Thursday, January 10, 2008

Myopic Medical Ethics

Janet Stemwedel has an interesting post describing "considerations from medical ethics that might explain why a birth control pill for men has not happened yet." Apparently the standard understanding of medical 'ethics' requires that any health risks involved in a new treatment are outweighed by specifically health benefits for the treated individual. It's insane.

First, health is not all that matters in life. Indeed, the value of good health is entirely derivative of how it enables one to live a good/flourishing life more generally. So it's just weirdly myopic to look only at the health benefits of a treatment, and ignore everything else that matters (which is, after all, a whole damn lot). Reproduction, in particular, is a big -- life-changing -- deal. As Janet says, "men have an interest in controlling their fertility, too." Unwanted paternity could really mess up a guy's life! This fact ought to carry some ethical weight.

Second, the individual focus is jarringly odd, especially in the context of intimate relationships. We care about the health and welfare of those we love, as we do our own. So in weighing the costs and benefits of some action, I care about more than just the benefits to me. If some course of action would benefit my partner, that's clearly a reason in its favour, as I see things.

There are things we care about besides physical health, and people we care about besides ourselves. It is ridiculous and myopic for medical "ethicists" to dismiss these legitimate values and interests. In fact, I don't see the need for ethicists here at all. I certainly don't appreciate their "concern" to limit my options. Just provide all the relevant information, then let me make an informed decision for myself, thank you very much.


  1. This seems like a bizarre policy to me, especially in light of the fact that we already have policies that have this effect. For example, live-donor organ transplantation. I can choose to donate a kidney, or a piece of my liver, or a piece of my lung, or some bone marrow to an ailing friend or relative. Any competent doctor will happily cut it out of me, despite the fact that the procedure poses me considerable health risk and offers me no direct benefit. Since this is allowed, how on earth could there even be a question about male contraceptive pills?

  2. "medical ethics" is, basically just plain evil.

  3. I wouldn't jump the gun here and point it at medical ethicists.

    This is a narrow reading of principle at play and I would agree with the commentators at Jane's blog, I doubt this is the main factor involved with the lack of such a pill. I certainly doubt it would deter researchers even if it may make it harder to get past an ethics committee.

    The principle that is usually applied is that if there is some risk of harm to the research participant there must be some proportionate chance and level of benefit for the participant. I don't think this has to read only in terms of health.

    Largely the principle is aimed at preventing exploitation by making it typically unjustifiable to use someone in research which involves significant risk but benefits only others.

    That said given that medical researchers are often doctors, they have their own ethical obligations towards patients, the principle also supports clinical equipoise.

    It still isn't going to suit your utilitarian inclinations, but in general people don't accept that some may be sacrificed for the potential benefit of others, so I don't read the general principle as insane, though I agree the version Jane gives is.

    "In fact, I don't see the need for ethicists here at all"

    Richard the reason you might get the chance to make a fully informed decision of your own to engage in medical research is largely a result of those interfering ethicists... If you need a reason do a google search on unethical research. Working in research ethics on these committees you see some pretty scary proposals for research.

  4. David - I agree that ethicists are necessary in some circumstances, e.g. vetting research that involves deception. But not here.

    Also, note that my second point was not strictly "utilitarian", but the far more mundane point that many of us would happily volunteer to aid our loved ones. (This is quite a different matter from forced sacrifice to benefit strangers!)

  5. yup - medical ethics is evil.

    OK things could be worse, but they could be a hell of a lot better.


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