Tuesday, 5 May 2009

Rogue Ethicists

Associate Professor Nicholas Tonti-Filippini advertises himself as an "ethicist". An "Independent Consultant Ethicist" no less.

From the John Paul II Institute:
Associate Professor Tonti-Filippini is the Institute Associate Dean (Teaching, Learning and Research) and Head of Bioethics and also a consultant in bioethics. He is a member of the Australian Health Ethics Committee of the National Health and Medical Research Council and chair of the sub-committees on the Unresponsive State and Comercialization of Human Tissue. He is the subject co-ordinator for:

* JP502 – Philosophical Foundations of Bioethics
* JP540 – Foundations of Christian Moral Life
* JP543 – Theological Bioethics

* JP544 – Beginning of Life Ethics
* JP545 – End of Life Ethics
* JP546 – Current Controversies in Bioethics
* JP547 – Theology and Practice of Natural Family Planning
* JP564 – Educating in Sexuality, Marriage, Family and Life
I think it's fair to describe him as a paid apologist for the Catholic Church, rather than a neutral party.

But that doesn't make him a mere Religious spokesperson for the Vatican. For example, consider the fraught issue of human cloning. An "ethicist" could reasonably express concern about a variety of issues, such as the safety of it for a cloned child. Experiments on animals show premature aging from clipped telomeres: clone a 40 year old, and you get a foetus that is already showing signs of 40 years of aging in the womb. An "ethicist" could also be concerned about the ethics involved in allowing multiple direct genetic copies for a privileged few, rather than them having to mix their genes with someone else's. There's plenty of valid concerns here. So what does this "ethicist" have to say? :
“Cloning is asexual reproduction – suitable for worms and amoeba. The origin of a new human being warrants a context of dignified human love that only spouses can provide through their love-making.”
Ah. Not ethics, but Religious Morality. He's not an "ethicist" so much as a religious spokesperson. Nothing wrong with that, as long as it's not concealed. So what are his opinions on scientists who work for groups with their own agendas, commercial organisations and the like? People in situations not unlike his own? From the ABC :
...I had said that 75 per cent of Australian medical research is unregulated.

Well, that's a figure stated from the NH&MRC documents.

The NH&MRC really only regulates Commonwealth funded research.

I don't think he really understand the local situation in that respect.

The other was the use of the phrase rogue scientists.

And what I had said, and I don't know if he had read it, was that those scientists who operate outside of the National Health and Medical Research Council guidelines are rogue scientists.
"Those scientists who operate outside of the National Health and Medical Research Council guidelines" - that is, the 75% of them that receive no Commonwealth funding - "are rogue scientists". Because they are presumed to be paid apologists for their employers.

He hurriedly backtracked in the interview, saying
I made no claim as to the proportion of them.
Right....

So if I was to say that those "ethicists" like him in the pay of religious groups are "rogue ethicists" because of their obvious agenda, that would be equally true.

I make no claim about the proportion of course. Libel laws in this country are fairly strict, and truth is not a reliable defence.

Oh, the "he" who this "ethicist" refers to? That's Lord Robert Winston, who had these pungent words to say about this "ethicist"'s calumnies:
PHILIPPA McDONALD: But it was Mr Tonti-Filippini's assertion that rogue scientists are flourishing which had Lord Winston crying foul.

LORD ROBERT WINSTON: Well, this, ladies and gentlemen, is rubbish and it should be treated, actually, with scorn.

It's rubbish because, of course, it's patently untrue.

Rogue scientists actually don't exist in any community.

This man who calls himself an ethicist is lying.

He's actually using something which is fundamentally not ethical.

PHILIPPA McDONALD: As far as Lord Winston is concerned, the great majority of scientists are in the business for altruistic reasons.
As are, no doubt, associate professors at the John Paul II institute. Just because one is a paid apologist doesn't mean one is automatically dishonest and unethical. I'm certain that this "ethicist" does his best to very strictly and ethically adhere to Catholic dogma, regardless of the facts of individual cases, and regardless of scientific evidence. Science is notoriously fallible, unlike say, the Pope speaking Ex Cathedra on doctrinal issues.

I note that this "ethicist" has a handful of publications - none of a scientific nature though. Only in ON-LINE. Australia's E-Journal of Social and Political Debate. That he has no scientific publications isn't surprising though. His qualifications are a B.A.(Hons) and M.A. (Monash), and a Ph.D. (Melbourne) in the Department of Philosophy.

Of course, let it be noted that my own qualifications are only a BSc (Sydney), an MInfoTech(Distinction) (Charles Sturt), and I'm working on a PhD at the Australian National University, in the Department of Computer Science. So while I'm a Scientist rather than an "Arts Student", I have no more qualifications in biology than Doctor (of philosophy that is) Tonti-Phillipini.

So let's look at one of these articles - on (you guessed it), Transsexuality.
Gender Identity Disorder affects about 1 in 100,000 adolescent girls.
Er, that comes from a textbook nearly 30 years old. But they were last repeated in the DSM-IV-TR, the Psychiatrist's Bible as it were - the Diagnostic Standard Manual version 4 Text Revised. The actual wording is:
Prevalence:
There are no recent epidemiological studies to provide data on prevalence of Gender Identity Disorder. Data from smaller countries in Europe with access to total population statistics and referrals suggest that roughly 1 per 30,000 adult males and 1 per 100,000 adult females seek sex-reassignment surgery."
These figures came from Walinder in Sweden, and are over 40 years old now. Better numbers are in the World Professional Association for Transgender Health "Standards of Care" from over 5 years ago:
"The earliest estimates of prevalence for transsexualism in adults were 1 in 37,000 males and 1 in 107,000 females. The most recent prevalence information from the Netherlands for the transsexual end of the gender identity disorder spectrum is 1 in 11,900 males and 1 in 30,400 females."
But never mind. I can't expect a philosopher to know such details, and in philosophy (unlike biology) textbooks don't become obsolete every 5 years.
This is not just a matter of a girl who wants to be like a boy. But a girl who believes that despite her female biology she is a boy and hates her own femaleness to the extent that it affects her ability to function normally.

The official description of the condition provided by the American Association of Psychiatrists states that a girl with this condition may claim that she has or will grow a penis and may not want to grow breasts or menstruate. She may assert that she will grow up to be a man. Such girls typically reveal marked cross-gender identification in role-play, dreams and fantasies.
Er.. that's for young children, up to about age 12. Not adolescents. They're not delusional, and neither are the youngsters. Just not well educated in comparative biology.
The accepted management of this condition is usually psychotherapy aimed at relieving the distress and anxiety by helping her to accept herself as she is, a biological female who identifies as a male. More radically, some clinics have been established that offer gender reassignment which includes hormonal treatment initially followed by surgical treatment to remove female organs and construct male sexual organs.
Minimal intervention is always best: but in severe, obvious cases, psychotherapy is like putting a band-aid on a sucking chest wound. Minimal intervention here involves triadic therapy - psychological assessment (and treatment of any co-morbidities), hormone therapy, and surgery. From the Standards of Care again:
Many persons with GID will desire all three elements of triadic therapy. Typically, triadic therapy takes place in the order of hormones = = > real life experience = = > surgery, or sometimes: real life experience = = > hormones = = > surgery. For some biologic females, the preferred sequence may be hormones = = > breast surgery = = > real life experience. However, the diagnosis of GID invites the consideration of a variety of therapeutic options, only one of which is the complete therapeutic triad. Clinicians have increasingly become aware that not all persons with gender identity disorders need or want all three elements of triadic therapy.
So far so good. Some minor issues due to quoting obsolete figures and I'd differ in emphasis, but if even if a regurgitation from a textbook, it's a good textbook. A reasonable background that is close enough to what I would have written myself.
In adults the medical evidence concerning hormonal and surgical sexual reassignment is equivocal. It appears that those who have the sexual reassignment still suffer similarly high suicide, low unemployment and high levels of social dislocation. Sexual reassignment therapy is not evidence-based medicine. There have been no controlled clinical trials to assess its benefits.
Actually... no. Almost completely false in every respect.
See Sex Reassignment. Thirty Years of International Follow-up Studies After Sex Reassignment Surgery: A Comprehensive Review, 1961-1991by Pfaefflin and Junge.

Adolescents who don't receive triadic therapy have a rate of self-harm of 50% by age 20. Those who do receive it have rates approximating that of the normal population of that age.

It's true that there have been no controlled clinical trials. That's because it would be unethical to hold them, when we have 98% success rate of triadic therapy from clinical evidence, and at least a 30% mortality rate if treatment is withheld. Many medical therapies - such as amputations of gangrenous limbs - have also not had controlled clinical trials, as it would involve deliberately causing the deaths of many patients.
It is thus very disturbing that the judge should have embarked on such a medically untested path, especially in someone so young.

In the judgement there is reference to the evidence of six medical experts. Surprisingly, given the medical controversy and lack of evidence for the procedure generally, all six are completely in agreement as to the medical management of the condition.
Well, it would be surprising if there was any controversy. But the only people who consider it controversial are those whose religious beliefs contradict the actual evidence.
Given that sexual reassignment is not medically mainstream, the nature of the agreement between the experts raises a question of selection and balance in relation to the choice of experts.
From the Standards of Care once more:
Sex Reassignment is Effective and Medically Indicated in Severe GID. In persons diagnosed with transsexualism or profound GID, sex reassignment surgery, along with hormone therapy and real life experience, is a treatment that has proven to be effective. Such a therapeutic regimen, when prescribed or recommended by qualified practitioners, is medically indicated and medically necessary. Sex reassignment is not "experimental," "investigational," "elective," "cosmetic," or optional in any meaningful sense. It constitutes very effective and appropriate treatment for transsexualism or profound GID.

It's about as mainstream as it's possible to be.
The report also indicates close associations between experts, even working in the same place. In an area of controversy it is not unexpected to find experts clubbing together. What is unexpected is that others not so involved appear not to have been asked to provide more balanced evidence.
The trouble is that the numbers involved are relatively small, so of course the handful of specialists all know each other. And that because the accepted treatment is so mainstream, the only opponents are those who have strong religious objections to it. This is like complaining that all doctors seem to see blood transfusions as appropriate therapy for massive blood loss, and asking for alternate views from Jehovah's Witnesses.

Now onto a current case before the courts: that of a 16 year old boy suffering from gynecamastea, who wants cosmetic surgery so he looks more like his peers. Except that this boy is transsexual, so he has to get permission not just from the psychiatric establishment, but from the courts too. He's now 17 as the result.

When doing a story about the shape of the Earth, it can be difficult finding astrophysicists who don't say that it's somewhat round, an oblate spheroid. But a good journalist can always find the president of the Flat Earth society to argue differently. Which is why the same few names keep cropping up on one side, versus the multitudes of different names on the other. Now in this case, the choice is more limited. It's this "ethicist" versus, well, pretty much everyone else who doesn't shre his strictly Theological view of medicine. From the ABC:
Dr Tonti-Filippini argues it's a psychological condition and he thinks in this case the Family Court has been given limited expert opinion and that surgery isn't what's needed.

NICHOLAS TONTI- FILIPPINI: Most psychiatrists who treat people with gender dysphoria don't recommend the surgery and the transsexual changes.
To the extent that's true, it's misleading. Cardiologists don't recommend open heart surgery either. Except where, you know, it's needed. Similarly with psychologists and psychiatrists specialising in treating Transsexuality.
It worries me that this young woman is to have her breast cut off with the authority of the court, when the court hasn't got, well they haven’t got the mainstream view.
By that he means not the medical mainstream, but the Catholic Philosophy mainstream. At least I hope so. Could he really be that misinformed?
SARA EVERINGHAM: How do you think this should be managed?
Sara... he's not a medical doctor. He's a Philosopher. Oh well, carry on. I'm sure you could go to a philosophy department rather than a dentist next time you have a toothache.
NICHOLAS TONTI- FILIPPINI: You've got to look at it in terms of a person who is usually not well socially adjusted and so you would need to deal with those things. So that there are beliefs there, there are attitudes there which are harmful to her, that prevent her from forming normal relationships with women.

MICHAEL ROBERTSON: Well that reflects a very simplistic view.

SARA EVERINGHAM: Dr Michael Robertson is a senior research fellow at the centre for values, ethics and the law in medicine at the University of Sydney

MICHAEL ROBERTSON: There are some people were confusion or distress about their gender reflects a mental illness, like a psychotic illness or a severe disturbance of personality, but the large majority, in my experience of these people, live lives in very rational and reflective ways as a different gender and do not have a psychological disorder.

SARA EVERINGHAM: Dr Robertson says the key issue in this case was whether Alex could give consent.

MICHAEL ROBERTSON: A simple question of capability or capacity was resolved in this case.
Because by the time someone is 17, they know what sex they are, to state the bleedin' obvious. This isn't even about the Philosophical view vs the Medical view. It's about someone who is a paid apologist for one particular Philosophical-Religious viewpoint vs the actual experts in medicine - and ethics.

Oh well, at least he's consistent.

10 comments:

Nicole said...

Excellent Zoe!

This blog entry should be sent to each and every media outlet in Australia!

Battybattybats said...

Great post Zoe!

A much longer and more thorough post than my own Blogpost. More measured too :)

Cardinal Pole said...

"Not ethics, but Religious Morality"

Morality is the subject matter of ethics is it not? Morality is related to ethics as matter to form, is it not, in the same way that number, space and quantity are related to mathematics? I'm just wondering why it is that the likes of you, MgS and a commenter at your blog some time ago separate ethics from morality. And it seems rather puerile the way you keep putting 'ethicist' in scare quotes; Prof. Tonti-Filippini is an ethicist, is he not?

Have you seen the letter on this topic in today's Sydney Morning Herald? I'd be interested to know how you or your readers would respond to it. (It's available at the Herald website or at my own blog, where you're also welcome to comment on what I've written there.)

[That deleted comment was mine; I deleted it because of a mistake in it.]

Zoe Brain said...

Welcome back, your eminence!

I replied in short on your blog, but the sound-byte: the SMH letter is 100% rubbish.

I'll talk about the difference between ethics and morality later, and address your other points.

Battybattybats said...

Cardinal Pole,

The difference between Morality and Ethics, a growing argument in definition in Philosophy thats been around quite a while, is simple.

Morality is based on a doctrine, or set of rules, often religious and via revelation or cultural traditions or personal view.

Ethics is based on an internally consistent set of principles that flow on logically from a basic assumption or definition of right and wrong. (Such as all people should be treated as having equal rights with liberties restricted only by minimal obligation to The Social Contract and to respecting the rights of others)

As such you get schools of Ethics such as Utilitarianism, Egalitarianism and the like while you get Religious Morality.

Ethics, provided the basic principles can be shown to be fairly Universal is therefore able to be applied objectively and define what is right and wrong in interpersonal and political space. So you get Legal Ethics and Medical Ethics where differences of faith for example are dissallowed from interfering in the performance of duty.

Ethics says a non-Jehovah's Witness Dr cannot force a patient to go through a blood transfusion, or for that matter a JW Dr cannot withhold one from a non-JW patient.

Ethics can function in determining right and wrong in intercultural and interfaitn interactions. Morality on the other hand often cannot.

Morality says its perfectly good to murder Witches if Christian, or to tear out the hearts and cut off the heads of unwilling living victims if a follower of Camasotz the Meso-American Vampire-Bat-God.

Morality is personal and invalid outside the self as others may not share the same faith, belief system etc.

Ethics on the other hand can apply on everything else. If I worshipped Camasotz it would be Moral of me to sacrifice you excruciatingly to my God, but it would be Unethical without your free uncoerced informed and sane consent.. an unlikely prospect.

Cardinal Pole said...

Thanks for your comments, Zoe and BBB (if I may so abbreviate your handle, Battybattybats; you are welcome to call me CP if you wish).

BBB,

You say that

"The difference between Morality and Ethics, a growing argument in definition ..."

An argument over terms, not substance. Morality is related to ethics as matter to form; ethics is, by definition, the scientific study of morality. This definition has served us pretty well for several thousand years; I see no reason to change it, especially since the subtext to the argument is the attempt to advance relativism.

Regarding your proposed definitions:

1. "Morality is based on a doctrine, or set of rules, often religious and via revelation or cultural traditions or personal view."

2. "Ethics is based on an internally consistent set of principles that flow on logically from a basic assumption or definition of right and wrong."

The way you've described it then, ethics and morality differ only in the terms, not in the substance. Morality, as you say, is indeed concerned with a set of rules. But these rules must follow, with internal consistency, from a basic assumption or definition, so the essence of morality, as you've described it, is the same as the essence of ethics.

"Morality ... often cannot [function in determining right and wrong in intercultural and interfaitn interactions]."

This does not necessarily follow from your definitions. And in any case, any school of thought other than Religious Morality in ethics will have its own problems in certain situations; why single out Religious Morality? Also, you say that

"Morality is personal and invalid outside the self as others may not share the same faith, belief system etc."

But one can take this and say

"Any given school of thought in ethics is personal and invalid outside the self as others may not share the same school of thought."

So in your example:

"Ethics says a non-Jehovah's Witness Dr cannot force a patient to go through a blood transfusion, or for that matter a JW Dr cannot withhold one from a non-JW patient."

you can really only say that

"This or that school of thought in ethics says a non-Jehovah's Witness Dr cannot force a patient to go through a blood transfusion, or for that matter a JW Dr cannot withhold one from a non-JW patient."

So to sum up: morality is the subject matter of ethics. Each school of thought produces moral imperatives. Re-defining morality to make it a mere subset of ethical thought is arbitrary, unnecessary and self-defeating--if morality isn't the subject matter of schools of thought other than Religious Morality, then what is? No-one would take you seriously if, to refer to my earlier example, you proposed to redefine number, space and quantity so as to make them the concern of just one mathematical school of thought, so why do the same with ethics and morality?

And finally, to relate this back to the original topic: Prof. Tonti-Filippini is an ethicisit who is religious, but Religious Morality is a misnomer for his school of thought: his school of thought (the only true one, in fact)is natural law, whose fundamental assumption or definition is 'do good and avoid evil', where the good is that which suits the nature--the objective, observable, empirically-verifiable characteristics, tendencies, &c.--of the thing desiring it. It's hard for me to imagine what could be regarded as objectionable about this; certainly it applies consistently in 'determining right and wrong in intercultural and interfaitn interactions'.

Zoe Brain said...

Your Eminence, may I ask you to have a look at What is the Church's position on Transsex and Intersex over at the Catholic Answers Forum? I know it's long, but you really should wade your way through it all to the end.

The opinions of the Canon Lawyer was particularly illuminating. I've quoted one of them in a previous post, but there was more on the subject.

My strong impression is that Dr Tonto-Filipini is making things up as he goes along, based on an extremely good grounding in morality, ethics, and theology, and an almost total ignorance of the biology and clinical facts.

It's not his morals I object to: it's his ignorance. And that his ignorant opinion most emphatically does not reflect the position of the magisterium.

Anonymous said...

I read Andrew Bolt religiously and I read that you cannot possibly be an intersexed woman which kind of relieved me. I sympathise for your tsness but why didn't you know what you were at 17 and save your wife the hassles? It's obviously impossible for a woman to father a child, even for an intersexed woman so stop shamming. And Nick Tonti Filippini is a good bioethicist. If you were what you say the media would make you a millionaire plus.

Zoe Brain said...

Why relieved? Your relief may be premature, anyway.

The diagnosis since August 2005 has been "severe androgenisation of a non-pregnant woman".

As the hospital endocrinal registrar would confirm, this is not a diagnosis available to pre-operative transsexual women.

I had genital reconstruction alright - but in November 2006, 15 months later.

Oh, and I was 17 in 1975. Women with my build were not considered candidates for transition till the late 90's. Svelte, I'm not.

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