Has the sanctity of life law ‘gone too far’?: analysis of the sanctity of life doctrine and English case law shows that the sanctity of life law has not ‘gone too far’

The medical profession consistently strives to uphold patient empowerment, equality and safety. It is ironic that now, at a time where advances in technology and knowledge have given us an increased capacity to preserve and prolong life, we find ourselves increasingly asking questions about the value of the lives we are saving. A recent editorial by Professor Raanan Gillon questions the emphasis that English law places on the sanctity of life doctrine. In what was described by Reverend Nick Donnelly as a “manifesto for killing patients”, Professor Gillon argues that the sanctity of life law has gone too far because of its disregard for distributive justice and an incompetent person’s previously declared autonomy. This review begins by outlining the stance of the sanctity of life doctrine on decisions about administering, withholding and withdrawing life-prolonging treatment. Using this as a foundation for a rebuttal, a proposal is made that Professor Gillon’s assertions do not take the following into account:

1. 1)
   A sanctity of life law does not exist since English Common Law infringes the sanctity doctrine by tolerating quality of life judgements and a doctor’s intention to hasten death when withdrawing life-prolonging treatment.
    
2. 2)
   Even if a true sanctity of life law did exist:

   1. a)
      The sanctity of life doctrine allows for resource considerations in the wider analysis of benefits and burdens.
       
   2. b)
      The sanctity of life doctrine yields to a competent person’s autonomous decision.
       
    

This review attempts to demonstrate that at present, and with the legal precedent that restricts it, a sanctity of life law cannot go too far.     

Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for Black Women Living With HIV

In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.     

“Do I Know You?” Altering hairstyle affects facial recognition

Background: Research has demonstrated that both internal features (e.g., eyes) and external features (e.g., hair) are important for recognizing unfamiliar faces; however, the impact of altering hairstyle on the recognition of unfamiliar faces has yet to be isolated and investigated in the absence of deep processing. Objectives: We sought to examine the extent to which altering hair impacts the recognition of a previously viewed face. Methods: Participants were presented with a series of face images followed by a recognition probe of either a new face or a face that was among the previously presented images with either the same hairstyle (identical face) or a different hairstyle (disguised face). Results: Participants showed significantly less accuracy in the disguised condition compared to the identical condition. Conclusions: Our results provide evidence that hairstyle plays a role in recognizing unfamiliar faces. This appears to hold true across race and sex, as well as across deep and shallow processing.     

The ethics of separating conjoined twins: two arguments against

I argue that the separation of conjoined twins in infancy or early childhood is unethical (rare exceptions aside). Cases may be divided into three types: both twins suffer from lethal abnormalities, only one twin has a lethal abnormality, or neither twin does. In the first kind of case, there is no reason to separate, since both twins will die regardless of treatment. In the third kind of case, I argue that separation at an early age is unethical because the twins are likely to achieve an irreplaceably good quality of life—the goods of conjoinment—that separation takes away. Evaluation of this possibility requires maturation past early childhood. Regarding the second type, I point out that with conceivable but unrecorded exceptions, these cases will consistently involve sacrifice separation. I present an argument that sacrifice separation is unethical, but in some cases a moral dilemma may exist in which separation and refraining from separation are both unethical. Perhaps in such cases a decision can be made on non-moral grounds; however, the possibility of such a decision serves not to mitigate but to underscore the fact that the separation is unethical. My conclusion, which applies to all three types of cases, is that it is unethical to separate conjoined twins before their developing personalities give some reliable indication as to whether they desire separation and whether they will achieve those goods of conjoinment.     

The Guise of the Bad in Augustine’s Pear Theft

In the second book of his Confessions, Augustine of Hippo presents his famous juvenile Pear Theft as an apparent case of acting under the guise of the bad. At least since Thomas Aquinas’ influential interpretation, scholars have usually taken Augustine’s detailed discussion of the case to be dispelling this “guise of the guise of the bad”, and to offer a solid “guise of the good”-explanation. This paper addresses an important challenge to this view: Augustine offers two different “guise of the good”-explanations in his text rather than just one, and the two explanations seem to be mutually exclusive. A number of more recent attempts to reconcile Augustine’s two lines of explanation are discussed and found wanting, and a new suggestion is made. The proposed solution focuses on the Pear Theft as a joint action, and it departs from the Aquinian interpretation in that it accounts for a way in which the “guise of the bad”-hypothesis survives the explanation.     

Contractualism,Person-Affecting Wrongness and the Non-identity Problem

A number of theorists have argued that Scanlon's contractualist theory both "gets around" and "solves" the non-identity problem. They argue that it gets around the problem because hypothetical deliberation on general moral principles excludes the considerations that lead to the problem. They argue that it solves the problem because violating a contractualist moral principle in one's treatment of another wrongs that particular other, grounding a person-affecting moral claim. In this paper, I agree with the first claim but note that all it shows is that the act is impersonally wrong. I then dispute the second claim. On Scanlon's contractualist view, one wrongs a particular other if one treats the other in a way that is unjustifiable to that other on reasons she could not reasonably reject. We should think of person-affecting wronging in terms of the reasons had by the actual agent and the actual person affected by the agent's action. In non-identity cases, interpersonal justifiability is therefore shaped both by the reason to reject the treatment provided by the bad suffered and the reason to affirm the treatment provided by the goods had as a result of existing. I argue it would be reasonable for the actual person to find the treatment justifiable, and so I conclude that Scanlon's contractualist metaethics does not provide a narrow person-affecting solution to the non-identity problem on its own terms. I conclude that the two claims represent a tension within Scanlon's contractualist theory itself.