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Archive for the ‘Politics’ Category

Making the market king

Making the market king. See post at Jericho Tree.

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Pope Francis, his vision of social justice, and what it means for us: See the post at Jericho Tree here.

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I’ve just finished reading Antifragile: Things That Gain From Disorder by Nassim Nicholas Taleb. It’s a sprawling, fascinating, maddening book that is badly in need of a copy-editor. But one of Taleb’s pet hates (he has many) is copy-editors.

antifragile

There is a simple and profound central idea. Think of anything at all: a person, an idea, a relationship, a business, a country, a piece of technology, an ecosystem.

Some things are fragile. When some kind of crisis occurs, an unexpected event, a systemic shock – then they break. It might mean a small bit of damage or the destruction of the entire unit. Fragile things are harmed by crises.

What is the opposite of fragile? Our instinct is to use words like robust, strong, solid, resilient, perhaps flexible or adaptable. Robust and flexible things do not break when a shock comes; they can withstand crises and shocks. That’s true. They are unharmed. But this isn’t the opposite of fragile. The opposite would involve something that positively benefits from a crisis or a shock, that comes out better rather than just the same. We genuinely don’t have a word for this, which is why Taleb invents one: antifragilility.

He gives a neat illustration. If you put something fragile in the post, like a teapot, you pack it carefully and put a big sticker on the outside saying, ‘Fragile: Handle with Care’. What is the ‘opposite’ kind of package? You are tempted to say this would be a robust or strong parcel. But if you send something in the post that is more-or-less unbreakable, like a block of wood or a stone, you don’t put a sticker on the outside saying ‘Unbreakable: Don’t Be Anxious About This’, you just send it without any warning signs. The opposite kind of package, with something antifragile inside, would have a sticker saying something like this: ‘Antifragile: Handle Carelessly, Drop Me, Be Reckless With Me, Try To Damage Me’.

What would go into such a package?

Taleb shows how many things in life and society are antifragile. They actually benefit from crises and shocks, at least within certain limits. The human body is one example, it doesn’t benefit from being pampered, it grows stronger through certain shocks and stresses – within limits. Some ideas only develop through challenges and awkward confrontations. Some businesses are perfectly poised to benefit from difficult and unexpected situations, because they are able to adapt and seize new opportunities. Some relationships are able to discover new depths and different kinds of intimacy through problems and difficulties.

What is it that makes some things fragile, some robust, and some antifragile? You’ll have to read the book yourself!

The other big theme is the nature of rationality: how we try to predict the unpredictable, and when we fail and are caught off guard we try to pretend we knew what was going to happen. It’s much wiser, argues Taleb, to admit that many things, especially future crises and disasters, are completely beyond our powers of reasoning (even though they may be rational in themselves). The trick is not to be ready for a particular unexpected event, which is by its very nature unpredictable, but to be ready for something unexpected and unpredictable to happen, so that when it does happen we are able to react in a creative and intelligent way, bringing an unexpected good out of these unexpected difficult circumstances (antifragility), and to create systems that are resilient to major shocks or at least not set up so that they will shatter when the first unpredictable jolt takes place (a certain kind of flexibility and robustness).

It was the perfect bedtime book for me. Easy to read, full of stories, provocative. And it genuinely made me rethink a lot of things I had taken for granted without question before.

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If you live in Wales there will now be a presumption that you are willing for your organs to be donated, unless you explicitly opt out of the scheme.

broken glass by arnaud...

John Bingham reports on the recent legislation:

The “opt-out” system means organs could be taken from a person who has died unless they or their loved-ones actively object. It would mean that the current voluntary scheme, in which people carry Donor Cards or register their consent online, would no longer operate nationwide. Under the plans, organs taken from bodies in Wales could also be used in other parts of the country where active consent is still required…

The presumed consent system could come into force by 2015. The new consent law would apply to over-18s who die in Wales if they have lived in Wales for more than 12 months. Organs made available under the system would be the same as the “opt-in” method – including kidneys, heart, liver, lungs and pancreas – and would not only go to donor patients in Wales. They could go anywhere in the UK.

Dr Peter Saunders, chief executive of the Christian Medical said the change was “unnecessary and unethical”. He is good for a soundbite:

We strongly support organ donation but so-called presumed consent involves neither consent nor donation – it is neither voluntary nor informed and involves taking organs rather than giving them.

It means effectively that the state will be able to overrule families and there is a very real danger that it could also prove counterproductive and undermine trust leading to fewer rather than more donations.

The Anscombe Bioethics Centre submitted evidence against the new legislation. You can read their report here. The main objection is that it turns a gift into an act of theft.

Here are the main points from their report:

THE CATHOLIC VIEW OF ORGAN DONATION: ORGAN DONATION AS A PROFOUND ACT OF HUMAN SOLIDARITY

0.2  This response will first outline a Roman Catholic understanding of organ donation, and how this coheres with a true humanism and helps to reinforce positive attitudes of solidarity within society. It will then turn (in paragraphs 1.1 and following) to the consultation questions.[1]

0.3  Organ transplantation from the dead saves and transforms lives. It offers hope for those with diseases that would otherwise be untreatable, or treatable only by ongoing, imperfect means such as kidney dialysis. Transplantation is, in principle, welcomed by the Catholic Church.

0.4  When solid organ transplants were first being attempted in the 1950s, Pope Pius XII explained to Catholics that this was “not a violation of the reverence due to the dead”. Rather, it was justified because of “the merciful charity shown to some suffering brothers and sisters.”[2] More recently Pope John Paul II said that, “We should rejoice that medicine, in its service of life, has found in organ transplantation a new way of serving humanity”.[3] Far from opposing the use of the dead body in the service of medicine, the Church actively encourages Catholics to offer their organs after death. The Catechism of the Catholic Church states that “Organ donation after death is a noble and meritorious act and is to be encouraged as a expression of generous solidarity”.[4]

THE NEED FOR CONSENT

0.5  While encouraging Catholics to donate organs, Pope John Paul II emphasised that what justifies the use of the human body is the free act of donation. “Above all, this form of treatment is inseparable from a human act of donation. In effect, transplantation presupposes a prior, explicit, free and conscious decision on the part of the donor or of someone who legitimately represents the donor, generally the closest relatives. It is a decision to offer, without reward, a part of one’s own body for the health and well-being of another person. In this sense, the medical action of transplantation makes possible the donor’s act of self-giving, that sincere gift of self which expresses our constitutive calling to love and communion.”[5]

0.6  If the organs are taken without the consent of the donor, or that of the relatives speaking on behalf of the donor, then this is not an act of “donation”. It is taking without asking. The words of Pope John Paul II regarding donation without consent are very clear: “In such a perspective, organ transplantation and the grafting of tissue would no longer correspond to an act of donation but would amount to the dispossession or plundering of a body.”[6]

0.7  For this reason the Catechism says that organ donation “is not morally acceptable if the donor or his proxy has not given explicit consent.”[7] It is not morally acceptable because it fails to respect the human meaning of the human remains. Instead of donation being an expression of solidarity between people, it becomes a violation of the dead.

THE BENEFITS OF A SYSTEM OF TRUE DONATION

0.8  It should not be assumed that undermining the principle of consent will in fact increase the availability of organs. A look at the history of medicine shows that for many centuries there was a stigma attached to dissection. Bodies were taken from the poor and criminals who died in prison, and so people did not want the bodies of their loved-ones handed over to the surgeons. The consequence was a shortage of dead bodies, and this shortage gave rise to widespread grave robbing. This reached a peak in the early nineteenth century when the price for fresh dead bodies induced Burke and Hare to turn from grave robbing to murder. It was in reaction to this that, beginning with the Anatomy Act 1832, there was a concerted attempt to encourage voluntary donation and to remove the stigma associated with dissection.

0.9  The principle of voluntary donation has remedied a problem which had dogged medicine for centuries. The success of voluntary schemes should not be underestimated. According to UK Transplant a total of 17,761,585 people or 28% of the entire population have joined the NHS Organ Donor Register.[8] There are other countries which have still higher numbers of people on the organ donor register. Currently it is not clear whether people are given adequate information prior to signing the ODR, and thus whether it constitutes effective consent. Nevertheless, the success of efforts directed at increasing voluntary participation should be acknowledged as should the ethical importance of personal involvement when the decision pertains to one’s own remains: no decision about me without me. Thus, subject to adequate information, sensitivity to relatives of the dying, and other ethical constraints, it is “opting in” for organ donation that should be encouraged.

0.10  In contrast, consider the reaction to the Alder Hey scandal and the sight of parents forced to bury parts of their children in three or four ceremonies. This dramatically weakened public trust in the collection and storage of body parts. The same kind of scandal could happen with organ donation if consent is not respected.

0.11  A system of donation, in which people explicitly give permission for their organs to be used after their death, allows the human body to be used while respecting the dead. It is also helps to reinforce positive attitudes of solidarity within society. This is what Pope John Paul II meant when he talked of organ donation as part of the culture of life. An “opt out” or “presumed consent” system of organ donation undermines the principle of consent and effectively, even if not intentionally, violates the reverence due to a dead body. Even in pragmatic terms, there is a serious danger that it would harm transplant medicine because it would erode public support for organ transplantation.

An earlier paper from 2002 raises deeper issues about the ambiguity of brain death and the necessity of explicit consent in order ‘to protect the interests of the donor in avoiding premature retrieval of organs’. In other words, the unintended consequences, the risks, could far outweigh the presumed benefits. [The Linacre Centre later became the Anscombe Bioethics Centre]

Brain death

The Linacre Centre’s own view is that `brain death’ protocols are insufficient for establishing the death of the body: we have become increasingly convinced by evidence suggesting that integrated bodily activity can continue after `brain death’ has been diagnosed. There have been documented cases of `brain dead’ patients maintaining bodily functions for months or even years: pregnant women have gone through pregnancy, children have grown up and passed through puberty, etc. 3Moreover, it is well-known to transplant teams that heartbeating donors move when organs are taken, unless they are paralysed by drugs, and that their blood pressure goes up when the incision is made. It is worth noting that some anaesthetists recommend that the supposed `cadaver’ be anaesthetised when his/her organs are retrieved. Most organ donors are unaware that their hearts may be beating when their organs are taken, and that they may be pink, warm, able to heal wounds, fight infections, respond to stimuli, etc.

We would urge that while the adequacy of brain-related criteria for diagnosing death is fully and fairly investigated, the retrieval of organs from heartbeating donors should be put on hold. Donations from non-heartbeating donors – perhaps after organs have been cooled to preserve them – could continue while this investigation was carried out. At the very least, those who wish to donate their organs should be given the option of being non-heartbeating donors only, and should be fully informed of the state their bodies will be in when their organs are retrieved. Such information requires a proper interview with a medical practitioner who can explain current controversies: simply signing a donor card in no way indicates that the prospective donor understands what organ donation will involve.

Consent

In view of the uncertainties surrounding diagnosis of death, it is all the more important that an `opt out’ system of organ donation be firmly excluded. We welcome the emphasis placed on consent in Human Bodies, Human Choices. Explicit consent by the donor, in addition to consent (or non-objection) by relatives is needed both to safeguard respect for the body, and to protect the interests of the donor in avoiding premature retrieval of organs. We would urge that even if the donor had given fully informed consent to organ donation, objections raised by relatives should be seen as overriding. This is particularly the case with retrieval of organs from heartbeating donors, which can be most distressing for relatives who believe – not without evidence – that their loved one may still be alive.

In the case of non-heartbeating cadavers, we would require consent from the donor him/herself, while relatives should be kept informed and could veto the procedure if they raise strong objections. In the case of children, however, parental consent should be both necessary and sufficient for the retrieval of organs from a non-heartbeating cadaver. Parental consent should also be necessary and sufficient in the case of stillbirth or miscarriage, at whatever stage of pregnancy. Wherever practicable the consent of both parents should be obtained, as generally both will have a legitimate concern for the child, though this will depend on the circumstances of the relationship, contact and custody. However, the deliberate termination of pregnancy and the destruction of human embryos are serious acts of injustice against the child in which the parent or parents are complicit. The use of the body of a child whose life is taken in this way adds insult to injury and is wholly unacceptable.

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Kolbe's gift

Book now for this new production from Ten Ten Theatre. This is from their website:

Kolbe’s Gift is a full-length play written by David Gooderson which tells the story of two men, Fr Maximilian Kolbe, a Franciscan priest, and Franek Gajowniczec, a Polish soldier, whose lives crossed in the most extraordinary way in the Auschwitz concentration camp in 1941. Spanning three decades, Kolbe’s Gift will be produced by Ten Ten Theatre with a cast of seven actors at The Leicester Square Theatre in Central London for one week only in October 2013. With many enriching events surrounding the production, it promises to be a theatrical event not to be missed.

“This place is not simply a concentration camp. It’s a laboratory dedicated to the destruction of human identity. It is the gospel of hate, which can only be defeated by the Gospel of Love.”

In 1941, Polish priest Maximilian Kolbe entered the Nazi concentration camp Auschwitz.

A gifted man, Kolbe was the founder of monasteries in Poland and Japan, produced a monthly magazine with a circulation of over one million, and formed an international movement to help bring people to the Catholic faith. Then, a chance encounter with an ordinary soldier, Franek Gajowniczec, led Kolbe to an extraordinary act – walking away from all that he had and could have achieved.

David Gooderson’s powerful play tells the true story of these two men. One became feted across the globe. The other faded into obscurity. This is their story.

Tickets priced from £12.50 – £20.00 can be booked through the theatre box office on 08448 733433 or via their website.

There is also a booking page here at the TenTen site.

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I was at the Catholic Medical Association Annual Symposium on Saturday. I heard a talk by the barrister Neil Addison about the recent decision in favour of the Scottish midwives, who argued that their conscientious objection to abortion meant they should not be forced to supervise abortions.

Three points that emerged from the judgment stuck in my mind.

First, that ‘treatment’ includes not just the immediate procedure but the whole ‘support’ that is given to the person before and after the procedure; and that someone can therefore object on grounds of conscience to be involved in this wider aspect of treatment.

Second, that if someone is supervising any treatment then they are medically and morally involved in that treatment, even if they are at one stage removed from it.

Third, that if there is some doubt or disagreement, the law should if possible rule in favour of respecting someone’s conscientious objection, in order to avoid putting citizens in the position of having to choose between loyalty to their faith and the law.

This is my summary from memory. Here is the report from Neil Addison’s own blog about the ruling (sorry the text is messy – it hasn’t copied over very well. At least you can read it…).

As a follow up to my post on 7th march 2012 regarding the case of the Scottish Midwifes who did not want to supervise Abortions the earlier decision has now been overuled and their right to conscientious objection recognised in Doogan & Anor v NHS Greater Glasgow & Clyde Health Board [2013] ScotCS CSIH_36   
This a unanimous decision by three Judges of the Inner House of the Court of Session (equivalent to the English Court of Appeal) and recognises in clear terms that the Conscientious Objection clause in s4 Abortion Act 1967 allows Medical staff to refuse to participate in ALL aspects of Abortion “treatment”.
The Court rejected the Hospitals suggestion that s4 only covered participation in the immediate act of Abortion  and also rejected arguments based on inconvenience to the Hospital.  The Court recognised that Abortion is a uniquely controversial aspect of Medical practice and that the right of Conscientious Objection is “a right” which Hospitals have to accommodate regardless of any managerial inconvenience it may cause.
This covers a point I have been involved in as Director of the Thomas More Legal Centre where I have had to protect Nurses being pressurised to participate in Abortion especially the administration of Abortion inducing Drugs. Frequently Hospitals have suggested that s4 only applied to the actual giving of the Drugs but did not cover other aspects of Nursing work.  This Judgment vindicates the Nurses I have represented who have refused to participate in any aspect of Abortion “treatment”
Interestingly the Court also endorsed a South African Court decision Christian Education SA v Minister of Education (2001) 9 BHRC53 where the Judge had said
“believers cannot claim an automatic right to be exempted by their beliefs from the laws of the land. At the same time, the state should, wherever reasonably possible, seek to avoid putting believers to extremely painful and intensely burdensome choices of either being true to their faith or else respectful of the law. “
This case could therefore become an important decision in relation to issues of Religious Freedom extending beyond Abortion”
I am also pleased that the Judgment agreed with a criticism I had made of the earlier decision in my Blog last year when I said
“the Judge in what is a rather sparsely reasoned decision decided that what they were doing in supervising the Abortion process did not in law amount to participation in Abortion. She mentions and in large part relies on the wording of the Nurses Contract and the guidelines issued by the Nursing and Midwifery Council and the Royal College of Nurses which is somewhat peculiar in view of the clear wording of s4(1) that the right of conscientious objection overrides any “contract or .. any statutory or other legal requirement”, that to my mind means that s4(1) should have been considered without any reference to the views of the NMC or the RCN or their guidance.”

In para 33 of the Judgment the court makes clear that even professional guidelines can be legally wrong and cannot overule statute, it says (my emphasis)” Great respect should be given to the advice provided hitherto by the professional bodies, but prior practice does not necessarily dictate interpretation. Moreover, when the subject of the advice concerns a matter of law, there is always the possibility that the advice from the professional body is incorrect. …….It also proceeds on the basis that a midwife has a duty to be non-judgmental and that to be selective is unacceptable, but this ignores the fact that the Act allows a degree of selectivity to those with a conscientious objection”

Even though the Judgment is from a Scottish Court and Scotland is a different jurisdiction to England and Wales the judgment will apply in England and Wales.  The Abortion Act 1967 applies in England, Wales and Scotland (but not in Northern Ireland) and wherever Scottish Courts have adjudicated on such “cross border” legislation their decisions have been accepted without question in England and Wales and vice versa.

The Inner House of the Court of Session is equivalent in status to the Court of Appeal and therefore this case will be treated south of the border on exactly the same basis as if it had been a decision of the Court of Appeal.In the judgment it is noticeable that much of the case-law referred to was English but was treated as binding in Scotland because the Scottish Court was dealing with the same piece of legislation as the English Courts.

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