Sometimes called “compassionate use”, expanded access is a potential pathway for a patient with an immediately life-threatening condition or serious disease or condition to gain access to an investigational medical product (drug, biologic, or medical device) for treatment outside of clinical trials when no comparable or satisfactory alternative therapy options are available.
Yes, the FDA will insert itself to regulate medicine wherever it can. For example, the FDA has been pushing to regulate diagnostic tests as medical devices.
It’s funny how Americans surrender medical autonomy to the government but draw a strict line in the sand in other issues
I have a weird muscle disease that is treated with just taking over the counter L-Carnitine. The issue, vitamins and supplements are not regulated. So, I will try to take a new brand and after a few days my symptoms will come back because the pills don't have the L-Carnitine like it says and there is no one to make sure it does. It will cost me four to seven days of pain, and no one is held responsible.
My best guess is one in a thousand actually needs them so the 999 have a placebo effect and the 1 suffers. I told my neurologist, and he couldn't even prescribe them for me because that isn't a thing. So now I buy all I can find that works and hope they don't stop making it.
I don't know if this helps you, but in case it does:
They are regulated in Australia. Products that conform will have an AUST R or AUST L number on the packaging.
I learnt this at a talk I went to about 10 years ago. At the time, in the speakers opinion (who from memory was involved in surveillance testing of these products), some countries did regulate stuff like vitamin supplements, but Australia was the only country that "did it properly". And a major component of this was that their regulations covered ingredients and the supply chains.
Finally, a word of caution given by the speaker: many companies/suppliers try to trick consumers online by selling cheaper versions with identical labelling but no AUST number and shipped directly from overseas so it technically counted as a consumer "importing" on their own. Idk if this loop hole still exists.
That sounds severe enough I'd consider it worthwhile to pay a lab to run spectroscopy on a range of supplements just in case, or consider hiring a lab to synthesize a batch I _know_ will meet my needs. The first option is probably a lot less pricey than you'd expect.
> So, I will try to take a new brand and after a few days my symptoms will come back because the pills don't have the L-Carnitine like it says and there is no one to make sure it does.
Unlikely. What's more likely is that something else interferes with the absorption.
Anyway, don't just take my word at face value, have a sample tested: liquid chromatography can give you an answer quickly. Also, don't buy on amazon where cheap fakes and inventory comingling make the problem unsolvable.
Grab a monster energy drink: content in L-Carnitine is guaranteed,
I had to spend thousands to go through a dozen medications for medical issues. Eventually turned to supplements in part because it was much easier to experiment.
I have a couple meds and treatments I’ve been begging doctors to try, but they aren’t aware of them so refuse to consider.
Go onto any support forum and you’ll find countless tales of doctors not listening or not knowing current info on a condition.
You'll also find tons of people who swear by their home "witches brew" medication. People who are just feeling a placebo. Or people who think they have the forum's banner illness but actually have something totally different and much more benign. They heal over time naturally, but attribute it to gum root jelly concentrate.
I've been there a few times before. And while inevitably monkeys popping random pills will find something, separating the signal from the noise takes time and studies. The things that doctors pay attention too.
Disclaimer: Yes there are out of touch doctors and yes random medicating has lead to amazing discoveries.
If there are two brands exposed to the same market rules and one cost half the price there is a fair possibility that will contain less amount of the expensive active stuff and more of the cheaper ingredients. Technically is still carnitine, but one can have 90% of carnitine and the other just a 60%.
> For example, the FDA has been pushing to regulate diagnostic tests as medical devices.
I assume you mean COVID home tests and things like that? Call me strange, but if I buy such a thing then I'd like to make sure it's held to some standard of accuracy and safety. I do not have the resources or knowledge to find this out myself. Most people don't, and you can't just rely on "internet reviews" or the like.
Someone has to do this, and while the FDA and government authority may not be perfect, they're the best we've got, and we can at least somewhat hold them accountable through the democratic process (which also isn't perfect, but better than anything else we've got).
I'm surprised by the popular take on this. Hasn't HN spent the last 3 years lamenting how the FAA ceded too much regulatory power to industry?
... because this is where it starts. The answer to "there are regulatory inefficiencies" is not "get rid of regulations" or "allow industry to self-regulate."
The hostility towards FDA on HN is incredible. I wouldn't trust some VC funded startup bros with anything related to medicine at all without having passed every single regulatory board tangentially related to whatever they are doing, even more so after Theranos.
It's not like "enforce more" vs. "enforce less" is the only axis along which the behaviour of a government agency can be tweaked.
For an extreme example, imagine you had a court system that picks 100 people at random to execute each year (most of whom are naturally innocent). Then, you have a crime wave. Would you say that the solution to this problem would be that the courts need to be tougher? ...more lenient? Both seem quite obviously wrong: being more lenient would solve the problem of innocents getting executed but do nothing about crime, being tougher would only trivially solve the problem of crime near the limit point where everyone is executed. However, being hostile towards such a court system seems quite appropriate.
Likewise, I don't think Theranos is sufficient evidence that the FDA needs to simply be stricter, nor is the difficulty of getting approval for pig hearts sufficient evidence that the FDA needs to be more lenient. Instead, taken together the two imply that the FDA needs to be more specific at blocking the bad therapies and allowing the good ones - in other words, it simply needs to get better at its job. Is this not something we can demand of the government?
The issue here (and with regulators in general) is that in general "being better at their job" means going into more depth to determine whether an approval is warranted, which means expending more resources on investigation. I don't know that I've ever seen any overlap between the people who think the regulators do a bad job at regulating and people who think we should be funding the regulators more thoroughly.
All that not to mention that when a regulator like the FDA starts going into more depth in its investigations of an industry, that industry's firms start spending more money on either complying with or deceiving the regulator, risking a downward spiral of wasted resources.
But the FDA isn't executing 100 people (or corporations) per year. FDA isn't even indiscriminately halting progress. Your argument has no premise.
The FDA regulates with cause and investigates all new medical products before they can be brought to market. They don't willy nilly approve some and nix others.
I wouldn't trust startup-bros either, without regulatory oversight. That being said, the hostility towards the FDA is not without basis (see below). Though I would argue that much of that hostility it due to it doing too little, rather than too much.
Why is the FDA Funded in Part by the Companies It Regulates?
Why? Because citizens want an expert-staffed and functional regulatory body, but aren't willing to pay the tax necessary to fund it, at parity with private sector salaries.
The root of all government problems is "We trust you to make decisions that impact a large amount of monetary value, but also pay you less than the amount of money flowing through you, and also pay you less than private industry would be willing to."
Which... sets up an interesting dynamic.
There are a lot of selfless saints out there. But there are also a lot, not. And so internal processes and regulations pile on top, in an attempt to curb the worst of corruption.
Can we make the system better? Eh... maybe? But it's important to remember that a lot of features that look insane are actually reactive solutions to problems inherent in the system.
> Why? Because citizens want an expert-staffed and functional regulatory body, but aren't willing to pay the tax necessary to fund it, at parity with private sector salaries.
The FDA (and the CDC and others) and pharma sectors trade people all the time. There is a revolving door between the two. Medicine isn't the only place this happens. It happens in telecomm, military, manufacturing, and so on.
We have experts at all levels. Those same experts may or may not have patriotic tendencies. They are placed for their knowledge of their respective industries. They may also have a financial ax to grind.
Is there a conflict of interest? Only if the appointee was appointed by the other party. I argue that the apparent conflict of interest is only surface level. In the US we don't have "capitalism", we have "crony capitalism" that is verging on technocracy (rule of The Science and unelected bureaucrats).
> The root of all government problems is "We trust you to make decisions that impact a large amount of monetary value, but also pay you less than the amount of money flowing through you, and also pay you less than private industry would be willing to.
The kinds of people who make those decisions are paid very well, and if they make it out without media incident, they are nearly always guaranteed a job in the industry they used to regulate.
> Is there a conflict of interest? Only if the appointee was appointed by the other party. I argue that the apparent conflict of interest is only surface level. In the US we don't have "capitalism", we have "crony capitalism" that is verging on technocracy (rule of The Science and unelected bureaucrats).
There is no such thing as capitalism separate from democracy, with a government that performs many functions.
It's not crony capitalism or technocracy. It's just normal capitalism in a democracy. Same way it has been since the founding of the United States.
> The kinds of people who make those decisions are paid very well
That's a good salary. But it's not necessarily something I'd feel comfortable going to sleep with, knowing they had a finger on the scales of millions of dollars, if there weren't watchdog and mitigation measures in place.
> In the US we don't have "capitalism", we have "crony capitalism"
The real world system for which the term “capitalism” was coined, was, is, and always has been crony capitalism; the idea of a non-crony capitalism is a utopian fairy tale that was invented to justify real-world capitalism which has never resembled it.
The idea of "freedom" and inalienable rights are also utopian fairy tales. There's a reason the guys that wrote the Constitution called it "a more perfect union". We aren't perfect, by we may strive for that ideal.
> The idea of "freedom" and inalienable rights are also utopian fairy tales.
No, they are normative ideals, not fantastical models of how interactions do, or even could, work. Entirely different class of things, even if you disagree with them.
(It's true that people build utopian fairy tales out of them, such as the idea that a society observing certain complexes of multiple and conflicting rights without any tradeoff between them can exist. But the ideas of the rights themselves aren't the utopian fairy tales, they are just a value function.)
There are a wide range of options between startup bros and government. For example, in the US, a lot of electrical component standards and testing are managed by the UL, which is a nonprofit ngo.
Maybe something like "a UL for drug approval" might be worth a go.
The market for counterfeit and unregulated chargers and electronics on Amazon/Alibaba (most all of which are UL marked) and fires related to the above suggests that the UL doesn't really have any teeth.
It's possible that medical approvals would be less prone to this sidestepping of independent regulators, since much of the spending is proxied by insurance companies looking to maximize profits and minimize BS spending, but I have very little confidence that such a system would function.
> Besides, if it's counterfeit, then it's not actually UL marked, so I'm not sure what your argument is.
Consumers can't tell the difference between devices that are fraudulently or legitimately marked with the UL logo, and the UL doesn't appear to be able to do anything about the prevalence of fraudulent uses of the UL mark.
Getting regulation "just right" is a complicated process, people differ in their risk tolerance, and it isn't clear to me at all that "more powers to X" is always the right answer.
I don’t sense hostility outside the typical vocal minority. Having straddled the FDA-regulated world and the libertarian-leaning internet cultures through the aughts and teens, my experience is that the internet libertarians are simply ignorant of how the FDA actually serves us. Pretty typically libertarian—freedom as long as nothing gets more dangerous. Kind of like rebellious children.
The fda is responsible for keeping hearing aids at insane prices my entire life. They serve as the gatekeepers for a cartel of once manufacturers, now IP holders (pure rent seekers,) who have successfully used the US government to exploit one of the most overlooked and vulnerable classes of people. Almost everyone loses hearing when they're older.
When you live with hearing loss, it leads to social isolation and embarrassing situations, depression, and all the usual attendant disasters in people's lives.
The hearing cartel has used their wealth to create a pseudomedicine so as to brand their salespeople as doctors, and infested almost every state with bureacrats who determine policy and direct licensing and enforcement.
Hearing aids that are priced at $5000 or more are produced at scale for less than $5 per unit. It'd be trivial to turn most modern headphones into hearing aid equivalent technology, but there is a regulatory moat surrounding real time audio enhancement that will cause the fda to shut down any attempt to augment regular hearing, let alone allow the hearing impaired the ability to operate what amounts to a stereo equalizer.
The fda does engage in legitimate business, but that's insufficient to justify the costs paid by people who get screwed when the FDA is exploited for profit.
I currently pay for "hearing aids as a service" and lose $200 a month for the privilege of hearing. I pay what amounts to extortion money for my disability. Because my loss is classified profound, none of the Obama era loosening of hearing aid restrictions help. It's lip service that acknowledges the problem but leaves 95% of it unsolved.
Libertarian shmibertarian, I think I'm entitled to not get specially fucked because my ears don't work. I think it's sick that I feel grateful that I can afford hearing as a service when it should be something covered by insurance, or something I can buy for the same cost as premium earbuds.
Government shouldn't be involved in hearing aids, except in the consumer protection arena. The fda has no business enabling the exploitation of disabled and vulnerable people, but hearing aids are just one area they happily strong-arm the public on behalf of cartels and industry lobbies.
I'm so sorry you're having such a hard time hearing and dealing with all this BS. Sending a firm but warm internet handshake your way. I don't have an answer to your issues and am here to listen if you need someone to vent to.
This One example is not just due to the FDA, but the larger medical system. Yes they shouldn't cost that much and it is a cartel that overcharges, but also yes medical devices need regulation to prevent hucksters from exploiting people.
The FDA doesn't set prices. The cartels provide a product that works, which as far as the FDA is concerned, is all they care about. The FDA does not set prices.
As of 2017 there is already laws being changed to help lower prices and provide OTC hearing aids.
>Government shouldn't be involved in hearing aids, except in the consumer protection arena.
That is what they are involved with...
You seem to have demonized the FDA over one issue they don't really control and are now throwing the baby out with the bath water.
> Pretty typically libertarian—freedom as long as nothing gets more dangerous. Kind of like rebellious children.
Or, as this guy[1] put it, like house cats. “convinced of their fierce independence while utterly dependent on a system they don’t appreciate or understand.”
As a former Libertarian who luckily grew out of that phase, I love this analogy.
It's easy to be Randian when you're young, don't have dependents, and are in good health.
One of the things I always liked about HN (even years ago HN) is that it seemed to feature a diversity of age ranges. Which brings some nice perspective.
On the other hand, countless lives would have been saved had we started using the Covid vaccine before the FDA got around to authorizing it. Those VC-funded startup bros at Moderna really could have moved a lot faster without the government’s interference.
Incredible, thank you for the live example of this mindset.
This is the epitome of survivorship bias. The Moderna vaccine could have just as well made a lot of people very very sick. There are countless examples of problematic medicines and vaccines which didn't get the scrutiny the COVID vaccines got (and continue to get) simply because not enough people were relevant for the studies and statistics are subsequently weaker.
We should all appreciate it went through the regulatory process (accelerated) to confirm it does not before injecting millions of people with it.
Too often it seems it's blood of the lobbyist who slipped and fell on ice while carrying a suitcase full of benjamins.
Your quip is an easy one to make but there is very clearly no shortage of entities who peddle goods and services seeking, often successfully, to influence lawmaker so those goods and services are legally required despite the benefit to society being marginal if even measurable.
You can look up any and all regulations online. Then you can read the transcripts of public comments regarding the regulations. You can find relevant court cases online. What else do you need?
Nobody does that now, for the most part, why would they do it if there were a hyperlink attached to the regulations themselves? Who actually reads the text of regulations in the general population? I have zero data, but I'm willing to bet it's virtually no one. Specialists with a vested interest sure do, and they will probably already know relevant cases or thought processes.
Edit: This was written in a very US-centric way, because it is in response to something originally about the FDA.
Finding of all that information requires a lot of time and dedication. In my country (Ukraine), a lot of information about law development process is available online. For example: http://w1.c1.rada.gov.ua/pls/zweb2/webproc4_2?id=&pf3516=509... . It contains notes with explanation about why law need to be changed, but it hard to follow. Some information is available online, some in docx files, some in a random database, some on a video, some is not available at all.
The process is not fully transparent. It means that it's easy to create two laws, which are contradicting each other, or modify laws against their original purpose, etc., because it's hard to see consequences when the law is not transparent. For example, our ex-president Yanukovich just replaced Constitution on president site with an older version. Yes, it's online, but it took 2 years(!) until people noticed that and start to revolt.
In software development, we have test cases, which must be passed. In law development, we have nothing like that.
In my county, we read laws fairly often, because they are easy to get, but most of the time people prefer to read «commentary» — a book about law with comments and cases.
If there was indeed a way to pull back the scope and power granted to the government I think a lot of us Americans would love to hear about it. The way it is, it seems like the US government is an unstoppable machine that will grow until it destroys itself.
I don’t think the American governments biggest problem is it’s scope and power: I think it’s biggest problem is inefficiency due to corruption (regulatory capture, etc). It seems to me that the biggest obstacle to fixing this is that many Americans see this as an inevitable character of government rather than something specific to their system, and thus spend their time trying to reduce government (ironically making it even less effective by hobbling it with silly restrictions) rather than fixing it into a well functioning system.
The two are interrelated — regulatory capture doesn’t make sense if there’s no power to capture. So one must first grow the size and power of government through other means, then capture/influence that power. This cycle has been going on for a long time.
One of the amendments is supposed to shield you from tyranny. But, going down a less risky path, I'd vote (no pun) for migration. My parents migrated away from a country that trades in humans to this day, in full view of the gov, and i can't be thankful enough.
>> to regulate diagnostic tests as medical devices.
Like MIR machines? Like blood labs? Like home pregnancy tests? Without the FDA's regulation of medicine we would quickly be back to snake oil and cocaine in everything. It is bad enough that drugs stores are allowed to sell water as a "homeopathic remedy". The snake oil people are out there waiting for deregulation.
That's actually why we're against it. Once they have the power it's basically impossible to recall it. There were many lines in the sand in the past and they keep being crossed.
Private companies also rely on the state for liability reasons as we just now saw with the vaccines. I believe overall this is a good idea to have high expectations for medical procedures as it does not inhibit progress.
Would have been interesting to hear what the feeling was like 2 weeks later (ie lethargic? walking alright? breathing well?) TFA only says he's alive "with his new heart beating soundly", which could mean a lot of things.
My dad took weeks(like more than 2 months) to back to being some what confidently ok'ish with things after his coronary artery bypass graft. He needed physiotherapy. His knees were weak and he needed a knee replacement only an year later. But in the after math of bypass surgery I had to hold his hand and make him walk, even feed and took him to rest room personally, I would even bathe him.
It took like ages to let him confidently use the toilet on his own. And I'd always keep the toilet door open 'Just in case'.
The Knee replacement a year later was obviously more brutal given the bypass was only an year back and we were peak in COVID times. He was infected, and I had sleep on the road as I caught it too(couldn't go home out of fear of infecting the family). Pretty much saw hell in bare form during that(weeks in anxiety, walking in COVID wards and suffering every single minute), and of course that recovery took months, as the drugs they gave him caused a huge spillover of issues.
It might just be that as a I child I felt more for my father.
But let me tell you major surgeries like bypass grafts, or knee replacements are nightmarish experiences, even more more so in the COVID times today.
I think two weeks after heart surgery is never fun... A few days ago I noted that recovering from having your sternum broken open takes 6-8 weeks to be able to resume daily basic activities under the best circumstances.
> A few days ago I noted that recovering from having your sternum broken open takes 6-8
Can also confirm. I received CPR which cracked some ribs. I had to sleep in a chair for the first 5 weeks because lying down flat and getting back up again was so painful. Sneezing and coughing were excruciating until I found the trick of 'hugging' oneself just before to reduce chest movement.
I was amazed at how soon I could pick up my baby after her 4 heart surgeries. Obviously, it was a bum scoop as opposed to picking her up under the arms (never had that luxury), and she was medicated, but literally 3-5 days after surgeries, we're back to having skin-skin. Maybe it's because their bones aren't as strong as an adults and there's more flex, but still, really took me by surprise. Even hours after surgeries, her diaper/nappy needed to be changed, so the nurses/I/we would carefully do it, but it was really eye-opening considering she just had major open heart surgery.
If you want to explore the concept further, I suggest you watch the movie "Never Let Me Go" (2010). The premise is very similar, apart from the fact there's no secret or conspiracy about it, children are just grown to become sacrificial organ donors, and since it's socially accepted, there's no way out of it.
Speaking from a country with ongoing human organ harvesting, this is absolutely amazing, everyone involved in this deserves an enormous amount of praise.
Donors are usually 35-50 at time of donation, so way more than 10 years away from average life expectancy. The donated organs fail for other reasons.
There are many examples of donated organs living past 100 (years since donor's birth) even though the number of humans who live that long is quite rare.
Even if it is psychological, it's a valid question how people will respond. Really there are a lot of ways people might think about it. I imagine it might change some recipients views on pork. And I wouldn't be surprised if some reported a connection to the pig from which it came similar to human transplants. Whether it's objectively real or not
A podcast called Straight Talk MD talks about several different weird transplants like this in this episode: https://pca.st/episode/1628074d-b415-477b-b1f6-81c9d81fc261 (For Fame or Money? The Dark Side of Ten Amazing Medical Firsts on Straight Talk MD)
Of note is the disastrous synthetic heart in the 90’s. I was surprised that such a thing was attempted.
Is this compassionate use or experimentation on a dying patient for the future benefit of the rest of us? I’m fine with the latter, if consensual. But only if we call it what it is.
First generation transplants are always both. David would have died soon without this (he's quite likely to die soon with it too, unfortunately, if this goes anything like other first of a kind transplant receivers). Desperate people accept desperate measures, and the hope that it may teach us how to save others helps too.
It's a way to potentially prolong a terminally ill patients life with an experimental technique, potentially advancing medical science in doing so. I fail to see why this should be cast in a negative light.
That is what a clinical trial is. There is now other way. Although with organs-on-a-chip we are working on at least getting the animal testing stages confined to a minimum. Over time we may reduce the risk to first recipients of new tech using these new technologies. Perhaps even digital models may at somepoint start playing a role. But until we have digital models, this is what we have. And it does seem to work well in this case.
Yes. No matter what the treatment might be, someone always has to be the first human it's tried on.
Even if we did have good digital simulations, someone would still have to be the first human to get it "for real". That's just the nature of things. Someone has to be the first patient of a new heart surgeon. Someone has to be the first person to hire a newly-minted PE to design a bridge that might fail and kill thousands. And so on.
We mitigate these risks to the best of our ability by ensuring rigorous training of doctors and PEs, and stuff like animal testing and computer simulations, but someone still has to be first.
It sounds like this patient was well aware of the risks, and opted to get the procedure since otherwise his death would be a certainty.
It is quite clear since the first article on this topic that the recipient is very aware of the potential and risks. If I may say, he sounds like he geeks out about it. He had previously received a pig heart valve which kept him alive a long time. This probably affects his perceptions positively too.
From everything I read it was consensual. But that raises a larger moral question. Is it really consent if you're about to die? I think that almost anyone given the choice to either die or get a pig heart will choose the latter, there's a good chance you will die if you get the transplant but there is a 100% chance that you will die if you don't.
I don't think that is necessarily true - people reject potentially lifesaving treatments all the time for many different reasons. Yes, the desire to live is very strong in us, but it's not infinite.
Since it's consent to do the best option available and he wasn't put into the position of needing the help by the ones offering it I don't think it's much of a moral issue. Usually the moral problems come when less than ideal alternatives are proposed or people are forced into a situation where they otherwise wouldn't have had to choose. I.e. conflict of interest stuff from the ones proposing to get consent to try to help.
The guy would have died pretty soon without the procedure. If the choice is between dying for sure in a few weeks, or maybe dying in a few weeks but maybe not dying for another few years.... I'll take the 2nd option.
I just want to say huge respect for Dr Mohammad who despite his faith decided to do what is right. It might not be well known but most muslims are raised with strong beliefs, even in educated countries (eg 85% in Pakistan support sharia).
The recipient is a non-Muslim, so no Sharia-related problems in his case.
AFAIK it is not forbidden for a Muslim to touch pigs, only to eat them. Pigs and dogs are impure, but you can perform ablution afterwards. Muslims normally own hunting and guarding dogs. That would actually be a common problem for Coalition soldiers in Iraq when they tried to enter a village by stealth - lots of barking.
"This impureness nevertheless doesn't imply that one might not touch a pork, but that one might need to wash his hands and maybe even re-do the ablution to be able to pray after touching it."
Pigs are no more impure than dogs, fwiw. That belief is merely a result of having been raised in a culture that arbitrarily chooses to love dogs and cats and hate most other animals.
Dogs can be infested with parasites just as easily as pigs.
This rule was written in an age when rabies was a big problem. It has a lot of sense to avoid scavenger dogs and pigs in those places in the past. Now we have developed a solution to this problem but, as is included as part of a religion is a fossil rule that can't be changed. We have still many of this rules around.
Science welcomes change when we find a better way to do something. Is assumed that humans can be wrong and learn. Religion will fiercely oppose change because god can't be wrong by definition (and nobody has the authority to fix it). Ideology will oppose also changes that see as a menace, but can be more flexible.
In Judaism at least, and I'd assume the same translates to Islam, "impurity" is understood to mean "ritually impure". It doesn't necessarily mean there's a specific scientific reason to avoid the meat, just that God asked them not to partake.
Yeah, ritual impurity is forgotten in modern West and hard to describe to a modern non-religious person.
It is not the same as "being unhygienic", though it overlaps to some degree. (Faeces etc.)
An interesting example from Judaism is "Tzaraath", which means skin disease, but it could also afflict houses. Today we do not know for sure what it even meant. Mold infestation? Maybe.
“Dogs are pets” is one of those cultural background assumptions that can be pretty jarring when you realize it’s not a universally held belief. There are pretty large chunks of the planet where dogs are mostly unwanted pests at best.
It’s not a religious thing, it’s a geographic thing. Wild dogs are a serious problem in some areas, and whether or not dogs are viewed as common pets varies wildly. To pick one example, a mere 16 million homes in India have a dog, and that is up a lot over the past decade. Compare that to the 63 million homes with dogs in the US, a much smaller country by population.
I don't know how many Muslims you're friends with but I wouldn't assume without some indication that this was difficult for him. There is a huge variety of beliefs in a population of over a billion adherents. Most of the ones I know have no issue with, for example, picking up a pack of bacon from the store as long as they're not the one expected to eat it.
Abortion is largely accepted by Catholic scholars if there is, otherwise, a high risk of death. That doesn't mean all Catholic medical practitioners would carry out such an operation. I don't think the respect is misplaced.
That is absolutely false and made clear in the Catechism (though abortion is, fundamentally, not a matter of faith, but of ethics, contrary to popular misconception). Abortion understood as the intentional killing of the unborn child, even in the case of high risk of death, is always gravely morally illicit and falls under murder. Even in the given circumstance, it would violate the principle of double effect.
Now, what is morally licit is not abortion, but also by virtue of the principle of double effect, a procedure intended to save the mother's life that unintentionally and as a side effect results in the child's death. For example, it is morally licit to extract the affected tissue with the implanted embryo during an ectopic pregnancy. This extraction will result in the death of the child, but the death was neither intended nor was the death of the child the means by which the mother's life was saved nor is saving the life of the mother a lesser good than the life of the child (though in this case, both would very likely have perished if this condition had been allowed to continue). Note that the situation must be proportionally grave, meaning you could not licitly perform such a procedure if the risk to the mother was not proportional (like experiencing headaches because of the pregnancy). In those cases, proportional care is permissible.
> That is absolutely false and made clear in the Catechism (though abortion is, fundamentally, not a matter of faith, but of ethics, contrary to popular misconception).
A bit nit-picky, but while all authoritative documents (like the catechism) unequivocally condemns abortion, there is no shortage of Catholic scholars who are pro-abortion. Just like the Pontifical Commission on Birth Control. The scholars gave it the green light, but not even having “Pontifical” in the name made it remotely authoritative.
Can anybody offer some insight into what people mean by that? I know that in the 19th century, sharia was basically just a legal tradition, that drew on Islam (just as western legal traditions draw on Christianity, or eastern ones Confucianism). Is it more extreme these days?
No. Sharia means different things to different people. Think of someone who calls themselves a "practicing Catholic", and then think of what that might mean to a non-Catholic hearing that. Do they eat meat on Fridays? Do they attend church every day? Do they protest health clinics? There are practicing Catholics who do all of these things and none of them.
Unfortunately, the word has been seized on in western culture to refer to the legal beliefs of militant Islamism. But that's not at all what it means to most Muslims.
There's a sugar that most animals produce but humans don't[0]. These pigs have been genetically modified to not produce that sugar, the thought being that that's what's responsible for the xenotransplantation rejections[1].
It is also becoming more common in drug research. It is fairly common to adapt animal genomes to be closer to that of humans so that the drugs will work in similar ways.
For a layman like me on medical matters, it seems very strange that a pig's heart is used. Would it more logical idea to use a primate, our closest "cousin"?
"While it is true that pigs are less compatible with humans than monkeys, they can be genetically manipulated to produce organs less likely to be rejected on transplantation. Pigs quickly grow to full size, produce larger litters and can be more easily reared by biotechnology companies."
Pigs have a lot of physiological similarity to us (thus why fetal pig dissections are often done in high school/undergrad biology). Plus there are fewer ethical concerns around using an animal we already use for food.
I imagine there's also a consideration for ease of raising. These pigs had to be kept separate from others and tested frequently for disease because of having some aspects of their immune system weakened to reduce rejection risk. This would probably be easier to do ethically for pigs compared to primates.
Pigs are not too far off when it comes to the overall body. I believe the idea to use a pig's heart is one off availability (and maybe ethics). A ton of pigs are slaughtered each and every day, we already use several parts of a pig's body (which is a good thing, waste as little as possible). If we can successfully use it's heart for transplantation, even better. This means there is a good supply of hearts to be used.
A good test. The guy is older and wanted to remain alive, despite the wishes of his family. And pigs are so close to humans anyway -- which is why I have the theory of why humans love bacon so much.
Best wishes to Mr. Bennett, and hope that whatever happens, it will be a good leap for humanity.
> And pigs are so close to humans anyway -- which is why I have the theory of why humans love bacon so much.
Are you claiming (most/many) humans are closet cannibals? I don’t agree with that.
Also, pigs aren’t particularly close to humans, genetically. In biological classification they even are in a different order (even-hoofed ungulates) than humans, who are primates.
I've said this before here and got downvoted for it, but bioethicists as a profession are responsible for more death than pretty much anything else I can quickly think of.
People are dying from heart disease all the time, very often in predictable conditions. Literally millions every year. Statistically this means we should hear about such failed procedures many many more times than we do now - there is literally no downside from doing this much more often, and a strict upside: a chance to live longer and a definite advance in medicine leading to other lives saved. Sure, it may mean more stress for a dying patient, but quite a few would prefer their death have some meaning. But they can't chose this because it's not "ethical".
Moderna had the mRNA vaccine for Covid ready in about 3 weeks. This means the tech was already there - I'd really like to see an argument where we had three major companies create mRNA vaccines, only one failed (harmlessly!) but we shouldn't have used this technology a few years early. mRNA tech is incredibly versatile - it should have applications from curing cold to curing cancer. But no, we needed a pandemic and 10 months of testing to start using it, because it wasn't "ethical".
We knew from month 1 that the young and healthy are not hit hard by Covid. Mortality in those groups was always comparable to flu, more or less. But we didn't do challenge trials. We wasted ... I have to take a break from typing, tbh, I'm overwhelmed. We wasted almost a year while literal millions died while wondering if Covid is transmitted by touch, aerosols or airborne when we could have fixed this in two weeks with a bunch of 25 year olds. We spent half a year before even realizing masks help, and we still don't know for sure how much and what's the difference between each kind. We had Omicron - we knew it was different, we had good reason to think it's not significantly worse from the start, but we still had a _lot_ of questions. But two years from the start of the pandemic we STILL didn't put a bunch of healthy volunteers through a completely harmless study to find out things early. Because it wouldn't have been "ethical".
This isn't ethics we're talking about. It's pure and unadulterated cowardice. We as a society shy away from doing things which we _know_ would save more lives in the aggregate because we'd have to risk causing much less harm, but harm which we'd be directly responsible for. Joe from the street would be excused from making these decisions, but when you deal with the people directly charged by the society from making these decision, it's just failure to do their job. And in a supermajority of case we're dealing with volunteers anyways.
100% agree. I think the unsolved meta problem here is large-scale game theoretic stalemates where we all lose in grand ways, and yet nobody can bust out of their local incentives.
To do so successfully would require thousands of unacquainted people to coordinate changes (against their backdrop of incentives) simultaneously.
Governments are made for this but after a certain size and complexity, their people get stuck in the same frontier of stuck incentives.
They (CureVac) failed because they started trials too late, and by then the Delta variant was going around and caused the numbers to not look as good as Pfizer and Moderna's.
v
If you look back, it's a real shame, because Pfizer's and Moderna's Delta numbers are no better than CureVac's.
[Also, speaking completely anecdotally, but I'm in that clinical trial and thus a recipient of 2 CureVac shots and 2 Moderna shots. I have yet to catch Covid despite taking nearly zero precautions and a lot of high risk contacts. And yes, I get tested constantly. There might be something more interesting yet to discover about this.]
Ethical protocols are useful to have to prevent genuinely bad stuff from happening but they are indeed over used to instead limit legal and political liability; which is not the type of "bad stuff" most people would care about but which is something that gets expensive quickly if you are a multi billion dollar corporation in the business of converting government funding into profit (aka. a Pharmaceutical company). The only bad outcome they really care about is of a financial nature.
When ethics devolves into morals and religion, it gets worse because in that case the "bad stuff" is somebody feeling offended/insulted and when that conflicts with potentially life saving new treatments; that in itself might be considered a bad thing (unethical?). Ethics has this way of contradicting itself.
When you weigh two bad outcomes, the rational thing to do (the least bad thing) might not be the ethical thing to do but some people (me) would still consider that the right thing to do. When letting people die that want to live (an important caveat) is more ethical than doing something to prevent that, something is very wrong. Also letting them die when they actually want to is considered unethical by some.
When people don't feel they are equals in society, the whole "for the benefit of all" sounds pretty cynical.
Also, some governments have a poor record for taking responsibility (e.g. looking after veterans), or making others take responsibility (DuPont), so the people who do come off worse don't necessarily expect to be taken care of.
I respectfully disagree. It is patient's right to refuse any medical procedure.
A mere suspicion, impression that doctors are not treating life and health of this particular patient with all sainctity will do a lot more harm than good.
I mean, life is precious, doctors should know this best and act like it is. Recklessness even in words will do a lot of harm. A lot of credit will be lost if standards slip even a little bit.
I know this very well because people around me are not vaccinated yet because they are suspicious of Sputnik-V. Yes, this is reality where I live. People are suspicious and refusing a life-saving procedure.
The patients who don't get the experimental treatment didn't refuse the experimental treatment -- they were never offered it at all which is the problem.
The ethics and regulatory red tape kills any hope for such a treatment before patient consent is even a question.
This is risking another rant, but I'll hold. Keeping things short - authorities lied their asses off for the whole pandemic, and this is what (legitimately) destroyed trust. People are a lot less stupid than usually given credit for - sure, they can't always do the research themselves, but they do know to look around and orient them in complex situations. And it got pretty obvious pretty soon that the official message was not about the truth, but about getting the "correct" response. Which turned out to be a lot less precise and correct in practice. So yeah, now you get people mistrusting vaccines because you can't get them to trust anything.
>Moderna had the mRNA vaccine for Covid ready in about 3 weeks. This means the tech was already there
Not quite. While this line of research has been occurring for some time, it wasn't quite at that point yet. It wasn't developed and not being used because testing them would be considered unethical. It was developing technology, and Covid came at an opportune time in that things were close enough for researchers to rush things along.
>But no, we needed a pandemic and 10 months of testing to start using it, because it wasn't "ethical".
Yes, we did need testing before we started using it. It could make everyone sick for all we know. Or perhaps only a select few populations. Testing also allows guidance to be developed on what expect, and what doctors need to look out for. If it were to cause bleeding in people with a certain blood type, for example, then just giving it out would result in huge numbers of people rushing to already overworked ER rooms. Which could just worsen the health crisis we were trying to avoid. There are many good reasons to test treatments even when time is limited
>We as a society shy away from doing things which we _know_ would save more lives in the aggregate because we'd have to risk causing much less harm, but harm which we'd be directly responsible for.
Y
I'll take this logic further and say why not do some DNA alteration experiments on babies? We may have to destroy the specimens after, but so what? A finite number of lives can lead to saving countless lives in the future. Think of the things we could learn about rare diseases, removing harmful genes, improving human health, etc. The millions, even billions of lives we could save and enrich. It's immoral NOT to do that, when the rewards are so great.
That's the line of thinking that doctors try to avoid, hence "do no harm". It doesn't matter how common sense it seems, some lines you just don't cross. Because if people do cross those lines, eventually some might use it to justify doing immoral things. There's certainly a lot of rigorous debate about medical ethics, but these decisions are the results of groups of doctors and ethicicts. I'm of the belief that the alternatives have indeed been considered in most cases and the best choice has been made.
I follow your arguments, but I just find them incredibly weak.
We're not talking about slippery slope here and "may have beens", we're talking about already having a soft form of worst case scenario, and _still_ not bringing out the big guns. Not doing challenge trials for Covid is just stupid, no matter how you try to push it.
"DNA alteration experiments on babies" - we do that, actually, and I'm seriously considering waiting on having a family until they become mainstream. It's a pretty cool tech, they had the first designer baby out last year. Just putting the scariest form you can think of in writing isn't an argument in itself, you know. You also have to say why it's a bad idea. Otherwise, no offense and please don't take it personally, but it's purely equivalent of somebody saying 200 years ago: "what's the next step, feeding MOLD to BABIES?". Turns out yes, feeding mold to babies is exactly what we're supposed to do. It's just progress - it looks weird until it's in the kitchen cabinet.
The mRNA vaccine not being ready - it's just incredibly improbable that you had three major corporations being able to "rush things along" and finish exactly at the same time. It's 10x to 100x more probable that they were already finished and stuck at some regulatory step.
And a final thought - please don't interpret my comments to say testing and regulation in general is bad. FDA is bad, and probably should be destroyed outright and something else, something much leaner, built instead. But some regulation and a lot of testing are of course necessary. It's just that currently 1. they've gone waaaay beyond what's needed and into pure bureaucracy and 2. the system is such that it ignores major slices of reality and focuses only on what's in front of their eyes, i.e. they don't do challenge trials because it's not ethical for the volunteers, but if they lead to 1% less death overall this means tens to hundreds of thousands saved - which they ignore.
I'm a full on speciesist. let's do more of this. since we're already eating them I feel like this even a more reasonable usage of their lives. can we do kidneys next please? we can basically shut down most dialysis clinics after that.
They did so a pig to human kidney transplant recently however it was on a brain dead man as an initial test. Probably soon it be on a living patient. As a person on a kidney transplant waitlist, it given me some hope for the future.
The next logical step is to breed pigs with organs that especially suit humans, maybe with some genetic engineering to optimise them. I really can't see anyone needing an organ complaining that they're GMO.
As long as we treat animals well while they're alive (and why wouldn't you, you want high quality low stress organs) then there's really no limit here, morally.
That's what they've done here, this are GMO pigs designed to be more compatible with human biology.
> The heart transplanted into Mr. Bennett came from a genetically altered pig provided by Revivicor, a regenerative medicine company based in Blacksburg, Va.
> The pig had 10 genetic modifications. Four genes were knocked out, or inactivated, including one that encodes a molecule that causes an aggressive human rejection response.
> A growth gene was also inactivated to prevent the pig’s heart from continuing to grow after it was implanted, said Dr. Mohiuddin,who, with Dr. Griffith, did much of the research leading up to the transplant.
> In addition, six human genes were inserted into the genome of the donor pig — modifications designed to make the porcine organs more tolerable to the human immune system.
Depends on whether he's going to use his heart to create more GMO pigs.
I mean if you buy a book that's it. You don't get a license to redistribute, but you get an unlimited license to read and use the book for whatever. That's how copyright law works.
And then the next step is to do research showing that pigs that are happy, stress free, and eat a good diet produce organs that are better for transplant. If so, this might be one of the most ethical animal industries.
Oh we can, there was this guy in Germany that failed art school, he had a couple mates, they figured that with good genes, training and education they could...
You see where this is going, right? Oh, what you describe actually might fit the book Brave New World as well.
Anyway yeah I know what you mean, this is why things like education, well-paying low-stress jobs, housing, health care, access to food are so important. They encourage an overall healthy and happy population without imposing on them.
But the US is a bit of a shithole in that regard; low paying jobs, food deserts, financial worries, crippling debts to pay for a lifestyle that people can't afford but need, etc. The country and its policies are self-destructive, and, dare I say it, a kind of economic eugenics - if you're too poor to afford health care you'll be removed from the gene pool.
Yes, a slippery-slope argument that all gene manipulation leads to eugenics.
Here's the counterpoint: The Nazis (and eugenicists / race-scientists in general) used the authority of science, but didn't actually do good science (and slipped in a lot of stuff that was pure ideology); so actual science is automatically different.
Ah, but the human is more economically productive than the pig, particularly when taken as a cohort, and healthcare and happiness are expensive - and there is therefore a point of diminishing returns for increased happiness and health.
It makes more sense to allow a certain portion of your population to die of preventable causes than to make them all happy, as the current net goal is economic productivity, not human happiness. This is demonstrated aptly by the lack of socialised healthcare in much of the world, and where it does exist, the relative paucity of resources provided.
So, while I agree in spirit with what you posit, capitalism and the value axis it brings has to die first.
If we're genetically modifying the pigs to be more like humans, I wonder if there would be health risks with eating the meat - specifically from prions. Similar to those that come from eating humans. Admittedly probably negligible until we modify them a heck of a lot more than we are right now (if they do theoretically exist).
Prions don't appear from thin air - and you can already get deadly prions eating meat, the reason why you don't is the same why you don't get all kinds of deadly diseases from meat - it's (usually) well regulated and any outbreaks are immediately culled. A pig genetically modified to be "more like a human" wouldn't spontaniously get deadly prions.
Apparently they have recently granted permission for these (type of) pigs to be sold for meat so those who suffer with alpha-gal syndrome (and are thus allergic to regular meat) can eat it. So I’m guessing by not.
I think the ones approved for consumption don't have the full set of genetic modifications used for this transplant, they just have the alpha-gal change.
Pigs are already similar enough to humans that there are major risks from parasites; I don't think the small modifications we've seen so far would significantly increase prion risk.
The pig kidney and heart recently transplanted have already been genetically engineered. So far it's only to avoid rejection, but other modifications are likely on the roadmap.
In TFA that's actually what they describe - the pig was genetically engineered to reduce rejection and to control the growth of the heart to stay human-sized.
> As long as we treat animals well while they're alive (and why wouldn't you, you want high quality low stress organs) then there's really no limit here, morally.
We have a really, really, horrible history of treating animals. It's obvious we wouldn't treat them well.
As long as we treat humans well while they're alive (and why wouldn't you, you want high quality low stress organs) then there's really no limit here, morally.
Pigs reach slaughter weight at about 6 months[0] and the lifetime of a domestic pig is 15 to 20 years. Their breeding age is 8+ months. So we kill them before they reach the prime of their life most of the time. Killing them at their prime might be less of a moral issue than what we do currently.
That is an interesting comparison to other reasons why we kill animals, however, the point wasn’t a relative moral comparison to animal slaughter for food purposes but that it’s not zero cost morality wise to kill an animal in its prime.
It's not zero cost morality wise to kill anything at any point in their lifetime; from bacteria, to worms, to flies, to pigs each has its own weight on a person's conscience be it nil or hefty. I mean that. But a pig is not human so it's acceptable to me.
Yes, but if I were a cat I wouldn't lick my own anus and yet cats happily do that - my opinion on what I would or wouldn't like as a cat is not really relevant.
My point is - we are not cats, and cats aren't humans. They deserve good treatment, respect and all the love they can get - but at the end of the day they are not humans and should not be treated as such.
Friction and liquids? Seems pretty much like the wet wipe used to clean my countertop - only a different friction material, and a different liquid solvent.
Your earlier comment mentioned morality without qualifiers; here you refer to your own morality; this seems more accurate. Note that there are people who refuse to eat or otherwise harm animals and they cite moral reasons too.
I understand your view and agree with what you’ve said, however, the primary point was that there are moral implications if you intervene in another life so it is not a moral freebie.
I'm vegetarian and have no issue with using animals for medical purposes like this. It's one thing to kill for pleasure as in fur, cosmetics and food, but quite another to kill an animal to save a human life. I am pretty sure even most vegans would be happy to accept an animal death to save their own life, even a pet.
Similarly, I guess, I was vegan but I had to stop that diet as it caused severe health problems for me.
Nothing in an animal for slaughter goes to waste, they're too expensive for that.
I mean the value of various parts like organ meat varies by what it's used for, but eventually everything is used up. A lot of offal ends up in animal feed, for example. And their hooves end up in keratine supplements for the gymbros.
These are genetically altered pigs with human genes inserted, though. I can see some people being uneasy about consuming them, either from moral or pragmatic (possible pathogenicity) point of view.
Perhaps I'm somewhat of an atypical veg, but I am okay with that - although I personally wouldn't as I no longer like meat.
I also would not ban meat consumption if I was a dictator, but I would enforce extremely high ethical standards, carbon neutrality and proper management of agricultural effluent. I suspect that would make a pork chop pretty expensive too.
The adage "use the whole buffalo" has never really died out in terms of meat processing. There's a lot of good product in an animal and you can find buyers for all of it. There's the obvious stuff like hotdogs, sure, but even stuff like the blood is also important. Fetal bovine serum, a supplement for cell culture media, for example comes from the slaughterhouse and is extremely important for biomedical research.
>“The key principle in medicine is to treat anyone who is sick, regardless of who they are,” said Arthur Caplan, a bioethics professor at New York University. “We are not in the business of sorting sinners from saints. Crime is a legal matter.”
This is so simple and newspapers trying to make it into a matter for debate is actually compromising that.
> This is so simple and newspapers trying to make it into a matter for debate is actually compromising that.
Even if one were to consider moral character when allocating organs in general: the researchers needed someone who was sick and likely to die, ineligible for human organ transplant (here, because of severity of condition), and not so sick that there was no chance of success or useful data.
So, we're already picking someone who doesn't meet the normal rules.
And, of course, considering moral character when allocating organs probably isn't a great idea.
Yeah, the Post complaint (echoed elsewhere) is basically a call for having a social credit score that can say “you’re not a good person, so we’re not going to let the doctors save you.”
That's a common rationalization for the moral judgment, but without evidence. "Recent studies have shown similar survival rates among individuals who undergo LT [liver transplant] for ALD [alcoholic liver disease] and those who undergo LT for other chronic causes of end-stage liver disease." [1]
That is not a universal statement[0]. They may get lower priority in many cases, but MELD[1] or a similar model is used to determine who gets priority for liver transplant.
I’m all for providing telemedicine to those who choose not to be vaccinated against COVID (compared to those who medically can it be vaccinated). But letting them into health care facilities? Nah, get your shots and come back.
'Actively' seems to be accurate for the scenario when one is choosing to make body conducive to incubate virus, or already incubating them (albeit unknowingly if asymptomatic).
[Edit] And if you meant active in context of 'Active shooter', then still use of the word active is not wrong. Virus laden body is like carrying a concealed gun which is on 'auto pilot', it is actively spraying bullets; it IS active all the while.
I can't think of a single person I know that hasn't ducked down to the shops to pick something up when they have the flu. By your definition, they are actively attempting to cause harm to others - which is an interesting take.
Even before covid, I would always wear a mask if I had a flu and would try as much as possible not to go to shops or pick up anything. A lot of people I know do the same.
I'm vaccinated myself and basically I have the same opinion as you. But David Bennett also actively chose to stab someone seven times in 1988 - "only" leaving him paralyzed, but probably with the intent to kill him? Ok, he probably served time for that and it was a long time ago, so judicially you can consider him rehabilitated. My argument was that once you refuse to treat (former) criminals, that's a slippery slope. And apparently I was right, since some here seem to consider people who choose not to get vaccinated worse that violent criminals...
Worse? No. The unvaccinated are far more likely to get sick or die as a part of any medical procedure right now just because of the base risk of COVID in hospitals. If you can’t take the first step to protect yourself and others, there’s not much health care providers can do to change your mind.
That's different because there's no moral judgement in that position. If you refuse treatment for a condition, even a preventative one, then there's no moral imperative to offer a different treatment later. Doctors did their best to save you, but you didn't do your part. That's on you.
You won't be denied tramua treatment for a gunshot because your doc told you to stop playing with guns.
You won't be refused heart medicine because you didn't stop eating bacon when your doctor told you to 5 years earlier.
You won't be denied ER treatment because you were drunk when you crashed your car.
There is no rule where we have to treat all patients equally (including mass murderers) except those who didn't accept n earlier-offered treatment or who did something that caused their own medical condition (i.e which probably includes most medical conditions).
Medical care is not an exploding offer.
Honestly - shame on you for trying to sneak in an absurd exception just so you can abuse the medical system to hurt people you don't like. That's not what hospitals are for.
I think if we really ran out of health care capacity, it might make sense to prioritize people who took preventative measures over those who didn't.
Especially with COVID: if you're at the point of triage and rationing resources, you need to consider likely outcomes, and people with the vaccine presenting at hospital are more likely to survive than those presenting without.
It seems like we're not going to bump into those limits, though, so it's moot.
It seems like we're not going to bump into those limits, though, so it's moot.
Only because people who got the vaccine are significantly less likely to require hospitalization though. At the start of the pandemic there was a very real possibility that we'd actually run out of ICU beds and ventilators. Much of the 'flatten the curve' effort was to protect healthcare services.
> people with the vaccine presenting at hospital are more likely to survive than those presenting without
In my opinion, that logic is flawed.
The currently available COVID-19 vaccines vastly reduce the likelihood of developing severe symptoms from a SARS‑CoV‑2 infection. They also somewhat reduce the risk of getting infected in the first place.
So, getting vaccinated against COVID-19 makes you far less likely to need to be hospitalized, should you contract the virus, which apart from of course being beneficial to yourself also helps with keeping the healthcare system from being overwhelmed.
However, if you've already been hospitalized, it is because you've developed severe symptoms, which in turn means that, in that situation, for you, the vaccine has failed.
At that point, all other factors being equal, your likely outcome is no different from that of a person who hasn't been vaccinated. Therefore, using vaccination as a criterion for triage (which - like you said - is all about rationing resources, not passing judgement) doesn't make sense.
Now, it could very well be possible that being vaccinated improves your outcome even once you've already developed symptoms sufficiently severe to require hospitalization. However, I'm not sure there's conclusive evidence suggesting that is indeed the case.
> Now, it could very well be possible that being vaccinated improves your outcome even once you've already developed symptoms sufficiently severe to require hospitalization. However, I'm not sure there's conclusive evidence suggesting that is indeed the case.
Current data seems to show that fully vaccinated people who require hospitalization have hospital stays that are 33% shorter and are also about 33% less likely to die (despite having more comorbidities on average than unvaccinated hospitalizations).
So, if you have one bed left, and can put either an unvaccinated or vaccinated person in it-- all else being equal-- the vaccinated person is less likely to die with hospital care, and is more likely to free up the bed for someone else soon.
(We don't know, though, if you deny hospital care to both what the death rate for each would be-- here's where you have to guess. If you assume both die without hospital care, then you should give the bed to the vaccinated patient).
You won't be refused heart medicine because you didn't stop eating bacon when your doctor told you to 5 years earlier.
Yes, you would. Doctors refuse to give people treatment until they've lowered their weight, reduce their cholesterol, given up smoking or drinking, or increased their level of exercise all the time.
There is no point giving someone life-saving medical treatment if it isn't going to work because of some other factor. That's a waste of time and money. In every case the patient has to show that they're willing to do their part. Medicine is not just popping a few pills or turning up for surgery. There's effort required in order to get better.
In the case of Covid, having the vaccine is part of that effort. Someone who hasn't tried to improve their long-term health by, for example, giving up smoking, and someone who hasn't tried to improve their long-term health by having the Covid vaccine are basically the same - they're both putting their health at risk unnecessarily. Doctors should consider that when they're prioritizing treatment.
If a collapsed lung from a gunshot wound was contagious you sure would.
If having your head split open in a DWI accident was contagious you would.
Like 99% of the arguments against vaccination this isn't nearly as pithy as you think.
After seeing what going through the initial wave of COVID in a medical provider in the ER did to my mother I could not care less about how many loopholes in efficacy people want to tout.
Vaccines help reduce severity in some capacity. If you can be vaccinated (and not everyone can), and you chose not to because you know better, ask your YouTube doctor of choice to patch you up.
Honestly - shame on you for treating self-preservation as some sort of moral judgement against people someone doesn't like. People don't like to risk their lives for people who won't help themselves.
You seem to have very strong views on this and I don't but as a natural follow up from your arguments, how do you propose we deal with the obesity crisis under the lens of people who don't self preservate and have all sorts of cardiovascular issues and bring healthcare costs to unbearable highs for everyone else?
To be clear my position is that you should treat everyone, fatties, smokers, antivax, whatever, merely because I don't know when I'm going to find myself in one of the "wrong" groups and I'd like to get treatment then, so I think they should get it too.
The data I saw suggested these people are actually significantly cheaper in total for society since they die so much earlier. YMMV depending on the details of your social system of course.
We have a vaccine that significantly reduces the odds of putting our healthcare providers at risk and becoming part of the group of people crippling our ability to provide emergency medical care... if you don't take it not because you're ineligible, but because you've decided you know better, you should not be a priority.
And really this is already how it works. When ICUs get overwhelmed, people with COVID who code might not get resuscitated.
The massively increased risk to the provider combined with the chances of recovery mean you will just die:
And I guess saying I have strong feelings supposed to be some backhanded ad hominem? I mean clearly you have strong feelings as well, writing tirades about the "fatties", the difference between us is what I write is based on reality
I understand your point about infectiousness I think it's good and I agree.
My comment was as a follow up to your statement: "Vaccines help reduce severity in some capacity", there's a lot of behaviors that reduce severity in some capacity, and doing those would translate in lots of time savings and less pressure on the healthcare system in the same way as the vaccines do, the vaccines just have the extra "bonus" of being able to infect healthcare workers, so their negative effects compound. But if your argument is about first principles, any sort of self preservation has the same problem. So I was just commenting on that.
You're right the bit about feeling strongly was probably a subconscious dig, sorry about that, but I was amused at the "shame on you" and had a moment of weakness, my bad.
Also I didn't intend much with the fatties, I find it eandearing and have been a fatty myself at times in my life and have many I like, if that offended I'm sorry and I wish I hadn't used the term, but that's life and these are just internet comments.
> People don't like to risk their lives for people who won't help themselves.
That's an entirely reasonable position that I can understand - my advice to those people would be to avoid careers in which they are required to risk their lives for people who won't help themselves.
There's a good reason I'm not a police officer, doctor, fireman, etc. The risk/reward payoff in those careers is far, far too low.
Comparing armed police sent in to deal with possibly armed suspects... firefighters who get sent into infernos... with doctors.
The risks doctors normally face from one patient to another are identical, so it was nonsensical to say they were risking their life for a specific patient. Especially since we've known how to protect from _normal_ bloodborne and airborne pathogens for a long time. The difference is COVID had no vaccine and treatment was limited at the time, it was repeatedly a death sentence.
Your examples are not the same, you're presenting cause and treatment. The parent comment discussed one treatment over another: refusing preventive treatment over curative treament.
Problem is that there is not enough capacity for curative treatment only. In this case it would make sense to allocate some hospital capacity for people without vaccination, and more capacity for people that have been vaccinated (maybe in the same ratios as population vaccination).
And also allocate some hospital capacity for people with other diseases so they're not impacted by the fact that some people refuse vaccination.
Everyone deserves care. It’s unpleasant to think about giving emergency care to people who actively refuse preventative treatments at the cost of canceled appointments and surgeries for non-COVID patients. Triaging really sucks.
They're getting it. Everyone is offered the vaccine. If people choose not to accept that care then what happens afterwards has to be assessed and prioritized on a case by case basis. If there's an ICU bed and two patients, one who's a Covid patient who refused to protect themselves and the other someone who has something not preventable, the second one should get priority.
Ideally there would be two beds, and everyone would get the care they need, but reality means choices have to be made. Refusing a vaccine should send you to the back of the queue.
The organ board base their decision on likelihood that the receiver will benefit from the transplant (for a long time), so some habits that are medically relevant are taken into account: smoking, drinking, taking drugs, and when AIDS was a concern, having sex with people who might transmit it. All those also come a moral judgement so many people assumed that the board was making a moral judgement. They are not: having other conditions complicating the process is relevant; being old too. Being a crimimal is morally relevant but doesn’t come into the judgement of the board.
For lack of a better word, they are maximising the duration of the organ.
"The New York Post (NY Post) is a conservative[8] daily tabloid newspaper published in New York City. The Post also operates NYPost.com, the celebrity gossip site PageSix.com, and the entertainment site Decider.com."
Someone who has served their time in prison and is now released is considered to have paid their debt to society.
You may think, as I do, that this man served nowhere near what he should have for the crime he committed. However, the law has been followed and he is no longer in prison.
If the people the New York Post is targeting think that he should still be punished, then he should still be in prison. The problem is that the type of people clamor for these people to stay in prison also are at the forefront of refusing to pony up the money to pay for that prison.
I do not want to sound like a person who would deny ex-prisoners medical care (I wouldn't), but legal disabilities even today do not end with your release from prison.
For example, felons in the US are banned from owning guns even after they served their time.
> For example, felons in the US are banned from owning guns even after they served their time.
I'm not a big fan of that, but I would prefer that it reflect the harm done from the crime and the statistics surrounding recidivism.
A simple drug possession offense should not warrant banning you from voting or guns when you are done. If you were convicted of an armed robbery, maybe the guns should be banned.
I really don't like the idea that once you're done with the justice system it continues to punish you. Once you are done with it, you should be done--especially if the crime was "victimless" (ie. something like drug possession where the only harm would be to yourself).
This becomes a significant issue in, for example, sex offenders. Some places have so many restrictions on sex offenders that, for all intents and purposes, they cannot comply with probation and cannot function in society. Well, if you're going to do that, at least be honest that you are simply "executing them on the cheap and out of sight" and either keep them in prison or execute them explicitly.
This is one of the problems with low-level drug convictions--the "felony" conviction becomes a poor man's "social discredit" system. And most of us from Western democracies understand pretty solidly why "social credit" systems are pernicious.
My experience has been that the kind of people that want longer prison sentences for folks like this are more than willing to tolerate higher taxes to pay for them.
Well, the Zeitgeist of the social networks is "destroy the sinner mercilessly and crush him into dust" plus "whoever does not take part in that crushing or even advocates for mercy is suspicious himself". And too many journalists are on their social network accounts every waking hour, so it seeps through.
I suspect that quite a lot of people would support denial of medical care to sinners. For example, the sentiment of "triage against the unvaxxed" seems to be pretty strong.
(For the record, I am fully vaxed but do not support mistreatment of people who believe in conspiracy theories.)
What you see on social networks is a reflection of who you choose to follow and engage with. I use social networks to engage with people who actually make those decisions and they do not encourage any of that.
Denying medical care is made either by individual health care professsionals or, in cases that require more consideration, health services ethics commity. I’d be surprised is anyone stating what you said would keep their medical license, let alone would be allowed to sit in a commitee.
> The key principle in medicine is to treat anyone who is sick, regardless of who they are.
The victims family is saying “Our principle is that people who stab Ed should not get a heart, therefore David should not get a heart.” The doctor is saying “Our principle is that we don’t use the patient’s past violence or convictions to determine whether they should get a heart or not, so the stabbing doesn’t disqualify David.”
Neither party can offer a valid argument as to why their principle is true, because both of their principles are normative.
The weird thing about saying "Do not save those who took another's life" is that you are saying, "The person took a life. That's bad. We should punish them for the bad thing." Then saying, "Let's take their life to punish them." (not saving a life you could being essentially the same as life taking, to me, here).
To me, you are undermining your view that life-taking is bad, by engaging in it yourselves. To me, this is a paradox. You seem to be standing up for your belief in the badness of life-taking, by doing something against those who do it, then you do something which goes against the very thing that you are trying to protect--which, to me, makes it seems like you are merely pretending to protect.
So, to me, their moral claim (?) that they are somehow "better" than this life-taker, and therefore have a right to say/do this life-save withholding, is completely undermined by their action of said withholding (or proposal to do it).
On the other hand, my ape-brain very much endorses the logic of revenge and sees no problem with an eye for a eye. It will teach people a lesson, let them know they can't mess with us, and let them know there are consequences if they try. Hopefully, my ape brain says, that will make us safer and rest easier, in future.
But the logical/rational part of me trying (but maybe failing) to consider this from an ethical or moral point of view, says, "Nah, that doesn't work."
Well put. Apart from the lengthy threads here regularly on how flawed the very notion of free will that's necessary to even justify this focus on vengeance, I absolutely agree with you that if you're going to argue for vengeance and have a moral leg to stand on you better at least not argue for such an outcome.
I like to point to this page from Franquin's Idées Noires (finally in English as "Die Laughing", only a few decades late) [1], which makes much the same point as you. (The whole book is very much worth it if you like dark humour - it's a crime it took so long for it to get translated to English given how many other languages it's been translated to decades ago)
Translated the speech bubbles are roughly:
"The law is clear: Every person who voluntarily kills another will have their head cut off. Let the executioner do their job."
"Over here, my friend."
"And so a good deed done..."
"Sorry, but the law is clear: Everyone who voluntarily kills another..."
Thanks for basing the ethical explanation so succinctly on the respect from life. Rarely do I find it put in such a clean and simple and accessible way. Connecting it to the ape-brain level urge for revenge is the icing on the cake.
From there I comfort myself with two thousand years it took a truly global institution to fully completely and no more strings attached reject capital punishment, the CCC, Catholic church law, closed the last loopholes allowing capital punishment only very recently.
We need to be patient with some nations to get there... Patient and persistent. As you were with your comment. Thanks again!
Wow, the positive comments here are really, nice. Thank you! Yes I was rather proud of that as well, I thought it deserved a bit of love--so thank you for sharing! :)
It's nice to get that here after slugging it out with someone who's seemingly misinterpreting what you're saying, so thank you for that support :) xx
So, thieves cannot be fined for their crimes (take their money after they took someone else's), kidnappers cannot go to jail (take their freedom after they took someone else's) - because it would undermine, what exactly? That makes no sense.
Well it makes sense to me. Your reading is a little bit uncharitable. Seems almost like you didn't make any effort to understand it, and just rather pretend that it's stupid...Sigh. But I suppose I could have helped you by saying the other part which I think about this:
That's why the legal system is so important. We need a way to do these things, that's not about individuals getting revenge. So...you kill Alice, then society takes it up with you, through their legal/punitive officers--rather than Alice's family.
But even so...that doesn't fully resolve it for me, the paradox I see there.
But at the same time, I get your point of view. I mean, what that means we can't punish anyone? Because we don't want to seem bad, by pushing back against the bad people? Are you saying we just turn the other cheek? That's crazy.
Yeah, I get that...But I think it's important...You do some crime, and I say, "I have to get back at you". But no, I'm the one that has to be moral. Individuals have to be moral. The state doesn't have to be moral in the same way. But we can't let that spill over to individuals otherwise everything collapses.
I mean, I'm not saying I can resolve this right here--and your strong reaction to what I said, indicates that I have raised a complex, subtle point that's not easy to resolve. People face stuff like that, it's difficult, so they react strongly, or emphatically, like you did.
So I think we need the state, the organs of the state, to be able to enact this violence on our part (take their money, their freedom, their life--maybe? I'm not sure about the last one). Then we can afford to be moral and live up to that, and that's good overall. It's not perfect but then what other options do we have?
I don't know if this will be helpful to you, but I'm throwing it out there.
In a consequentialist, utilitarian moral system, revenge cannot be a moral good on its own. If a universe where one person gets hurt is worse than a universe where no one gets hurt, a world where two people get hurt must be worse still.
So if you're utilitarian, you believe in justice as a means to prevent crime. Punishing people can act as a deterrent, imprisoning people can separate them from would-be victims, and rehabilitation can prevent future crimes.
Some people aren't consequentialists, but retributivists. They believe that deserved punishment is innately good. A universe that is fair is one in which those that cheat are issued handicaps to balance that out- think the reckless driver who gets pulled over frequently enough that it doesn't buy them any time in the long run. A fair universe is morally preferable to an unfair one. This also makes sense, though it's somewhat at odds with the utilitarian perspective.
Well this has been a surprising explosion of positivity here on this thread. Some of these comments, look at you, thank you!
That's interesting. And I don't know much about that, but your comment is going to help me look into that, when it's time for me to do so: consequentialists, retributivists, and utilitarianism. Thank you :)
It's an interesting, seemingly two valid perspectives that are in contradiction. Thank you! :)
Seems almost like you didn't make any effort to understand what I wrote. Sigh.
My interpretation is not uncharitable, it's precisely the same argument you are making, and, to me, it makes no sense - as shown by my examples. Clearly, you have no problem with fines for thieves and prison for kidnappers, and why should you - so you agree with me.
I think the resolution to the problem of 'punishment' is exactly the one you point out at the end: we hand over the monopoly of violence to the democratic state.
Thus the point you're making is wrong: the problem is not at all whether we punish by exactly the same measure that we're punishing for. The simple truth is that the death penalty is a qualitative very different kind of punishment (which I find barbaric, just for the record).
Edit: I don't really see where I react strongly or emphatically. I'm just pointing out that your logic does not hold up.
> But at the same time, I get your point of view. I mean, what that means we can't punish anyone? Because we don't want to seem bad, by pushing back against the bad people? Are you saying we just turn the other cheek? That's crazy.
> Yeah, I get that...But I think it's important...You do some crime, and I say, "I have to get back at you". But no, I'm the one that has to be moral. Individuals have to be moral. The state doesn't have to be moral in the same way. But we can't let that spill over to individuals otherwise everything collapses.
I mean doesn't that look like I'm making an effort to understand your POV? That's exactly what I'm doing? What does that look like to you? How did you take that?
---
Second thing:
> My interpretation is not uncharitable, it's precisely the same argument you are making
Well I'm saying it is uncharitable. I think you think that it's the same, but maybe you don't see how you've misinterpreted.
In my first post (GP?) I don't mention the state. Now, it's understandable if maybe you thought I was talking about that (use of possibly ambiguous "you", or "their", or "yourselves" to refer to who I was saying claimed they could punish like this), but to me I was clearly replying to the ancestor phrase "The victim's family is saying:" Maybe that was not clear, but I thought it was. Sorry, maybe that was what confused you?
So, in that context where I am talking about it (what I said up there), the context is: when people say they want to respond in the same way. That is different to the point you're making, I think. I think you're saying, that I'm saying:
"We don't have a right to punish people, because if we do, we are not moral. And we shouldn't punish people in the same form as their transgression."
That is what I'm saying...but I'm also genuinely trying to explore it and being more modal than, "well it is 100% like this." I'm just saying what I said up there.
But I think your mischaracterization is that your meaning is maybe like this:
"You are referring to the state. You are saying the state cannot punish people because it would undermine its moral position somehow. This is obviously nonsense. You are wrong. Because then we do not punish anyone. Also, what's really wrong with punishing in the same form? It's not even a point. Also wrong."
Let's leave aside the "same form" thing because that's, probably, you know, something else. But I just think your mischaracterization is to mischaracterize or misinterpret, the who of what I'm talking about. And that part's understandable maybe--ok?--because I didn't make it explicitly clear. But what you're saying I'm saying, is not exactly the point I'm making, and it is uncharitable because it doesn't seem to try to see it from the point of view where it could be true...your mischaracterization throws out the stuff I'm saying about the seeming moral paradox, and reduces the modal exploratory aspect to an absolute one, ignores the part where I'm making an effort to consider your PoV, and seems to deny that considering this as a moral problem is a valid consideration. Also, saying "You have no problem with punishing" is a complete mischaracterization, stripping off the subtlety of what I'm trying to explore, which is that, to me, these things are moral issues like I said above.
I mean one basic point is, if what you're trying to do is prove me wrong, then having to misinterpret and reduce what I'm saying in order to prove it wrong, is invalid...it doesn't touch what I'm saying. So you've only proved wrong, if you have, your misinterpretation of what I'm saying. And sort of validated what I'm saying and the difficulty of proving it wrong, by avoiding dealing with it.
Now maybe you don't see it like that, and I get it. Maybe you just genuinely think your interpretation was totally valid, and I'm just shifting the goal posts to avoid being pinned down by the formidable pincers of your immaculate logic...or some stuff like that, whatever. Or maybe you are doing it deliberately...or maybe it's just a blindspot and you don't realize you're doing it? Maybe?
For me the far more important point tho, is about how people interact in discussions, not the proving wrong. And it just seems like you're saying, what I've said is all invalid and wrong. It kind of hurts. Because it does hurt. And also because I'm dealing with the topic genuinely, and curiously. And it just feels like you just want to prove a point, and you don't care who you misinterpret, like you don't care how you misinterpret what someone says into some form you can say "it's wrong" because it seems you only care about saying "it's wrong." rather than about hearing or dealing honestly and respectfully with what someone is saying.
I mean you could have just said, "Well maybe it's right, how could this guy be meaning in a way that's right? What could they be trying to say here that's not the obvious rebuttal I can make or what I might be misinterpreting? Maybe they're more subtle than that?" Because when you do that, you know, mischaracterization and say "you're wrong", I feel a bit sad, because it seems like you're saying, "This person is stupid." Because you're assuming the stupidest interpretation, the one that obviously doesn't make sense. Is that what you think I'm saying? Why do you need to look down on me?
And I just think that's a bit sad. I'm engaging genuinely, but it seems you just wanna prove someone wrong...and you don't care who you hurt? I was a little scared to reply you because I got the feeling you might do that...but, I gave you a chance.
I picked up the strong reaction in your first answer, and I felt scared you would try and just do that, and you did. It was a feeling, but some points in the text you could link it to are: "undermine what exactly? [[ your point about undermining is invalid, there's no complexity here ]] That makes no sense." It was my feeling about your intention but those words are even pretty strong to me. I get that maybe you don't see that...sad to say, but I think that not seeing it might be obvious. Maybe you can think about how that might come across...
---
Third thing: I mean if you want to take some overly literal editorialized misinterpretation of what someone said, and pretend it's their logic that doesn't make sense, rather than your interpretation (because I guess that helps you feel smart(er?) for seeing the flaws in their logic, but it's a little unfair and twisted to foist your perverted misinterpretation on what they say, just to get your rocks off by feeling they're wrong and you're smart, right?), I mean it's actually not that difficult to do that...so how does it feel,
"My interpretation is not uncharitable...so you agree with me...Thus the point you're making is wrong"
I mean I can do that, and be like, "Gotcha. If I'm wrong, but I agree with you, then you're wrong too?"
Clearly a more simplistic misinterpretation than your more subtle misinterpretation, but of the same kind, and seemingly the same intention. The thing is, that kind of stuff, doesn't lead to interesting or fun conversations, I think...because then we got to waste time maybe going back over like, "i didn't mean that," "you didn't mean this", it's a time saving effort if you just respond to the strongest position. And even if I didn't mean that strongest position, then maybe I can rise to it (I mean--you see me as capable of that, right?) then we could have had a more fun and interesting conversation, right? but to do that you have to surrender the temptation of seeing someone else as stupid, and what they're saying as wrong, so you can feel smart(er)? because if you don't surrender that temptation, it's just for you then, it's not a contribution to the community. maybe you feel as if your contributions will not be appreciated, so you fall back to this. getting your jollies in this "taking" way (and in this current context, kind of immoral, because nobody took anything from you at the first, at least not here~~not saying you had an easy time online tho...but does that mean you keep being unkind/uncharitable?). because when you do that, it hurts, because you're devaluing what other people are saying. I hope you see that, or reflect on it, and maybe try to be better to others...please.
Ah, I see where you're confused by your own writing, but I'd be happy to spell it out slower, so that you can understand [0]: you write "I get your point of view", and you mistake making that statement with the factuality of it.
And let me help you with another thing you are confused about [0]. So, in essence your argument is that I am wrong because I am answering to what you wrote rather than what you thought you wrote or wish you wrote, and that's what you call 'uncharitable'.
The main problem with your 'argument' is that you make absolute statements, but then are not able to back them up, getting upset when someone points that out. It's simple engineering practice to check how things hold up at the limits. Not 'punishing' someone with the same thing they did does not hold up in the limits of simple wrongdoings, e.g. taking away some property. What this should tell you is not that you require a more charitable interpretation and special rules for the fringes to rescue your argument, but maybe that the overall logic is flawed. And it is: as I wrote in the other comment, the simple truth is that the death penalty is a different beast altogether.
[0] What's with that condescending tone with all your replies? Can you not simply make a statement that stands on its own two feet?
You’re exactly right. In fact resolving this paradox and avoiding the chaos of blood price for crimes committed are part of the themes of every system of law since Hammurabi’s code.
Thanks a lot, that's really kind. It's great to feel my struggle with is backed by thousands of years of other people struggling with it. And your comment helps me feel interested to read more into it! Thank you! :)
Note that graderjs is not saying that there could not be other morally justifiable reasons for calling for the death of someone.
What they were saying is specifically that arguing that someone who takes a life should be punished in a life ending way because of the severity of taking a life is undermining that argument's own central claim of the severity of taking a life by at the same time arguing for ending a life.
Your analogies are flawed for two reasons:
1. there are other justifications for punishments that may (or may not) be valid. One argument may be that it is preventative, for example.
2. in neither example would most people argue that we're imposing a particularly extreme sentence because the action was particularly extreme, and this is central to the argument made by graderjs.
In the case of the theft example, if anything we'd tend to argue a fine is not a very serious punishment. In the case of kidnap, we argue for serious sentences because of the seriousness of the crime, but a prison sentence would not be seen by most people as equally cruel as the uncertainty and fear and trauma imposed on both the victim and their loved ones, and most people would argue that the prison sentence is not just a response to the seriousness of the crime committed.
Some people might nevertheless find it hypocritical to argue for prison sentence on the basis of the seriousness of kidnapping, and its their right. But that in itself does not make a prison sentence unjustifiable even if you agree with them, because you may have many other arguments, such as e.g. risk of reoffending, or signal effect to others.
The point is in other words not that a given punishment can't be justified, but that if you choose to argue that something is particularly severe and then in the same breath argues for inflicting that same thing on someone because of that perceived severity, you're undermining that argument.
The analogy is not flawed because the comments you made are precisely my point: it's not a general, fundamental, moral conundrum -- it's that the death penalty is its own special beast. Graderjs argues from a general perspective using the example, but not limiting his arguments to, the death penalty. And then, as you and I point out, it simply does not hold up. It's the severity that makes it stand out, not the overall act of 'are we moral if we do the same thing'.
Graderjs also makes no argument about other justifications of 'punishment', and, again, I'm with you. Note that I often write 'punishment' in quotation marks. I don't believe (and the numbers between countries support that) that revenge is a productive reaction from a society.
Fines and jail sentences are imposed by courts. It would be weird for a grocery store clerk to overcharge a convicted thief after they served their sentence.
We're talking about the morality of the reaction, not about who imposes it. GP argues that it's morally fundamentally wrong to react to some else's 'misbehavior' by imposing the very same action as punishment.
Graderjs comment does not say they are morally fundamentally wrong.
They say that the specific argument that life-taking is bad is undermined by arguing for life-taking.
This does not preclude other arguments for why life-taking may be bad, nor other arguments for why it may be justified in specific circumstances.
Note that graderjs' very own comment gives examples of other possible arguments for "eye for an eye":
> It will teach people a lesson, let them know they can't mess with us, and let them know there are consequences if they try. Hopefully, my ape brain says, that will make us safer and rest easier, in future.
As such it's very clear that graderjs is not making any sort of claim to absolute morality, but addressing the weakness of a specific line of argumentation.
Well maybe not wrong fundamentally...but it calls into question your stance against the thing you end up doing. But I think it is wrong for individuals to do that...to maybe repeat myself unnecessarily.
Confining a person is bad. But we imprison someone who did that. Thereby, to show that freedom taking is bad, we engage in it. To me, this is a paradox.
When evaluating principles, the trick is to extrapolate from each principles what society would be like if they were followed.
The first one “Our principle is that people who stab Ed should not get a heart, therefore David should not get a heart.” means that there is no rehabilitation for ex-cons, that doctors have the power to condemn people to death based on their past by refusing a life saving procedure and that in the case of new research like this one, doctors cannot have access to the best candidate.
Extrapolating the second principle means living in a society where the judicial system decides the punishment and people pay their due afterward, potentially reducing recividism. It means that when doing an experimental procedure that requires very specific candidates, the doctors have to pass on an ideal candidate delaying discovery.
> Neither party can offer a valid argument as to why their principle is true, because both of their principles are normative.
Can you offer a valid argument for the truth of your own principle, that it is impossible to offer a valid argument for the truth of any normative principle? I think your own position is a normative principle, and hence your position is self-refuting.
To call an argument "valid" is to make a normative claim; it is to claim that a rational agent ought to accept it. To call an argument invalid is to claim that a rational agent ought not accept it. Rationality has as much oughtness as morality does, and hence is a normative discipline just as morality is.
Not being able to use emperical evidence to prove a normative claim is a very common (albeit not universal) belief. Probably because nobody has really convincingly done so in thoussands of years.
> To call an argument "valid" is to make a normative claim; it is to claim that a rational agent ought to accept it.
Idk, it could just be a claim that the argument can be expressed in a logical system, combined with the normative axiom that rational agents should only trust arguments that can be validly expressed in such a formal system.
Regardless this seems to be missing the forest for the trees. Nobody has put forth any arguments for either position that are emperical in nature. Is there really a practical difference between impossible and possible but nobody knows how?
> Idk, it could just be a claim that the argument can be expressed in a logical system, combined with the normative axiom that rational agents should only trust arguments that can be validly expressed in such a formal system.
The term "valid" has both formal and informal senses. I agree some of its formal senses are non-normative, but I think its informal uses have a strong normative element. The original comment to which I was responding wasn't very clear about in what sense it was intending the term, but when people aren't clear, it is not unfair to assume they mean a term informally rather than in some specific formal sense.
> Regardless this seems to be missing the forest for the trees. Nobody has put forth any arguments for either position that are emperical in nature. Is there really a practical difference between impossible and possible but nobody knows how?
What is the proper role of empiricism in human knowledge, including moral knowledge? You seem to be making some assumptions here which you are not making explicit.
If one accepts moral sense theory – that moral intuitions are a form of empirical knowledge – then we can have direct empirical knowledge of the truth or falsehood of moral propositions.
If one accepts pragmatism – that beliefs can be justified by the pragmatic benefits of believing them, and that pragmatically justified beliefs can constitute genuine cases of knowledge – then empirical evidence can be used to establish the pragmatic benefits of a moral belief, and hence (indirectly) to establish its truth.
One may believe that some axioms are self-evidently true, and that one's knowledge of the truth of those axioms is innate rather than empirical – in which case, if one accepts that for non-moral axioms, how about accepting it for moral axioms as well?
The practical/empirical argument would essentially be to extrapolate out what the world will become like if we spread X or Y normative belief/practice.
You can argue that one will lead to a preferable world than the other.
Of course, we may have different preferences, so we may not agree even if we agree on that extrapolation. But often basic human preferences like not wanting to be the victim of unprovoked public violence do align.
Consider this (meta-)moral principle: For some moral proposition P, if universal human obedience to P would lead to human extinction, then P is false.
Example of application: Consider "It is always immoral to have children". Obviously, if humanity universally obeyed that principle, human extinction would inevitably and quickly follow. Therefore, that principle is false. From which obviously follows: "It is moral to have children (at least sometimes)".
Now, I would propose we accept that meta-moral principle as an axiom. To me, and to many others, it seems self-evidently and intuitively true. Who seriously doubts or denies this axiom? Well, most of the people who doubt or deny it, do so not due to its specific content, but due to a philosophical objection to accepting any moral axioms at all. The number of people who are happy to accept moral axioms but would refuse to accept this particular one appears to be rather small. It seems as good a candidate to be an axiom as any other. So why not accept it as an axiom?
Thank you for prompting me to reevaluate my position.
Initially I claimed, “There are no valid arguments for normative claims.”, I would like to amend my claim.
Def: An inferential system is a tuple of axioms and inferential rules.
Def: An argument is a non-empty ordered sequence of statements. The last statement is called its conclusion.
Claim: If an inferential system produces an argument for a normative claim, the system is either inconsistent or permits inference from positive statements to normative statements or the argument proceeds from normative axioms.
Proof. Suppose S is a consistent inferential system and that A is an argument in S from S’s axioms to a normative conclusion. If S has only positive axioms then A makes inference from positive to normative statements.
QED
Corollary: There are no arguments for normative claims that don’t proceed from normative axioms in consistent systems that don’t permit inference from normative to positive statements.
You are saying that, a valid deductive argument with a normative conclusion must either have a normative premise, or else rely on a logic whose inference rules permit normative statements to be inferred from non-normative ones.
I agree with you there. But you haven't explained how this (obviously true) statement is relevant to the original discussion, about the morality of providing life-saving medical treatment to perpetrators of serious crimes.
> But you haven't explained how this (obviously true) statement is relevant to the original discussion, about the morality of providing life-saving medical treatment to perpetrators of serious crimes.
My original point was in response to the claim that “the key principle in medicine is to treat anyone who is sick, regardless of who they are”. I took this to be an ought and wanted to point out that its truth isn’t established anymore than the ought indicated by Ed’s family, and that in fact there would be serious difficulties with establishing either one for the reason given by your last post:
> a valid deductive argument with a normative conclusion must either have a normative premise, or else rely on a logic whose inference rules permit normative statements to be inferred from non-normative ones.
But also I think that this poster makes a good point that the doctors are actually making a positive claim.
> To call an argument "valid" is to make a normative claim; it is to claim that a rational agent ought to accept it.
I think I had in mind a textbook definition I had read.
An argument is called valid if it is impossible for the premises to be true and the conclusion false. And then we say that an argument is sound if it is both valid and has true premises.
Which seems like a useful pair of definitions, and in that context I was confused about the terms.
I actually haven’t ever thought about or heard of this idea of ‘when is a rational actor committed to accepting claims’. But yeah, seems interesting to me.
That textbook definition of “valid” only applies to purely deductive arguments. Outside of mathematics, most arguments humans make have a significant non-deductive component (inductive and/or abductive). So, unless we assume that moral reasoning is closer to mathematical reasoning than to the kinds of reasoning we normally use in the sciences and humanities-a very dubious assumption-the formal concept of “validity” you are invoking has rather limited relevance to morality. That’s why I read your statement as intending “valid” informally rather than formally, since in its informal sense the term is not restricted to purely deductive arguments; and informally it is very much a normative concept (formally, I think it has multiple formal senses, some of which contain more normativity than others)
I think your overall point is, you are expressing scepticism about claims to know the truth of some particular moral proposition, grounded in a more general scepticism of the possibility of any moral knowledge at all.
I think that kind of general moral scepticism is (usually) a form of normative scepticism. The big problem I see with normative scepticism, is that attempts to argue for it logically and rationally turn out to be self-refuting, because logic and rationality are themselves normative concepts. Furthermore, if one understands knowledge as having a normative component, normative scepticism collapses into radical scepticism (there is no such thing as knowledge), which obviously ought to be rejected.
> That textbook definition of “valid” only applies to purely deductive arguments. Outside of mathematics, most arguments humans make have a significant non-deductive component (inductive and/or abductive). So, unless we assume that moral reasoning is closer to mathematical reasoning than to the kinds of reasoning we normally use in the sciences and humanities-a very dubious assumption-the formal concept of “validity” you are invoking has rather limited relevance to morality.
I don’t have any sense for the various properties of inductive arguments. So to the extent that moral arguments are inductive, I have nothing to say. Thanks for pointing out that I’m assuming moral arguments must be deductive. Any recommendations for an introductory text on inductive arguments?
> That’s why I read your statement as intending “valid” informally rather than formally, since in its informal sense the term is not restricted to purely deductive arguments; and informally it is very much a normative concept (formally, I think it has multiple formal senses, some of which contain more normativity than others)
Understood.
> I think your overall point is, you are expressing scepticism about claims to know the truth of some particular moral proposition, grounded in a more general scepticism of the possibility of any moral knowledge at all.
Yes, that is my point.
> I think that kind of general moral scepticism is (usually) a form of normative scepticism. The big problem I see with normative scepticism, is that attempts to argue for it logically and rationally turn out to be self-refuting, because logic and rationality are themselves normative concepts.
This is the first time that I’ve heard of normative epistemology, which I gather is what you are talking about. One thing I will say though, thinking about this seems smoother than thinking about normative morality because (I think) I don’t have as many childhood memories of people telling me what I ought to think compared to those of people telling me what I ought to do.
> I don’t have any sense for the various properties of inductive arguments
You can easily find a lot of resources on this topic, but I can't think of any to particularly recommend. To give my own high-level summary, there are three main types of logical arguments:
- Deductive arguments: from the premises, the conclusion necessarily follows. If the premises are true, and the argument is valid, the conclusion must be true. These are the kinds of arguments found in mathematical proofs, and classical syllogisms such as "All men are mortal, Socrates is a man, therefore Socrates is mortal"
- Inductive arguments: from many particulars, infer a generalisation. If all swans so far have been observed to be white, it is reasonable to conclude that "All swans are white" – and the more observations you make, the stronger the conclusion becomes – but that conclusion can never be certain, only probable, because maybe tomorrow someone will discover a black swan, proving the conclusion to be false after all–which is of course what actually happened, when Europeans came to Australia and found swans which were black. (Also, confusingly, "mathematical induction" is a type of deductive argument, not induction in the logical sense.)
- Abductive arguments: from a situation, infer the truth of its most plausible explanation: If I walk into a room and find toys spread all over the floor, I am going to conclude that our four year old did it. Now, maybe some crazy stranger broke into our house, threw toys everywhere, then left – not absolutely impossible, but far less likely than it being our four year old.
The big difference: in deductive arguments, if the argument is good, and the premises are true, the conclusion must be true; in non-deductive arguments, the argument can be good, and the premises can be completely true, and yet the conclusion can still be false. A deductive argument which produces a false conclusion from true premises is by definition a bad one; a non-deductive argument which produces a false conclusion from true premises can still be a perfectly good one, provided that unfortunate outcome is improbable.
The natural sciences use all three, but rely heavily on induction and abduction. Historians primarily use abduction – induction works best for repeatable events, whereas many of the events historians study are essentially unique and unrepeatable (World War II was in many ways a unique event in human history, nothing quite like it had ever happened before, even World War I was different in many ways, and if World War III ever happens it is going to be very different again).
I think a lot of moral reasoning must be non-deductive, because deductive arguments generally deal with certainties, whereas it is quite natural for people to say about moral issues "I think it is probably wrong but I'm not 100% sure". I think moral reasoning often involves some degree of induction – if you repeatedly encounter particular situations which offend your conscience, you are likely to adopt a moral principle which condemns whatever those particular situations have in common – generalising a principle out of particular cases, which is essentially what inductive reasoning is. But, as in all inductive reasoning, you can never be sure that there will not be some case which might convince you that your generalisation needs an exception – a moral black swan.
> This is the first time that I’ve heard of normative epistemology, which I gather is what you are talking about.
Yes, exactly. A lot of the concepts traditionally used in epistemology appear to be normative. For example, in the classical definition of knowledge as "justified true belief", justification appears to be a normative concept – a belief which is justified given some evidence is a belief which one ought to hold (or, at least, one is permitted to hold) given that evidence, a belief which is unjustified given some evidence is a belief which one ought not to hold given that evidence.
> One thing I will say though, thinking about this seems smoother than thinking about normative morality because (I think) I don’t have as many childhood memories of people telling me what I ought to think compared to those of people telling me what I ought to do.
I think a lot of people grow up exposed to conservative religious approaches to morality, which they often experienced as being pushed on them inflexibly and never with any convincing justification–and it is unsurprising many such people become attracted to the idea that "morality is subjective". However, I wonder, is that "throwing the baby out with the bathwater"? Most of these people would feel strongly that genocide, slavery, apartheid, torture, child abuse, theocratic totalitarianism, etc, are immoral – yet, having accepted "morality is subjective", those moral positions they endorse must be just as subjective as those which they've rejected. Subjective morality weakens their own moral positions. Indeed, once you believe that morality is subjective, you can no longer claim (in any objective sense) that anyone else's morality is wrong, including that of various religious conservatives – the most you can consistently say about their morality is that you don't like it – but why should they (or anyone else) care about what you like?
> Neither party can offer a valid argument as to why their principle is true, because both of their principles are normative.
The majority of ethicists agree that normative statements can express true statements.
But the positive/normative distinction is also not important here: medical ethics is a prescriptive and lexical ethics, one that you must follow if you are to practice medicine. It's not interested in what any individual does thinks should or shouldn't be the case: you do no harm and you always render treatment in accordance with your means.
> The majority of ethicists agree that normative statements can express true statements.
What do you think is a good candidate for such a statement? My impression is that arguments must proceed from axioms, positive axioms aren’t helpful because the statement is normative and normative axioms just reproduce the issue.
> medical ethics is a prescriptive and lexical ethics, one that you must follow if you are to practice medicine.
What is the meaning of “lexical ethics”? Google didn’t return anything helpful.
I believe the essence of the claim you are making is that, “There is a powerful enforcement body that will only permit doctors to practice medicine if they do no harm and render treatment in accordance with their means.” I think this a positive claim about human behavior, a proposition potentially belonging to the set of sociological or historical facts.
I suspect the family is talking about the way things ought to be, “Heart transplants should go to good people”. And you are pointing out that the doctors are responding with a positive claim, “That’s not what we do here.”?
> What do you think is a good candidate for such a statement?
Here's an intuitive one: "you shouldn't kick puppies." Most people think that expresses a true statement (not that "most people" is itself indicative of truth value).
In terms of my own ethics: "act only in a way that you can will be universal law." Of course, not everybody agrees with that one, but I think it's an awfully good candidate.
We can talk about if and how those proceed from axioms, but I suspect that'll be a long thread :-)
> What is the meaning of “lexical ethics”?
Sorry: lex is in lex, legis, "law." Medical ethics don't concern themselves with normal moral objects or even moral laws in the deontological sense; they are literally a book of rules that doctors (broadly) are not allowed to disagree with.
So yes, I think it's correct to read the doctors' responses as a positive claim: they're pointing out that it's a category error to appeal to their (potentially true!) moral beliefs.
>Most people think that expresses a true statement
Worth pointing out that truth is a pretty complicated word in this case. The statement is intuitively true in the sense that it is a command that ought to be followed, but it's not a factual truth statement in an empirical sense. Likewise often truth statements or commandments are reframed emotional stances, say "you should not look at porn!" expressing simply disapproval.
Lay ethics discussions conflate truth claims a lot so it's hard to draw any conclusions from it. Also there's a deep cultural aversion to argue that moral statements have no truth value, despite it being a common philosophical position.
> The majority of ethicists agree that normative statements can express true statements.
Well, yeah, it would kind of be silly to be an ethicist if you didn't believe that, and even if you were it would be contrary to self-interest to admit to it. It’s like polling astrologists on the reality of planetary influence on personality and personal fortunes.
Not particularly! There are ethicists who believe all sorts of silly things, if you think "self-defeating" or "undermining" qualifies as "silly." For example, there are plenty of ethicists who think that moral statements are really just preference statements, putting "killing is bad" on the same epistemic level as "I don't like peanuts on my sundaes."
This all works out because it isn't actually contrary to their self-interest: academic philosophy doesn't care whether your position undermines some grounding claim, because there's no universal consensus around that grounding claim to begin with. You'll find plenty of moral philosophers who think that morality is a purely preferential mental phenomenon; they don't mind admitting that because there's still plenty of interesting work to be done if that's the case.
>The doctor is saying “Our principle is that we don’t use the patient’s past violence or convictions to determine whether they should get a heart or not, so the stabbing doesn’t disqualify David.”
>Neither party can offer a valid argument as to why their principle is true, because both of their principles are normative.
I'm pretty sure someone mentioned that the Dr's pov is that the doctors don't punish crime. Someone else does that. If they have a crime worthy of death, someone else determines that and administers that punishment. The Dr's stay out of that conversation.
Exactly. If the law was changed to allow judges to impose "denial of transplants" as a punishment, then one might consider that a good or bad thing, but in that case it would be the courts not the doctors who makes the determination, and the legislative who'd be ultimately responsible for the rule existing.
As long as there is no such law, it's not for doctors to impose such restrictions.
The first argument is a slippery slope. What crimes disqualify you from getting a heart? How much repentance do you have to go through the get qualified back? Who judges that?
The guy should have got the death penalty for attempted and arguably successful murder (the victim later died of a stroke directly attributable to the wounds he received from the stabbing). 10 years for stabbing a guy multiple times to the point of putting him in a wheel chair is a slap on the wrist.
Funny how a lot of problems work themselves out when swift justice is delivered. This whole thread doesn’t exist in that alternative, more just world.
In the article I see a few pictures of the guy with his large, seemingly happy family. Getting rid of the opportunity for that to happen would be like creating another tragedy from the ashes of the first. I don’t know where you’re from, but in America a lot of folks share your view. But our use of the death penalty hasn’t eradicated crime. So then one has to wonder if the possible benefits are worth the price.
They definitely do in my view. But if you were facing the death penalty as a part of a jury trial they might feel differently, character witness statements matter to some degree.
People who commit crimes should not get a heart can be transformed to Only people who have not committed crimes should get replacement hearts. The problem is, who hasn't committed crimes? Which crimes count? Who decides?
That question makes the more-topical issue When the ER fills up, should unvaccinated people be treated by administering carbon monoxide in the hospital parking garage? look trivial to resolve, in comparison.
Seems pretty damn simple to me. If you wouldn’t put someone to death for a crime, you shouldn’t deny them medical care in a manner that will kill them for the same crime. It’s functionally and legally the same as putting them to death. Withholding necessary medical care is the same as withholding food, water, air, or shelter.
We deny people waiting for organ transplants medical treatment regularly. there simply aren't enough organs to go around. In the case that people are already having life saving organs withheld from them, it makes sense to prioritize.
I think people have the ethical issue in this case backwards: the reason this guy got this transplant is because it was an experiment. We effectively used an ex-con as a guinea pig. (Personally, I'm fine with that, he was fully aware and consented, it was his only chance.)
If this guy had died due to the experimental heart failing, we'd probably be seeing a bunch of op-eds about our moral failure to prevent exploitation of a vulnerable (ex-)prison population.
> We deny people waiting for organ transplants medical treatment regularly. there simply aren't enough organs to go around.
Yeah. There is no shortage of pig organs which is kinda the whole point. Rationing limited care is different than denying perfectly available care simply out of retribution. I thought the context made that distinction rather self-evident.
There is shortage yes in the sense that the heart didn’t come from just any pig. It is a specific, modified breed which made the procedure more likely to succeed. The donor pig was also probably raised in more sanitary conditions than most other pig would be.
There is not a huge supply of these transplantable pig hearts at the moment. But if the procedure proves to be viable and the long term consequences make it favourable we can scale up transplantable pig heart production.
The reason we are not transplanting pig hearts to thousands of patients right now is not because of any such supposed shortage though, but because the procedure is not proven yet. The experiment in question is set out to provide data to help answer that question.
> If this guy had died due to the experimental heart failing, we'd probably be seeing a bunch of op-eds about our moral failure to prevent exploitation of a vulnerable (ex-)prison population.
On the contrary, you’re probably massively overestimating how much the society at large cares for convicted felons.
The sad reality is it’s not a lot.
Which is why I doubt we’d see a single op-ed about it.
> We deny people waiting for organ transplants medical treatment regularly.
Yes, but not for their moral failings. We deny care for health reasons, as generally speaking the goal is to optimize for additional healthy years of life.
In the vaccination example: it is based on triage. Which is based on predicted outcome and resources available.
If you have one hospital bed and two COVID patients that are looking like they will die if they don’t get admitted you treat the one with the greater chance of survival. Being vaccinated is predictive of a higher survival rate…
This. All these arguments over ethics miss the point. Doctors shouldn't be placed in the position of making morale decisions. Their job is to render care and given the grave consequences of malpractice, we should always expect them to do so to their fullest abilities. FULL STOP.
Let the legal profession handle how to deal with criminals. Punishment and medical care have no place existing together.
Side-comment that doesn't apply in this case, but worth mentioning: "regardless of who they are" seems like a shitty blanket principle to have. For example, hospitals are overstuffed with COVID patients means regular patients die as a result. In many cases, "The overwhelming majority of the patients had COVID-19, and 98% of those needing acute critical care were unvaccinated." This means people who choose to not take the vaccine are causing others to die. So the unvaccinated should be thrown out when a patient in need comes and no beds are available.
It's a slippery slope.. I think the uneducated are less likely to be vaccinated and it doesn't seem right to refuse service to someone because they believed something that was incorrect. Say there were people with mental handicaps that fell in this camp, it would be even worse.
And where do you draw the line for who gets help for stuff unrelated to covid? Having a do no harm type moral code seems like the best way to navigate and avoid the minefield of deciding who deserves care in what circumstances.
Consider a hypothetical scenario: there is a fire in the woods and the government says "do not go into the woods". People choose to go to the woods and return as burnt victims. Hospitals should help these individuals, but if they fill up 100% of the hospital beds and we need to turn people who got hurt due to accidents who then die, the fault is on those who chose to go into the dangerous woods.
It may be the case that implementing a policy of vacating beds of burn victims is too challenging, but that doesn't undermine the "should" in the "we should vacate beds of voluntarily hurt when accidentally hurt need the beds".
The problem is that it's not as simple as that, everyone knows fire will hurt you. Our country is polarized and the truth is under attack. A large part of the population doesn't trust vaccines, they are not all idiots. They are victims of circumstance and don't know any better. I don't think it makes sense to equate them to suicidal people that are wandering around in forest fires.
Counterpoint: it's not the uneducated that don't vaccinate, it's the cynical - and the "educated" are often ignorant of all the ways it's reasonable to be cynical because they haven't been screwed over as much.
At the end of the day, understanding the benefit of a vaccine requires trusting information, and I think that information, and trust, has been compromised. You could equally hate on anyone deciding that smoking was bad for you, not long ago, because of how thoroughly compromised the "science" around it was.
Why are so many vocal advocates for the covid vaccine such demons? Is the rhetoric surrounding the covid vaccine so toxic that it turns otherwise normal people into people who are so hate filled, or are such hate filled people simply predisposed to being influenced by such rhetoric?
The vaccine narrative is collapsing, and people are desperate for answers and to find someone responsible. They were promised high immunity from infection and close to 100% immunity from hospitalization/death. Real-world stats paint a completely different picture and people are desperate.
Why are people like you so hyperbolic? How is anything that the OP said demonic? The unvaccinated are literally causing people to die besides themselves. There is nothing hate-filled about that.
> The unvaccinated are literally causing people to die besides themselves. There is nothing hate-filled about that.
As a soon to be triple vaccinated healthy adult I wish we could soon admit that we do this for our own good and to not be away from work.
By now it is very clear that about the only thing the current vaccine does against Omicron is lessen the consequences for the individuals who take the vaccine.
I still recommend it but it won't save anyones life except those who take the vaccine.
Lessening the consequence of a COVID infection results in lesser chance of having to need a hospital bed. Whenever you use a hospital bed during a time of 100% occupancy, you cause one person who needs a bed to not get it, which can and does (on average) result in more harm and death.
what are you talking about? Are you under the impression the vaccines prevent transmission of COVID?
at best, the vaccines reduce your personal chance of hospitalization and death.
for those at risk from COVID, take the vaccine. But pretending you're assisting your community by doing so is ridiculous and unfounded in data. "Fully vaccinated" people appear MORE likely to catch and spread Omicron 90 days post-vaccination.
No, it really shouldn't. I'll be the first to say that unvaccinated people are morally bad, and their actions are harmful to wider society.
But, and this is a really important but, the way to punish that behavior isn't to deny them care in the hospital. For a variety of reasons, not the least of which is that not every unvaccinated person is unvaccinated by choice. But more generally because applying any sort of moral standard to who lives and who dies in an emergency gets incredibly murky incredibly quickly.
If you want to punish people for failing to get vaccinated, I'm all for it. But do so outside of a hospital.
Read the article. Sadden he took such drastic actions & that it led to someone’s suffering for so many years until their eventual death, but he served his time in jail. Isn’t that how we repay criminal debts in society? Not a very good argument to deny anyone life saving care after they served their sentencing(or because for their past actions for that matter). If the family believed the sentencing wasn’t accurate that’s a different matter
Glad Doctors don’t discriminate based on past actions of an individual. Would be a very dystopian society if we did.
I don't understand what people are arguing, he didn't even get a real heart that could've potentially gone to "a more deserving person". He literally got something that no one else would've gotten. The only reason they agreed to do this experiment on him is because he was about to die and he agreed to be part of an extremely risky surgery that he very likely would've never wake up from.
I could see him being all over the press being annoying for the victim's family, but I don't see this as him being rewarded with anything. What he got is one of the worst option, though the fact that he's survived this far makes it better in hindsight. Then again 2 weeks means nothing, let's see if it actually lasts.
> If the family believed the sentencing wasn’t accurate that’s a different matter.
It probably depends on what you mean by 'accurate'. They almost certainly do not believe this person has repayed a debt to the victim, the victim's family or society in general. Phrasing the issue as one of repaying a debt is problematical when it is beyond the means of the perpetrator to make amends.
Note that this is not an argument for the doctors doing anything different. All else aside, it is in the best interests of society as a whole that they should select the most medically-suitable candidate available for this research.
There isn't even a consensus on what prison is actually for, so this discussion is doomed to be ambiguous and fruitless. Is it punitive, is it rehabilitation, is it about separating danger from the rest of society, or is it some kind of morale debt collection?
The unfairness of a terminally ill person that's not eligible for a regular heart transplant receiving an experimental treatment that might just as well kill him, but in the long run might save many more?
Or is it the unfairness of never being able to escape ones past?
Ugh PETA, always have to butt in just to keep themselves relevant.
For the first one, I can totally understand what the victim's family must be going through, but doctors aren't (and shouldn't) be in the business of making moral judgements on who should and shouldn't get to live. There is an established process in place for organ transplants (time on the wait list, viability of the transfer) and that's all that needs to be followed.
He's still serving his sentence, right? At least he's being useful as a guinea pig. Maybe it's selfish, but at least it's data that will help the next person.
Frankly, I could care less what the family thinks. If they feel so strongly, then they should advocate for some legislative change. Most families would kill if given the option, and also the luxury of having someone else do it for them.
Right, he injured someone and shortened that person's life, but the justice system didn't know about that last part until long after he was sentenced. So it's not surprising that he's been out for a long time.
Punishing someone for a crime is the responsibility of the justice system. You are saying hospital administrators should basically be able to hand out death sentences at their discretion, which is a bizarre line of thought.
> to me it honestly seems pretty reasonable if hospitals were to lower the priority of people who've been convicted of serious, deliberate violent offenses (where "serious" can be rigorously defined based on
charges/sentences), given the very limited supply and high demand. Perhaps even restrict it to cases where the victim died, like this one.
Why would anyone want to add complexity to triage would be my knee jerk wonder, it’s supposed to be a quick process
Would the hospital need to wait for the legal system to get back to them before treatment can begin? How would you know if the patient has committed a crime without waiting?
Right, imagine someone convicted of possession of marijuana. There are still plenty of people who consider marijuana on par with hard drugs and serious crime. In their eyes, someone convicted of possession may as well be on par with murderers.
For the record, my original comment before I deleted it was exclusively referring to cases of deliberate violent crimes, with a caveat that it should probably be restricted to just homicide.
I see many answers arguing that doctors treat everyone the same regardless of their criminal past. That's ethically right, and the victim's family doesn't have to like it either. PETA doesn't have to like it either. My grandmother doesn't have to like it either. Maybe the victim's family would've been happy that he got the transplant if that had caused him to die; maybe PETA would be happy if pigs got transplants from humans. Thankfully it doesn't really matter what the victim's family or PETA thinks of it.
I was in jail with someone who had been given a life sentence. He needed a kidney transplant. He said there had been a lot of talk about giving a kidney to someone who was going to die in prison. He got the kidney transplant while he was locked up, and then he was later exonerated of the crime in an appeal.
I'm glad that he wasn't refused the kidney transplant simply because he was incarcerated, although I'm sure it happens.
Lets say a man goes to prison for 25 years for murder, and upon release the victim's husband kills him. The victim's husband gets revenge, but is it just?
I of course think that example is not just. However I think there a certain crimes like mass murder are beyond being forgivable. It's where I think the only just thing is vengance.
Also justice can't be objective. Put n people in a room and ask them what is just and you'll get n different answers.
There’s actually no suitable punishment for mass murderers/war criminals/terrorists at all. There’s no righting the wrongs they have caused. There’s no rehabilitation. There’s no real punishment.
When push comes to shove, how many of them even expect to get out alive? Is death penalty really just in such a situation?
The US just puts them in ADX Florence where they are tortured mentally (complete isolation, no end in sight, basically no human interaction at all). Which is probably what they deserve, but it’s still torture.
This comment is a great example of why social media doesn't work. Factual, cited, but totally irrelevant to anything around the technology. It's the top comment because it brings up the controversial elements that spur more comments, and it's in a positive feedback cycle from there.
Why are these points of view (especially the first) worth noting? They are quoted saying the heart 'should have gone to someone more deserving'. Yes, the precious, rare pig heart. It would be more fitting to look on this guy as a Guinea pig, so if he is a bad guy to you, who better to use?
I’m not familiar with the details of this case, but I can imagine that the time and expertise of physicians capable of doing the surgery is scarce. What do you say to the claim that, “The time and resources including the surgeons and the pig heart should be put to use helping a more deserving person.”
I already said: First time surgery that might not work is an experiment as much as a treatment. Hypothetically dialling the risk level up - just a matter of degree, still - we'd find ourselves regarding this operation as his sacrifice for the greater good.
> I already said: First time surgery that might not work is an experiment as much as a treatment.
I don’t think changing the name of what happened from “treatment” to “experiment” tells me anything new. If another person with a roughly identical health status but without the violent history is also willing to accept the pig heart, then the decision must be made to use the scarce resources to treat Ed or the “non-violent” person.
> we'd find ourselves regarding this operation as his sacrifice for the greater good.
I agree that people may be talking about the transplant and Ed differently had he died on the table.
I’m surprised to see such irrelevant and sensationalized information being pushed to the top of the comment section of a hn post.
Does a crime that happened 34 years ago, and a sentence served for said crime, hold any at all relevance to the medical breakthrough posted here?
Does a questionably-ethical nonprofit’s viewpoint matter on said medical breakthrough?
No to either.
I'm carrying a concealed weapon right now. (It's a S&W .380 M&P.) I have a card in my wallet that makes this completely legal in the state where I live, and in 35 other states. I'm always amazed at the culture clash between the anti-gun lobby (including the press), and people who choose to exercise an important constitutional right.
A gun is just a tool. It can be used for both good and bad purposes.
Also, the NY Post article says; "To some families, it’s an outrage that a person convicted of a violent crime would be awarded an organ others so desperately need. But doctors often disagree and there are no laws prohibiting someone with a criminal history from receiving a transplant."
Elsewhere in the same article, it says; "A jury found him guilty of battery and carrying a concealed weapon but acquitted him of of intent to murder. Washington County Circuit Judge Daniel Moylan called the stabbing a case of “extreme violence” and sentenced him to 10 years behind bars."
The facts of the crime are not given, but apparently a jury did not believe he intended to kill, and since the victim did not die right away, there was no killing to prosecute.
There is "open carry" and "concealed carry", but I've never heard the usage you are asking about. I suppose that if one had a knife sheathed and attached to their belt, but was wearing a jacket that concealed the knife, that might qualify.
I know of people who were legally openly carrying a firearm and got convicted of carrying a concealed weapon because of a jacket. The laws vary by state, so such a thing is possible in some states.
Well they are literally named "People for the Ethical Treatment of Animals." It shouldn't be surprising that they are not in favor of killing animals for replacement body parts.
I'm not either, but at least this was a case where the personally arguably "needed" it. Usually we treat animals like garbage just for fun.
My understanding is that given this was the first time this was tried, there was a strong possibility that the patient would not survive. Instead, the manner of their death would inform the doctors for the next person they tried it on.
Given that their chance of survival is so slim, choosing to use a person for whom such small odds give more information to science, rather than do moral good by helping this person survive, seemed a reasonable tradeoff.
Is this too cynical a read on the choice they made?
Reading all the responses to this on social media is both sad and mildly entertaining. The level of hypocrisy combined with fever and sensitivity everyone has been worked up into over the past few years, when anything even slightly complicated or nuanced comes up everyone is jumping almost panicked to figure out the "right" position is.
Excuse my"rough language" but I find PETA people stupid, aburd and straight up dangerous. Those bastards want to leave a human being to die because they care about an animal. Fuck you.
Look. I am a Muslim. That means, by religious scriptures, we are programmed to avoid pork. why? Simply because "god told us to avoid pork". No other thing. Abstain from eating pork and people follow that.
Now, when it comes to saving a life, those religious considerations do not stand because a life is at stake. Same for " consuming wine is prohibited" but if alcohol is necessary as a medicine, its allowed because the intention is not to get drunk but to get treated. That is important.
Now, when it comes to using a pig heart as a replacement, I am pretty sure no resonable person, from any religion would have problems with because the end goal is to save a human life.
These PETA people are keeping themselves relevant by being the dissenting voice that nobody has to listen. Yeah, if PETA or their supporters are reading this, again, fuck you. Let us save lives and your organization can watch us do it.
yeah.. pretty much. i did not say "I'm more important than animals because I said so!!!". i said "humanity is more important than animals". there is a difference. if you can't see that then the joke is on you
Would M.A.S.H. teach me to put the peta link first?
Just kidding, I think I know what you mean.
I think the main problem is not the life saving but the good publicity the guy gets. I'm not going to publicly agree or disagree with either article right now, though - I'm conflicted about each of them.
How? Is inserting animal parts into your body via your mouth fine but not via a hole in your chest? Both sustain life, both mean the pig lives relatively comfortably as a domestic animal for a while. Surely that's better than never been born at all.
It's a typical reddit-level-effort comment. These and annoying puns get automatic downvotes from me. Maybe a bit shortsighted, but I solely use HN for highbrow intellectual discussion, debate, and insight. The only reason I'm so protective of this kind of discussion is that HN is literally the only venue left.
If you're not a vegan and you're against this you're letting your squeamishness override your ethics. If an animal is worth killing for the convenience and taste of a meal, it's worth killing to save a human being with a transplant.
Your objection sounds like squeamishness, and in that case I'd avoid looking at medical procedures in general.
Maybe I can add some nuance as a vegan (I'm vegan btw, and I use Arch btw). I think that it's amazing that this is possible, but where it seems unethical to me is that there still are many other ways we could route heart transplants from willing humans. I think the only way I'd find this ethical is if the pig died from natural causes. But that probably complicates using the heart. If a pig is killed for food and then the heart is used for this, it still wouldn't be ethical to me, because it's plainly not ethical to kill another being for one's benefit in a situation that is not purely for survival (everyone's favorite deserted island). A heart transplant is a situation of survival, but again - we should continue to explore human donors first.
> The patient, David Bennett, a 57-year-old Maryland handyman, knew there was no guarantee the experiment would work but he was dying, ineligible for a human heart transplant and had no other option, his son told The Associated Press.
> There’s a huge shortage of human organs donated for transplant, driving scientists to try to figure out how to use animal organs instead.
> Dr. Bartley Griffith, who performed the surgery, said the patient’s condition — heart failure and an irregular heartbeat — made him ineligible for a human heart transplant or a heart pump.
I'm curious how you'd extract a human heart from a willing human donor without killing the donor. I'm also curious how you'd similarly prepare the human donor in any way to meaningfully reduce the chances of rejection, like genetic modification.
The last time I checked, we were already recruiting organ donors at the DMV. How do you suppose we go about increasing the (currently small) number without resorting to unethical means?
Am I reading this wrong? Isn't this how you'd do it?
> As of 2018, the most common procedure is to take a functioning heart, with or without both lungs, from a recently deceased organ donor (brain death is the standard) and implant it into the patient. [1]
The point is that there's a gigantic gap between supply and demand, and a lot if not most of the supply goes to waste because you can't stockpile hearts. They need to be harvested from a compatible donor and very quickly transplanted. The odds of finding a compatible match are not great.
Maybe you could at least address the points I gave instead of plainly ignoring them and repeating the same argument? I already addressed this - we aren't in tribal times. We can even grow organs in the lab. We can also coordinate complex routes to securing organ donations. There are so many available options. And again, if a heart from a pig that died naturally could be found, I'd be all for it. I think it adds a more to control than already a trans species heart, but that'd be my ideal.
So there's a shortage of human organs in general (especially heart and lungs), which means we need to get them from somewhere.
Using complex routes to secure organ donations isn't a great option, because the viability of organs decrease as time goes on, so there is an effective limit on how far they can travel. It also doesn't help people who are currently ineligible for organ transplants, because their current scarcity means that only prime candidates can get them (otherwise it would be wasteful).
We could change the organ donation system from opt-in to opt-out, but I get the impression that wouldn't be as ethical from a vegan point of view. That also doesn't help the afformentioned distance problems.
Lab grown organs could be a great solution that would actually be better than animal organs, but they're not a viable option yet.
Basically, if we had good options other than xenotransplantation, I would probably agree that it's unethical to use their organs. However, we don't have better options right now (especially ones that can scale to treat everyone that needs an organ), so in my opinion, xenotransplants are better than nothing.
(Also as a side note, a pig that died from natural causes wouldn't be viable for organ transplantation. The pig needs to be physiologically alive for the organs to be viable, and it needs to be genetically modified to not have animal proteins that the immune system can detect).
I was hospitalised for a month and didn't ask any questions, because I couldn't - I was dying. But if I had more capacity I would have requested vegan options. Once I came to I did refused any non vegan hospital food - which meant I only ate plain boiled potatoes.
So I was grateful for the medicines I received then that may have been tested on animals or may have had animal ingredients. But I still advocate and prefer medicines to not be tested on animals and to not contain animal ingredients. I think we have a vast amount of untapped technology that could avoid that.
I don't get what is so difficult for people to digest in discussions like these. Someone says something like "I try to do the best I can to minimize the unethical treatment of others," and it's a tidal wave of angry finger pointing and fallacious appeals to nature.
> "I try to do the best I can to minimize the unethical treatment of others," and it's a tidal wave of angry finger pointing and fallacious appeals to nature.
Maybe because the vegans people have met, are the obnoxious ones that want to push their eating disorder on everyone else, so they just point out the hypocrisy when appropriate.
Animals eat each other alive in the wild, they kill on a whim for the pettiest of reasons.
Dying at the hands of another animal is as natural a cause as you can get. Because we're human we don't treat animals badly while alive, that where our ethics come in.
Obviously if there enough hearts to go around no one would be looking at pigs.
Both can be true. Everyone considers sweatshop child abuse to be bad, but we still buy things that people know were produced in those conditions. We have a clear conscience because we just don't think about it too much.
Not a huge update but an interesting discussion of FDA approval; can the FDA actually stop or sanction experimental procedures like this?