted, animals can also feel restricted and pain. This ability is due our increase in our knowledge of the world rather than any increase in either cognitive ability or empathy. In the light of the above I would suggest that any aliens are unlikely to pose an existential threat to us. Language users must have a will. Having a will means caring about something. It seems probable that any aliens which might threaten us would have an advanced basis of knowledge, without such a basis it is difficult to see either how they would contact us or how they might threaten us. If some entity has an ability to care about and advanced knowledge basis, then it seems probable that it will have a wide domain of moral concern and that we would be included in that domain. I have argued above that if aliens ever contact we should be able to partly understand them. In the light of the above it seems that any failure on our part to fully understand possible aliens would not pose an existential threat to us.

Does the above apply to advanced AI or robots. If such entities don’t have a will then any threat posed by such entities would be due our failure to understand how such entities function or a failure to set them clear goals. The possibility exists that we might create some bio-hazard by failing to fully understand what we are doing. The threat posed by advanced AI or robots without a will is similar. However, provided we are extremely careful in how we set the goals of such entities this hazard can be minimised. I am extremely doubtful whether advanced AI or robots can acquire a will, nonetheless because we don’t fully understand how consciousness originated such a possibility cannot be completely ruled out. I have argued that it is unlikely that our inability to understand any possible aliens would pose an existential threat to us, however I would suggest any such failure to fully understand some advanced AI which is in the process of acquiring a will might pose such a threat. The threat might be due to an emerging primitive will being akin to that of a child. Perhaps the fact that some such emerging entity has a primitive will might mean it wouldn’t prefer the destruction of the whole world to the scratching of its metaphorical finger, but it might prefer the destruction of humanity rather than refraining from such scratching. It follows if the possibility exists that advanced AI or robots can acquire a will that we should take seriously the possibility that if this will starts happening that such emerging entities might well pose us with an existential threat. Any failure on our part to fully understand such entities would compound such a threat. Perhaps if such entities can fully acquire a will the threat will recede.

1. Ludwig Wittgenstein, Philosophical Investigations, 1953, Blackwell, page 223

Afterthoughts

Assuming that we can understand a lion AT/Alien to some degree the question arises what sort of things might we understand. Goals, intentions or reasons? Perhaps even if we understand the goals and intentions of some advanced AI we might be unable to understand its reasons. But we don't understand all our reasons, reasons run out according to Wittgenstein.  The question becomes how many reasons we need to understand and how many can we do.

What do We Mean by Work?

It is always important to be clear about what we are talking about when discussing philosophical questions. What we mean by work is important because it raises some interesting philosophical questions. For instance, John Danaher wonder whether work makes us happy, Tim Douglas wonders whether the future is workless (1), or perhaps robots will mean that in the future we will have no need to work. In this posting I want to consider what we mean when we discuss work.

The Cambridge online dictionary defines work as “an activity, such as a job, that a person uses physical or mental effort to do, usually for money.” Work seems tied to the idea of a job. In might appear that we could improve our definition of what we mean by work by considering what we mean by a job. Unfortunately, what we mean by a job, is like that of work, far from clear, moreover sometimes the definitions of work and a job seem to be intertwined. For these reasons I will restrict my discussion to what we mean by work. Let us consider an old fashioned couple, the husband works on a farm providing them with an income whilst his wife does the housework in their home. This example raises several interesting questions. Are both doing the same thing at some basic level? If they aren’t it would appear that there is a family of related definitions of what we mean by work.  Examples of members of such a family are easy to imagine, working for a wage, housework, schoolwork and someone working on improving her game or garden. Indeed it would seem perfectly natural for someone to say she is going to work in her garden. If we accept such a family of meanings do all members of this family have equal worth or does the value of work vary depending on which member of the family we are considering?

I want to reject the idea that the meaning of work is really a family of related meanings for two reasons. First, the apparent appearance of a family of different meanings might be an illusion. It seems entirely plausible that work might have only one meaning and that the appearance of a family of meanings is not due to any difference in meaning but rather to the different domains work is carried out in. Farmwork is not conceptually different from housework, the apparent difference is due to the different domains each is carried out in. Secondly let us assume that what we mean by work is a family of related meanings. If we accept the above, then it should be possible to say something about the relationship between family members. However, if we can say something meaningful about this relationship between family members then perhaps what we say could form the basis of a common definition for all forms of work.

Let us accept that there is something common to the meaning of work in different domains. Work is different from play. If considering what is meant by a job doesn’t help us to define work, then perhaps considering the differences between work and play might do so. Both are forms of work and most forms of play can be fun but play is never serious whilst all work is serious. What do I mean by serious? If someone plays at something she can simply stop playing at will because play isn’t serious. If someone works at something she can’t simply stop working for no reason because work is serious. Of course she might dislike work and be glad to stop working but work matters to her and she must have a reason to stop working. If we accept the above, then even if professional footballers are playing a game they are also working. Indeed, someone whose garden matters to her might be said to working in her garden.

Let us accept that work must matter to the worker. Accepting the above doesn’t mean the worker must like her work. Indeed, in some circumstances the worker might hate her job. I have suggested someone can simply stop playing and that stopping has no important consequences for her. The same is not true of work. Someone might well stop working at her dead end job but stopping has consequences for her that matter. Her work matters even if this is only for instrumental reasons, these reasons might simply be making a living or buying the things she values. For someone who loves her garden stopping gardening might mean the garden she loves becomes neglected. Work was defined by the Cambridge online dictionary as “an activity, such as a job, that a person uses physical or mental effort to do, usually for money.” In light of the above work might be better defined as an activity requiring physical or mental effort and that activity matters to the worker. Adopting the above definition would mean working for a wage, housework, schoolwork and playing professional sport could all be regarded as work in the same way and need not be regarded as a family of loosely connected definitions and any apparent differences could be due to the different domains the work is carried out in.

I have argued the definition of work above means that we don’t have to accept a family of loosely connected definitions. The definition I have adopted above depends on the idea that work matters, work is something we care about. Accepting this definition means we had workers before our modern ideas about workers, a Neanderthal hunter might be regarded as a worker. However, even if work might be defined one way we might care about work in two ways. First, someone might work in order to make a living or to obtain the things she desires. Work matters to her for instrumental reasons. Someone working solely to make a living would be a good example of the instrumental value of work. Secondly, someone might work at something because this something matters directly to her. Work has a kind of intrinsic value to her. Someone working in a garden she loves would be good example of such work. Work might matter for what it enables us to obtain or work might matter because we care about what we are working at. Someone working solely to make a living and someone working in a garden she loves are extreme examples and many forms of work might matter to someone because of both values. For instance, someone might drive a bus in order to make a living whilst also take pride in her driving abilities.

Let us accept that work might be defined as an activity requiring physical or mental effort that matters to the worker and that work might matter to the worker for two reasons or some combination of the two. What are the consequences of accepting the above? The first of these is that we must reject the idea that work is a family of loosely related definitions. Of course there are different kinds of work, the work of a banker is different to that of the cleaner in the bank. However, at a basic level both are undertaking some activity, requiring physical or mental effort, which matters to both of them. Of course the complexity of the activity and the domain in which the activity is carried out matter, but these considerations don’t affect this basic definition. Secondly if work must of necessity matter to someone, work isn’t play, then work must be of some value in her life. I argued above that work can have instrumental or intrinsic value, we can work for something or work at something. If someone works at something simply because it matters to her then work gives her life meaning. Moreover, the reason why it matters does not alter the fact that working at something gives someone’s life meaning. For instance, someone might work at providing relief to the starving because she believes it’s a good thing to do whilst someone else might work at studying quasars simply because she finds quasars interesting. Both of these persons work at something for different reasons, but for both of them their work has intrinsic value giving their lives meaning. Let us now consider someone who works for its instrumental value. If someone simply work for something, then this something permits her to pursue the things that matter in life to her, the things that give her life meaning. If someone works as a cleaner, then this might enable her to feed the family she loves. Lastly let us assume that work gives our lives meaning and that automation might destroy many jobs. What are the likely consequences of accepting these assumptions and how should we deal with them? Let us first consider those workers who work instrumentally to obtain the things that matter to them. Clearly some will be unable to make a living which might lead to social unrest. One solution to the above could be the introduction of some sort of universal basic income (UBI). I would suggest that in such circumstances even capitalism has an interest in introducing UBI as it is dependent on some sort of social cohesion. Unfortunately, even if automation does destroy jobs and a UBI is introduced this introduction by itself might be insufficient to maintain social cohesion. If people become bored and little matters to them then social cohesion might become eroded. Boredom in this situation wouldn’t be a minor matter but of major concern both to individuals and society. One way of dealing with this concern might be to refocus the way people work. Perhaps people should focus on working at rather than working for. Such a refocussing would accord better with stoic ideals. Someone’s ability to work at something is less dependent on her having a job. Nonetheless such a refocussing of the way we work is not straightforward as many people would need to be helped to change their focus from working for to working at. I have suggested in a previous posting that such a refocussing might be helped by a refocussing of our education system, see work, automation and happiness . The focus of education might be broadened from simply preparing people for work to helping them to lead a good life.  Such a shift might be aided by placing greater emphasis on the humanities. Once again such a change in emphasis would accord better with stoic ideals. It might be objected that I am adopting a somewhat elitist attitude. I accept this objection and offer two suggestions to combat such elitism. First, the focus of education might be broadened still further to enabling some people learn a craft. Crafts sometimes allow the craftsperson to enter a flow state giving her life some meaning. Secondly in ancient Greece the elite lead a life of leisure in which sport and the gymnasium were important. Perhaps sport participation should play a greater part in any society which finds its cohesion damaged by automation. I have suggested above that a professional footballer might be regarded as a worker if we accept the above definition an amateur footballer might be said to work at his game. Like UBI such participation would be expensive but these costs might be partly offset by health benefits.

1. Tim Dunlop, Why the future is workless, New South Publishing.

Good Government, Democracy and Referendums

 

Government is an ongoing process. Any single referendum aimed at making a binding decision on some issue is not an ongoing process. Any such referendum is of course a process, but it is a process designed to bring about closure if the possibility of a further referendum is excluded. In this posting I will argue that accepting the result of some types of referendums, such as the Brexit one, is damaging to good government and is fundamentally undemocratic.

Democracy might be defined as the belief in freedom and equality among people. Democratic government might be defined as “a system of government in which all the people of a country can vote to elect their representatives.” (1) The two definitions are connected because if people aren’t free they can’t govern themselves. What does it mean to govern oneself? The ability to govern oneself is the ability to make decisions without being deceived or coerced and to enact those decisions. The ability to govern a state is much the same. It is the ability to decide which policies a state wishes to pursue together with the capability to enact them. The ability to govern of course applies to both dictatorships and democratic states. Democratic government takes place by its citizens determining its policies either directly, through such means as referendums, or by electing representatives. Personal government must of necessity be an ongoing process. Let us assume someone governs herself and that she decides at time t1 doing x is best thing for her to do. Let us next assume at time t2 and in a roughly similar situation she finds that she is unable to do anything other than x. I would suggest that at time t2 she is unable to fully govern himself. To be able to fully govern herself at t2 she must have the ability to revisit her past decisions and if necessary revise or change them. Accepting the above of course does not mean she must change her decision or even consider changing it. Moreover, any inability at t2 doesn’t need to be connected to any lack of further reflection on her part, she may be perfectly satisfied with her previous decision and feel no need for further reflection. However, even if she simply accepts some decision her acceptance cannot be forced onto her and she must retain the ongoing ability to accept or reject this decision. The same is also true of states. Governing a state requires that the state retains the continuing ability revise and if necessary change its own policies. Governing a state must of necessity be an ongoing process. States that don’t do so become lifeless and fossilised.

I now want to argue that the use of some sorts of referendums damage this ongoing process. It might be objected that provided the electorate in some referendum is not deceived or coerced that the result of the referendum can contribute to good government. I accept my objector’s position holds in some circumstances referendums can contribute to good government. Nonetheless I would argue that my objectors position doesn’t always hold in all circumstances. I will argue that use of some sort of democratic referendums to determine policy can damage good governance. Of course a democratic referendum might help to determine a policy. However, a democratic government must retain he ability to revise and if necessary change its own policies. If a referendum determines some government policies for the foreseeable future, then that government loses part of its ability to make and change some of its own policies in the future. The above holds even if the referendum in question was conducted democratically. In what follows I will consider referendums which determine some government policies for the foreseeable future rather than binding ones. No binding referendum binds forever, binding referendums only determine some policy for the foreseeable future. Referendums can express the will of the people but this expression isn’t the everlasting will of the people as everlasting will just doesn’t exist, people can, do and should be able to change their minds. Accepting he above means accepting that the use of a democratic referendum by any government, when the result of the referendum determines a policy for the foreseeable future, damages good government because good government is an ongoing process.

I have argued that referendums which determine government policy for the foreseeable future damage good government. It might be objected that I’m misrepresenting the point of referendums. The point of referendums is to shift the focus from elected government to a more direct form of governance. I accept my objector’s point. I accept that referendums can shift the focus from elected government to a more direct form of government. However, I will now argue that any referendum which is designed to determine long term policy damages good governance. How can direct government by the use of referendums possibly damage good governance? I am not suggesting all such referendums damage good governance. I am only suggesting that those referendums which determine some policy for the foreseeable future damage the ability of the electorate to govern themselves directly. Let us imagine a state which is governed directly by its electorate by the use of referendums. Let us assume that one of these referendums determines one of this states policies for the foreseeable future. I will now repeat my central argument as to why such a referendum damages good governance. Let us accept that government must be an ongoing process. This referendum damages this ongoing process. I have argued that someone’s ability to govern himself means she must have the retain ability to change his decision and that the same is true of voters. If voters in some referendum determine some policy for the foreseeable future, then they deprive themselves of the ability to decide on some policy at some future date. Even if referendums, which are designed to govern directly, are conducted democratically they can still damage good government and if they deprive the electorate of the ability to make further decisions on some matter are undemocratic. Both good government requires retaining the ability to react to changes in circumstances, any referendum which determines government policy for the foreseeable future destroys this ability to react. I suggested above that such referendums in spite of appearances are fundamentally undemocratic. Clearly any democratically conducted referendum which aims to elect a leader for life destroys democracy. I now want to argue that any referendum which takes place in a democracy with the aim of determining some policy for the foreseeable future damages that democracy. In a democracy the electorate must retain the ability to shape government policy. It might be objected that if the electorate have democratically determined some policy in a referendum that nothing can be more democratic than that. I would suggest soundness of this objection depends on how long such a referendum is meant to determine a state’s policy. Let us assume that a referendum determines some state’s policies for the foreseeable future. Such a referendum is undemocratic. Over time he electorate changes. Some electors die whilst others become enfranchised. It follows that the result of the referendum over time might come not represent the will of the majority of the electorate. The will of the majority might be ignored.

Let me once again make my position clear I’m not saying all referendums damage good governance or are undemocratic. Referendums which are advisory or determine short or perhaps even medium term policy need not damage a government’s ability to govern nor are they fundementally undemocratic. I am saying all referendums which determine long term policy or policy for the foreseeable future damage good governance and are undemocratic. I believe the Brexit referendum to be such a referendum. What conclusions can be drawn from the above? Firstly, referendums should never be used to determine long term policy. Secondly if referendums must be used to determine policy in the medium term they should not be decided by a simple majority of actual voters. At the very least referendums to determine medium term policies should require a majority among all those eligible to vote in order to be valid. A larger majority should mean that the result of the referendum would remain the democratic will of the electorate for a longer period.

1. http://www.oxfordlearnersdictionaries.com/definition/english/democracy?q=democracy

Charlie Gard and Experimental Treatment for Children

Until recently I assumed without much reflection that it would be best if Charlie Gard was allowed to die peacefully. After some reflection I still believe this would be the most sensible option. However, after this reflection it seems to me that this case raises an important philosophical issue. What should form the basis of our decision making when deciding whether some experimental treatment might be appropriate for children. In this posting I will examine this issue. I have previously argued that autonomous adults with life threatening conditions have a right to try experimental treatments provided these treatments are privately financed, see wooler.scottus . I would argue that this right to try applies to all potential experimental treatments even when the chances of a cure are slim and possibilities of adverse side effects high. If the above is accepted, then it might appear to automatically follow that children’s parents have a right to try experimental treatment to combat their children’s life threatening conditions. I will argue this appearance is unsound and that the issues are more complicated when children are involved.

Let us accept a Millian account of autonomy is correct.  Let us accept that someone’s “own good, either physical or moral, is not a sufficient warrant” to preventing her from exercising her will provided this exercise does not harm to others. This acceptance implies that we must accept that autonomous adults have the right to try experimental treatments, subject to certain conditions, even when the results might be harmful. The same right does not extend to children. Parents must consider the physical, mental and moral good of their children. If parents fail to do so, then a court must decide what is in the child’s best interests. If we accept the above then it doesn’t mean children should never receive experimental treatment. However, it does mean the situation is more complicated than that in the case of adults.

It is generally accepted that parents should act in their children’s best interests and that if they fail the do a court has the right to intervene in order to protect these interests. Let us consider a case in which an experimental treatment becomes available to treat a gravely ill child. How should the child’s parents decide on whether she should undergo the treatment? Intuitively we might assume that they should decide whether the proposed treatment is in the child’s best interests. For any experimental treatment what is in the child’s best interests is a question of probability. Medical probabilities are complicated and parents and courts should usually take the advice of medical experts.

Does accepting the above mean parents should never accept any experimental treatment for a child who is gravely if this treatment is not recommended by the majority of medical experts and carries a low probability of success? Surely any treatment with a low probability of success cannot be in a child’s best interests. However, the above is not always true. In a few cases, experimental treatment might well be in a child’s best interests even if in the majority of cases it isn’t and in these cases might even be harmful. The philosophical issue I want to raise is on what basis should parents and courts use when deciding whether experimental treatment should be accepted. Most would suggest that the decision should be based on what is in the child’s best interests even if the probabilities attached to these interests are extremely hard to determine. I now want to argue such a suggestion is mistaken and that the decision should instead be based on the probability of whether any experimental treatment is likely to harm the child concerned.

Medical ethics is concerned with beneficence, non-maleficence and respect for patient autonomy. Usually parents or in some cases the courts decide whether experimental treatment is appropriate on the basis of what is in the child’s best interests. They apply the principle of beneficence. I appears that acting on the principle of beneficence excludes considerations of autonomy. I argued elsewhere that this assumption might not hold in the case of competent adults, see autonomy and beneficence . I have suggested above that in the case of a young child and experimental treatment that is sometimes impossible to ascertain what is in her best interests making it impossible to apply the principle of beneficence. Kant argued ought implies can. Let us accept Kant was right. It follows if we cannot ascertain what is in a child’s best interests that we ought not apply the principle of best interests. I would suggest that in this situation we should adopt the principle of non-maleficence. Adopting the principle of non-maleficence when considering the acceptability of using an experimental treatment for a child has two important consequences. First it means we need consider harm to the child. In the case of terminally ill children the harm of most concern must be the child’s suffering. Whether someone is suffering should be easier to determine than what is in her best interests. Secondly adopting the principle of non-maleficence brings respect for autonomy back into play. If the autonomous wishes of a sick child’s parents will not harm her then then these wishes matter.

What does accepting the above mean in practice? It might be objected that in practice it is just as difficult to act in a non-maleficent manner as it is to act beneficently. I would suggest such an objection carries little weight provided we ask and can answer three important questions concerning harm. First, we must ask whether the proposed treatment will cause any additional suffering to the child. Second, we must ask whether such treatment would extend the duration of her suffering. Thirdly, we must ask whether moving a child to receive such treatment will cause her further suffering. These questions remain difficult to answer. However, some further more practical questions might be asked to help us answer to answer the first three. I’m a philosopher and for this reason I will only tentatively outline some of these more practical questions. Is the child currently in pain? Will any experimental treatment lead to extra pain? Could any extra pain be controlled? Will the treatment cause nausea? These are clear cut questions and for this reason should be easier to answer than deciding if some treatment is in the child’s best interests. It follows that provided some experimental treatment will not cause a terminally ill child any further suffering, that from a non-maleficent basis, that there is no reason why that child should be denied such treatment provided it is privately financed. At this point I want to emphasise that I am only saying that experimental treatment should be acceptable according to the principle of non-maleficence, I’m not saying such a decision is a good decision.

What are the implications of the above in the case of Charlie Gard?  Should the wishes of his parents matter? When a court decides on what is in the welfare of a child the decision is based on what is in the child’s best interests. Accepting the above means that the wishes of Charlie Gard’s parents should play no part in the court’s decision. However, I have suggested that in cases such as that of Charlie Gard it is sometimes impossible to reach a decision based on best interests. Courts are concerned with practical matters and must make decisions. If a court cannot make a genuine decision based on beneficence then it might make a decision based on the futility of treatment in the belief that this equates with best interests. The two are not identical. Perhaps in these circumstances it would better not to fudge any decision and instead rely on the older principle of non-maleficence. It might even be argued that in these circumstances that a court deciding in a non-maleficent manner to limit a child’s suffering is also acting in a manner which might be loosely described as beneficent. I believe it would be more credible in these circumstances to simply admit acting on the principle of non-maleficence. If we accept the above, then certain questions need to be asked. Is Charlie suffering? Would any proposed experimental treatment cause him further suffering? Would moving him to receive any proposed experimental treatment cause him to suffer? Let us assume that Charlie is suffering then we must now ask whether any proposed experimental treatment likely to reduce or eliminate his suffering. If the answer is negative Charlie should be allowed to die peacefully. Let us assume Charlie isn’t suffering. It seems to me provided that the second and third questions above can be answered negatively that the wishes of his parents should matter and they should be free to seek experimental treatment provided it is privately funded. Accepting the above does not imply seeking such treatment is wise or desirable but only that it should be permissible.

In the light of the above discussion when dealing with difficult treatment options for seriously ill children we should ask the following questions when considering whether we should and if we should how to apply the principle of non-maleficence.

1. Is it possible to ascertain what is in a child’s best interests? Not just what we want to believe is in the child’s best interests. If the answer is no we can move on to apply the principle of non-maleficence.
2. Is the child suffering? If no we can move onto 4
3. Can this suffering be relieved? If yes we can go onto 4.
4. Will this proposed treatment cause further suffering which cannot be relieved. If no then such treatment is permissible according to the principle of non-maleficence even if others believe it to be futile