Accutane Ethics

My son has been taking Accutane for the last several months.  Boy it works well (for acne).  It also raises some first class ethical questions.  There's an extremely strict regimen for taking Accutane, because apparently if a woman takes it and conceives a child, the child will likely be born with significant but not super-serious abnormalities. For example, the child's external ears may be malformed.  As a result of this (and for other reasons), patients taking the drug have to see a doctor every 30 days. Women have to promise to use two forms of birth control while using the drug. Every time you break the seal on a pill, you see a warning about avoiding pregnancy.  The assumption behind all this is that it would be wrong or bad to conceive a child with malformed ears, when you could easily wait just 6 months (the usual course) and conceive a child with normal ears.  Of course it would be wrong or bad!

But maybe ... (Note: I truly love the Louis C.K. "Of course...but maybe" routine.  Do watch if you haven't seen it.  Start at 34:00.)   Enter: David Boonin's new book The Non-Identity Problem and the Ethics of Future People, reviewed here by Molly Gardner. At least in the review, the focus is on a slightly different sort of case.  Boonin contemplates Wilma, who can either conceive now and have Pebbles, who will be blind but will have a life worth living, or take a pill for two months and have Rocks, who won't be blind.  Boonin embraces the argument that concludes it wouldn't be wrong to conceive Pebbles. Here's how it goes--

According to Garnder, Boonin's book looks at all sorts of ways of rebutting this argument and finds them all wanting.  So we should just accept the conclusion. It really wouldn't be wrong to conceive Pebbles.

There's an Accutane version of the argument, and I would rather see that be the focus for two reasons. First of all, Wilma and Pebbles are just cartoon characters--literally.  These issues have a different feel when they come up in real life.  Thousands of women are right now considering whether to heed their doctors' warnings about conceiving while taking Accutane.  It's easy to give Wilma the green light to conceive Pebbles, but surely not so easy to give a real woman the green light to conceive on Accutane.  I'm not sure we're thinking seriously about these things until we're thinking about real people's decisions.

The Accutane version is more real world-ish, and also has some parameters that may make a difference to our intuitions.  In the Accutane scenario, a drug causes the undesirable features--the malformed ears. In the Wilma scenario, a drug causes the desirable features--sight, rather than blindness.  Unconsciously, what might make someone accept (C) in the Wilma argument is the intuition that nobody has to go out of their way, taking special drugs, to have a "better" child.  It might not really be that the conclusion gains whatever plausibility it has from the argument's explicit premises.

So let's look at an Accutane scenario. Mary is thinking about ignoring all the warnings and conceiving in July while taking Accutane. If she does so, she'll have a baby we'll call "July"--a baby with malformed external ears. If she waits until she's finished taking the drug, she'll have a different baby we'll call "December," one with normal ears.  Is it wrong to conceive July?  The argument parallel to the Wilma argument would go like this:

Now that we're talking about real decisions in the real world, not cartoon characters, the conclusion looks quite a bit more amazing, even thought the abnormality in question is far more minor.  Or so it seems to me.  I would be absolutely amazed if the wisdom of our best ethics gave permission to Accutane users to ignore all the warnings and conceive while using the drug.  That would be incredible.

So what's going on here?  July is not worse off for being born--P1 seems right.  So she's not harmed by being conceived--P2 seems right.  Let's ignore P3, since even if it were false, that's not the heart of the matter, surely.  If July is not harmed by being born, then she's not wronged--that's what P4 says.  OK, that seems plausible.  That leaves P5.  If an act wrongs no individual could it still be wrong?

Yes.  Mary wrongs no individual yet she causes more suffering than necessary.  The suffering of July about her ears--surely inevitable--just didn't need to be. It would have been no worse to create December, and creating December would have eliminated that suffering.  Usually what matters is harming individuals, wronging individuals and moral categories of that sort, but it doesn't seem surprising that in the special area of procreative ethics, other principles kick in.  "Cause no more suffering than necessary" is that sort of non-individual-specific principle.  Not that this is the only principle relevant to procreative decisions--the one and only master principle--but it seems relevant if you're a woman wanting to both clear up your acne and have a child.  Refusing to wait six months to conceive is wrong because you'll thereby cause more suffering than necessary.

I bet somewhere in Boonin's book this response is discussed and disparaged--I will have to read the book and find out.  Truth be told, I'm sure I'd shift to some other explanation if I could be convinced that this one was wanting, because what I'm absolutely sure about is that Mary shouldn't conceive while taking Accutane.  That's what's so extremely evident, not the reasons why.


Swastika Cakes and Gay Weddings

It's so rare that Jon Stewart reasons badly, but I wonder about the reasoning in his Indiana piece last night.  Start at 3:45--

Mike Huckabee, Rick Santorum, etc., compare the baker who refuses to "do" a gay wedding with--
  • A gay printer who refuses to print signs saying "God hates fags"
  • A black baker who refuses to bake a KKK cake
  • A Jewish baker who refuses to bake a swastika cake
Stewart than faults them for thinking a gay wedding is anything like a "God hates fags" sign, a KKK cake, or a swastika cake. Making these analogies, he says, just reveals their bigotry.

But no, I take it the idea is that all these business owners are being alleged to be alike in having reasons of conscience to turn away customers.  Nobody's saying the various things turned away are exactly alike.  Huck & Co are arguing that the freedom of conscience in question shouldn't be spurned by liberals, since there are situations in which they will want to invoke it too.

This is at least worth thinking about.  When should a business owner be able to turn away customers? We wouldn't want to restrict that freedom too much and I don't think we do.  "No shirt, no shoes, no service."  If you can turn away shoeless people presumably you can turn away all sorts of people.
The law gives businesses a lot of freedom, I take it, so long as their reasons are non-discriminatory.

Now, the gay printer, black baker, and Jewish baker wouldn't have discriminatory reasons to turn away the customers in question. It's not discriminatory to be offended by bigoted messages.  So their freedom to turn away these customers is secure. But would a baker have non-discriminatory reasons to "do" opposite sex weddings and not same sex weddings?  At least once gay marriage is legal in every state (in June, I hope), it doesn't sound as if any conservative bakers are going to be able to fuss about gay weddings.  No worries--the liberal bakers are still going to be able to take a stand against swastika cakes.

Oh my god, that's actually a thing!


Pet Euthanasia

Our soulful cat Snownose died on Saturday, from cancer, but with the help of euthanasia.  I've never had a cat euthanized before, though I've had many cats.  The whole month before, I had to work up the courage to do this, as did other family members.  I kept thinking about the conservative stance on euthanasia: that intentionally killing another person is always wrong.  (If this were right, I'd extend the prohibition at least to animals who are family members.) In the days leading up to calling the euthanizer--a vet who came to our house--I kept rooting for Snownose to expire on his own.  It seems like it would have been better that way.  It was unfortunate for those who love him to have to play any role in his death.

One thought that kept running through my mind, in the 24 hours just before the Dr. Westbrook came to our door, is that cancer had already taken away Snownose's future.  When he was euthanized, he had maybe a day or two left, if that. We took away only that brief time, and only to prevent suffering.  Does that even deserve to be called "killing"?  Can you really be a killer, and thus responsible for a death, when a disease is already wholly responsible for the death?  I'd be prepared to say "no" except what about this?  Evil nurse or vet sneaks in and injects the dying patient with a poison, just for kicks. Now you want to talk about "killing" again, despite the disease being wholly responsible.

And so--OK!--taking away one day of life, even out of mercy, has to be killing.  Or could a case be made that "euthanizing" is a different sort of thing from killing, because of the motives involved?  Is this one of those unusual cases in which motives matter to the kind of act performed? (And now I regret that I have not yet read Motive and Rightness, by my colleague and friend Steve Sverdlik.) In fact, the phrase "mercy killing" has gone out of fashion, and certainly vets don't use the "k" word.  They "put down" animals (at least here in Texas), or at worst euthanize them; they don't kill them.  Maybe (big maybe) the practitioners are onto something and these aren't just euphemisms.


The Marquette Situation

A word about Marquette's attempt to fire John McAdams.  One thing (among many) that bothers me is that Dean Holz's letter reveals a double standard.  In the second paragraph he charges McAdams with trying to "silence the less-powerful" but nowhere in the letter does he voice any concern at all about the undergraduate--who is the less powerful person in the instructor-student relationship.  Here are two excerpts from the transcript--

Being against gay marriage is having an opinion that's "not appropriate" and "harmful" Abbate says here.  The student can either keep his opinions to himself or drop the class. There are no two ways about it--she (the more powerful of the two) is silencing the student (the less powerful).  Despite the letter's concerns about McAdams allegedly silencing Abbate, the dean voices no concern at all about Abbate silencing the student.

Now you might say--some opinions are beyond the pale.  You do have to stop students from engaging in hate speech--which some will do, if given a chance (I know from experience).  But in the relevant context, can opposing gay marriage be put in that category? The student has enrolled at a Catholic University, and as we all know, the Catholic church opposes gay marriage. Furthermore, this is a time when gay marriage is being debated in the courts.  Several members of the Supreme Court are going to oppose it in hearings later this year.  It can't be right to lump opposition to gay marriage with forbidden, hateful speech.

So the student was quite right to be incensed.  But right to record the conversation? That's another matter.  And right to go to McAdams with his complaint? Again, another matter.  And was McAdams within his rights to blog about the affair?  Did he know he was going to bring an angry mob to her door? Did he continue stirring the pot even after she had come under attack?  All to be investigated carefully.  I haven't done enough homework to have a firm opinion.

But if you don't like the alleged silencing of a grad student by a more powerful faculty member, you shouldn't like to see a grad student silence an undergrad either.  I've read various defenses of Abbate's stance, and none of them really wash.  The next class period, she voiced her thoughts about gay marriage, explaining why the topic didn't fit into her lesson plan.  But what she says in that class (with the student now gone) doesn't change much.  She doesn't say that students against gay marriage would be welcome to speak out in the right context.

Holz says the student didn't actually drop the class because of the issue about his right to speak out.  But that doesn't alter the fact that Abbate did tell him to drop the class if he didn't like her policy on prohibiting homophobia--which (she implies) pertains to the student's desire to express opposition to gay marriage.

Another defense I've read is that there are provisions in Marquette's code of conduct designed to protect students from being exposed to hateful speech, and Abbate was merely abiding by those.  I can't believe anyone really thinks that was her actual motivation, and it would be scandalous if philosophers acquiesced in an interpretation of campus codes of conduct that would deligitimize considerable chunks of the standard content of ethics classes.

In all the discussion of this situation I've read, I've run into vast amounts of consternation about the silencing of powerless graduate students by tenured faculty, and no consternation about the silencing of powerless undergraduates.  I respect the fact that McAdams was concerned about the undergrad, though I realize his concern was mixed with right wing motives of various kinds.  McAdams doesn't stand up for feminists who feel silenced, or gay students who feel silenced, or animal rights advocates who feel silenced.  So he doesn't have a principled, universal concern about the speech rights of students.  But wait. Neither do the many supporters of Abbate.  I suspect they are on her side, against Adams and the undergrad, because she's the friend of gay rights in the trio.

We need consistent, content-neutral support for free speech, and not just for the speech we agree with.  It pleases me to see some liberals supporting McAdams, and pending my doing more homework on just how much he knew his blogging on behalf of the undergrad would incite an angry mob against Abbate, I'm inclined to be one of them.


Sexual Misconduct on College Campuses

Every week there's another appalling story about the way college campuses deal with sexual misconduct.  A Rolling Stone investigation of UVA shows that on some campuses there's not much of a response even if  a student complains of being gang raped by seven men at a frat party. Among many astonishing details in the story: there were 38 allegations of sexual assault in a recent one year period at UVA; and no student has ever been expelled for sexual misconduct there, while many have been expelled for violating UVA's revered honor code. 

On the other hand, there's this amazing story today about the other side of the sexual misconduct spectrum.  A male Swarthmore student was expelled for an allegedly non-consensual, non-penetrative sex act that occurred a day before the alleged victim initiated consensual intercourse with him (she complained about the earlier act nearly two years later).  Now Swarthmore is vacating that decision and giving the student a chance to have his case re-considered. (Understandably, he's moved on to another school.) Follow the link and read about the judicial process that led to the student's expulsion. Even if you're prepared to think an instance of sexual assault could conceivably precede consensual sex by just 24 hours, you have to agree that the accused student's case was horribly mishandled.

Anyone with college age sons and daughters (I have one of each) has to be completely appalled by both of these stories.  And everyone else with empathy and a sense of justice.