In this short response to Gray’s article Capacity and Decision Making we double down on our argum... more In this short response to Gray’s article Capacity and Decision Making we double down on our argument that risk-relativity is a nonsense. Risk relativity is the claim that we should set a higher standard of competence for a person to make a risky choice than to make a safe choice. Gray’s response largely involves calling attention to the complexities, ramifications and multiple value implications of decision-making, but we do not deny any of this. Using the notion of quality of care mentioned by Gray, we construct an argument that might be used to support risk relativity. But it is no more persuasive than the arguments put forward by risk-relativists.
Background: Medical Assistance in Dying (MAID) was legalized in Canada without a designated perio... more Background: Medical Assistance in Dying (MAID) was legalized in Canada without a designated period for implementation. Providers did not have access to customary alternatives for training and mentorship during the first 1–3 years after legalization. Objective: To report on how doctors prepared for their first provision of MAID in the early period after legalization in Canada. Design: Qualitative research design within an interpretive phenomenological theoretical framework. We asked participants to describe their experiences preparing for first MAID provision. Analysis of transcripts elicited themes regarding training and information desired by early adopters for provision of newly legalized MAID. Participants: Twenty-one early adopting physician-providers in five Canadian provinces were interviewed. Results: Few formal training opportunities were available. Many early-adopting providers learned about the procedure from novel sources using innovative methods. They employed a variety ...
1. Creating the Child D. Evans. Part 1: Infertility and the Role of Medicine. 2. Assisted Concept... more 1. Creating the Child D. Evans. Part 1: Infertility and the Role of Medicine. 2. Assisted Conception: The State of the Art J. Parsons. 3. Control of Human Reproduction: A Clinical Perspective on Bioethical Problems G.C. di Renzo, et al. 4. The Clinical Classification of Infertility D. Evans. 6. Ad hominem: A Consideration of a Feminist Critique of the Moral Discourse of Embryologists and Others N. Pickering. Part 2: Assisted Procreation: Rights and Duties. 7. Is a "Hands off" Policy to Reproduction Preferable to Artificial Intervention? M. Mori. 8. Naturally Conceived: The Idea of the Natural in Moral Arguments About Assisted Conception N. Pickering. 9. A Right to Procreate? Assisted Conception, Ordinary Procreation and Adoption M. Evans. 10. Child or Parent Oriented Controls of Reproductive Technologies? D. Neri. 11. Legal Approaches to Motherhood in Hungary J. Sandor. 12. The Interaction of Rationality and Freedom of Conscience in Legislation on Controversial Bioethical ...
In a recent JME article, Guidry-Grimes, Dean and Victor offer some signal and challenging insight... more In a recent JME article, Guidry-Grimes, Dean and Victor offer some signal and challenging insights into the ethical analysis of covert medication (in general) and in particular when administered via food. They warn of impacts on identity likely to emerge from using food in this way. In particular, they caution against allowing families to be involved in covert medication, in the light of their central role in sustaining identity. Their analysis has particular purchase in resource rich contexts and those contexts where individual identity is a central concern. But it is less clear that the article’s insights are relevant to other contexts. This article places the analysis of covert medication and identity in a wider context, arguing both that the focus on identity is equally significant when analysing potential alternatives to covert medication, such as coercion; and that the ethical analysis of covert medication offered by Guidry-Grimes, Dean and Victor lacks global applicability. I...
... Printed on acid-free paper All Rights Reserved й 1996 Kluwer Law International Kluwer Law Int... more ... Printed on acid-free paper All Rights Reserved й 1996 Kluwer Law International Kluwer Law International incorporates the publishing programmes of Graham & Trotman Ltd, Kluwer Law and Taxation Publishers, and Martinus Nijhoff ... 5. Evans, D., p. 57 and Soren Holm pp. ...
Mental health legislation that requires patients to accept ‘care’ has come under increasing scrut... more Mental health legislation that requires patients to accept ‘care’ has come under increasing scrutiny, prompted primarily by a human rights ethic. Epistemic issues in mental health have received some attention, however, less attention has been paid to the possible epistemic problems of mental health legislation existing. In this manuscript, we examine the epistemic problems that arise from the presence of such legislation, both for patients without a prior experience of being detained under such legislation and for those with this experience. We also examine how the doctor is legally obligated to compound the epistemic problems by the knowledge they prioritise and the failure to generate new knowledge. Specifically, we describe the problems of testimonial epistemic injustice, epistemic silencing, and epistemic smothering, and address the possible justification provided by epistemic paternalism. We suggest that there is no reasonable epistemic justification for mental health legislati...
Australian and New Zealand Journal of Obstetrics and Gynaecology, 2021
High adolescent pregnancy rates in New Zealand (NZ) are influenced by limited access to contracep... more High adolescent pregnancy rates in New Zealand (NZ) are influenced by limited access to contraception. In this paper, we discuss using a proactive contraception provision (PCP) model to overcome barriers that prevent effective contraceptive uptake. After outlining steps taken to assess acceptability of PCP in NZ, we cover three issues to consider with PCP: the range of contraceptives that should be offered, the age range that should be approached, and finally whether to include adolescents without uteruses. We conclude that PCP is an approach worth considering in the NZ context and should be piloted to assess feasibility and effectiveness.
Protocol for 'Doctors’ Reflections on Performing Face-to-Face Voluntary Medical Assistance in... more Protocol for 'Doctors’ Reflections on Performing Face-to-Face Voluntary Medical Assistance in Dying
If a person is competent to consent to a treatment, is that person necessarily competent to refus... more If a person is competent to consent to a treatment, is that person necessarily competent to refuse the very same treatment? Risk relativists answer no to this question. If the refusal of a treatment is risky, we may demand a higher level of decision-making capacity to choose this option. The position is known as asymmetry. Risk relativity rests on the possibility of setting variable levels of competence by reference to variable levels of risk. In an excellent 2016 article in Journal of Medical Ethics (JME), Rob Lawlor defends asymmetry of this kind by defending risk relativity, using and developing arguments and approaches found in earlier work such as that of Wilks. He offers what we call the two-scale approach: a scale of risk is to be used to set a standard of competence on a scale of decision-making difficulty. However, can this be done in any rational way? We argue it cannot, and in this sense, and to this extent, risk relativity is a nonsense.
In this paper, we make the case that a person who is considering or has already made a decision t... more In this paper, we make the case that a person who is considering or has already made a decision that appears seriously harmful to that person should in some cases be judged incapable of making that decision because of the harmfulness of the decision. We focus on the English case of C of 2015. C refused life-saving dialysis. The hospital wanted her declared incompetent to make this decision under the English Mental Capacity Act of 2005. The Judge argued that the consequences for a person's welfare of their decision are irrelevant to the assessment of competence, a position labeled "internalism." This aligns with an assessment of decision-making competence on a strictly cognitivist model. However, internalism misrepresents decision-making. The outcomes of decision-making processes should be part and parcel of judgments of decision-making competence, and in some cases are necessary for any judgment of incompetence to be made.
Szasz stoutly opposed the use of the insanity defense. This chapter considers the persuasiveness ... more Szasz stoutly opposed the use of the insanity defense. This chapter considers the persuasiveness of Szasz’s arguments against it, which fall into three broad categories: (1) arguments that the insanity defense is immoral; (2) arguments that it relies on a nonexistent entity, namely mental illness; and (3) arguments that the sciences of psychiatry offer no grounds for supporting it. Each category of argument is explored in its various forms. The most persuasive type of argument is found to be the third. Unlike the other two, it does not require us to buy into strong and broad beliefs which are indeed characteristically Szaszian (such as that mental illness is a myth), but which lack widespread acceptance. In contrast, Szasz’s argument that the sciences associated with psychiatry (such as psychology) do not offer grounds for the existence of the insanity defense appeals to a commonly held and highly plausible multifactorial account of the causes of human behavior. In short, analysed c...
AIM In New Zealand, there are sexually active adolescents who are using poor or no methods of con... more AIM In New Zealand, there are sexually active adolescents who are using poor or no methods of contraception, and who do not intend to become pregnant. The most effective methods of contraception suitable to this population are long acting reversible contraceptive (LARC) methods. A proactive LARC provision (PLP) programme has been proposed, and this study investigates whether such a model would be acceptable to adolescents. This study aims to determine how adolescents feel about a PLP programme. METHODS We conducted four focus groups (FGs) of female adolescents at three high schools and one university residential college, with 32 participants in total. The data from these were analysed for themes using a general inductive thematic analysis approach. RESULTS When asked how they felt about a PLP programme, the adolescents found the concept acceptable. This study identified misconceptions and myths around contraception in the adolescent population. The five identified themes were reprod...
In this short response to Gray’s article Capacity and Decision Making we double down on our argum... more In this short response to Gray’s article Capacity and Decision Making we double down on our argument that risk-relativity is a nonsense. Risk relativity is the claim that we should set a higher standard of competence for a person to make a risky choice than to make a safe choice. Gray’s response largely involves calling attention to the complexities, ramifications and multiple value implications of decision-making, but we do not deny any of this. Using the notion of quality of care mentioned by Gray, we construct an argument that might be used to support risk relativity. But it is no more persuasive than the arguments put forward by risk-relativists.
Background: Medical Assistance in Dying (MAID) was legalized in Canada without a designated perio... more Background: Medical Assistance in Dying (MAID) was legalized in Canada without a designated period for implementation. Providers did not have access to customary alternatives for training and mentorship during the first 1–3 years after legalization. Objective: To report on how doctors prepared for their first provision of MAID in the early period after legalization in Canada. Design: Qualitative research design within an interpretive phenomenological theoretical framework. We asked participants to describe their experiences preparing for first MAID provision. Analysis of transcripts elicited themes regarding training and information desired by early adopters for provision of newly legalized MAID. Participants: Twenty-one early adopting physician-providers in five Canadian provinces were interviewed. Results: Few formal training opportunities were available. Many early-adopting providers learned about the procedure from novel sources using innovative methods. They employed a variety ...
1. Creating the Child D. Evans. Part 1: Infertility and the Role of Medicine. 2. Assisted Concept... more 1. Creating the Child D. Evans. Part 1: Infertility and the Role of Medicine. 2. Assisted Conception: The State of the Art J. Parsons. 3. Control of Human Reproduction: A Clinical Perspective on Bioethical Problems G.C. di Renzo, et al. 4. The Clinical Classification of Infertility D. Evans. 6. Ad hominem: A Consideration of a Feminist Critique of the Moral Discourse of Embryologists and Others N. Pickering. Part 2: Assisted Procreation: Rights and Duties. 7. Is a "Hands off" Policy to Reproduction Preferable to Artificial Intervention? M. Mori. 8. Naturally Conceived: The Idea of the Natural in Moral Arguments About Assisted Conception N. Pickering. 9. A Right to Procreate? Assisted Conception, Ordinary Procreation and Adoption M. Evans. 10. Child or Parent Oriented Controls of Reproductive Technologies? D. Neri. 11. Legal Approaches to Motherhood in Hungary J. Sandor. 12. The Interaction of Rationality and Freedom of Conscience in Legislation on Controversial Bioethical ...
In a recent JME article, Guidry-Grimes, Dean and Victor offer some signal and challenging insight... more In a recent JME article, Guidry-Grimes, Dean and Victor offer some signal and challenging insights into the ethical analysis of covert medication (in general) and in particular when administered via food. They warn of impacts on identity likely to emerge from using food in this way. In particular, they caution against allowing families to be involved in covert medication, in the light of their central role in sustaining identity. Their analysis has particular purchase in resource rich contexts and those contexts where individual identity is a central concern. But it is less clear that the article’s insights are relevant to other contexts. This article places the analysis of covert medication and identity in a wider context, arguing both that the focus on identity is equally significant when analysing potential alternatives to covert medication, such as coercion; and that the ethical analysis of covert medication offered by Guidry-Grimes, Dean and Victor lacks global applicability. I...
... Printed on acid-free paper All Rights Reserved й 1996 Kluwer Law International Kluwer Law Int... more ... Printed on acid-free paper All Rights Reserved й 1996 Kluwer Law International Kluwer Law International incorporates the publishing programmes of Graham & Trotman Ltd, Kluwer Law and Taxation Publishers, and Martinus Nijhoff ... 5. Evans, D., p. 57 and Soren Holm pp. ...
Mental health legislation that requires patients to accept ‘care’ has come under increasing scrut... more Mental health legislation that requires patients to accept ‘care’ has come under increasing scrutiny, prompted primarily by a human rights ethic. Epistemic issues in mental health have received some attention, however, less attention has been paid to the possible epistemic problems of mental health legislation existing. In this manuscript, we examine the epistemic problems that arise from the presence of such legislation, both for patients without a prior experience of being detained under such legislation and for those with this experience. We also examine how the doctor is legally obligated to compound the epistemic problems by the knowledge they prioritise and the failure to generate new knowledge. Specifically, we describe the problems of testimonial epistemic injustice, epistemic silencing, and epistemic smothering, and address the possible justification provided by epistemic paternalism. We suggest that there is no reasonable epistemic justification for mental health legislati...
Australian and New Zealand Journal of Obstetrics and Gynaecology, 2021
High adolescent pregnancy rates in New Zealand (NZ) are influenced by limited access to contracep... more High adolescent pregnancy rates in New Zealand (NZ) are influenced by limited access to contraception. In this paper, we discuss using a proactive contraception provision (PCP) model to overcome barriers that prevent effective contraceptive uptake. After outlining steps taken to assess acceptability of PCP in NZ, we cover three issues to consider with PCP: the range of contraceptives that should be offered, the age range that should be approached, and finally whether to include adolescents without uteruses. We conclude that PCP is an approach worth considering in the NZ context and should be piloted to assess feasibility and effectiveness.
Protocol for 'Doctors’ Reflections on Performing Face-to-Face Voluntary Medical Assistance in... more Protocol for 'Doctors’ Reflections on Performing Face-to-Face Voluntary Medical Assistance in Dying
If a person is competent to consent to a treatment, is that person necessarily competent to refus... more If a person is competent to consent to a treatment, is that person necessarily competent to refuse the very same treatment? Risk relativists answer no to this question. If the refusal of a treatment is risky, we may demand a higher level of decision-making capacity to choose this option. The position is known as asymmetry. Risk relativity rests on the possibility of setting variable levels of competence by reference to variable levels of risk. In an excellent 2016 article in Journal of Medical Ethics (JME), Rob Lawlor defends asymmetry of this kind by defending risk relativity, using and developing arguments and approaches found in earlier work such as that of Wilks. He offers what we call the two-scale approach: a scale of risk is to be used to set a standard of competence on a scale of decision-making difficulty. However, can this be done in any rational way? We argue it cannot, and in this sense, and to this extent, risk relativity is a nonsense.
In this paper, we make the case that a person who is considering or has already made a decision t... more In this paper, we make the case that a person who is considering or has already made a decision that appears seriously harmful to that person should in some cases be judged incapable of making that decision because of the harmfulness of the decision. We focus on the English case of C of 2015. C refused life-saving dialysis. The hospital wanted her declared incompetent to make this decision under the English Mental Capacity Act of 2005. The Judge argued that the consequences for a person's welfare of their decision are irrelevant to the assessment of competence, a position labeled "internalism." This aligns with an assessment of decision-making competence on a strictly cognitivist model. However, internalism misrepresents decision-making. The outcomes of decision-making processes should be part and parcel of judgments of decision-making competence, and in some cases are necessary for any judgment of incompetence to be made.
Szasz stoutly opposed the use of the insanity defense. This chapter considers the persuasiveness ... more Szasz stoutly opposed the use of the insanity defense. This chapter considers the persuasiveness of Szasz’s arguments against it, which fall into three broad categories: (1) arguments that the insanity defense is immoral; (2) arguments that it relies on a nonexistent entity, namely mental illness; and (3) arguments that the sciences of psychiatry offer no grounds for supporting it. Each category of argument is explored in its various forms. The most persuasive type of argument is found to be the third. Unlike the other two, it does not require us to buy into strong and broad beliefs which are indeed characteristically Szaszian (such as that mental illness is a myth), but which lack widespread acceptance. In contrast, Szasz’s argument that the sciences associated with psychiatry (such as psychology) do not offer grounds for the existence of the insanity defense appeals to a commonly held and highly plausible multifactorial account of the causes of human behavior. In short, analysed c...
AIM In New Zealand, there are sexually active adolescents who are using poor or no methods of con... more AIM In New Zealand, there are sexually active adolescents who are using poor or no methods of contraception, and who do not intend to become pregnant. The most effective methods of contraception suitable to this population are long acting reversible contraceptive (LARC) methods. A proactive LARC provision (PLP) programme has been proposed, and this study investigates whether such a model would be acceptable to adolescents. This study aims to determine how adolescents feel about a PLP programme. METHODS We conducted four focus groups (FGs) of female adolescents at three high schools and one university residential college, with 32 participants in total. The data from these were analysed for themes using a general inductive thematic analysis approach. RESULTS When asked how they felt about a PLP programme, the adolescents found the concept acceptable. This study identified misconceptions and myths around contraception in the adolescent population. The five identified themes were reprod...
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Papers by Neil Pickering