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.