Bioethics & Justice

Alex Mayhew, Alex James Miller Tate

Bioethics & Justice
Sunday, February 7, 2021 from 1:00 pm to 2:30 pm EST

This webinar will feature two presentations. Each speaker has 25 minutes to present their arguments, and then there will be 15 minutes for a question and answer period.

Aging Justice: Health Justice Extended
Alex Mayhew, Faculty of Information and Media Studies, University of Western Ontario

One of the critical insights Venkatapuram articulated in his 2011 work Health Justice was that “to be healthy is a kind of freedom. To be free of impairment and pain.” He argues that our health expectations are socially constructed and have changed from time and place. Health has also come under increased human control. Major health failures such as famines and outbreaks of common diseases like Measles are no longer predominantly the result of random bad luck. Instead, today major systemic health failures are largely the result of social practices.

In Health and Social Justice Prah Ruger states that “justice demands that society should ensure that individuals are capable of avoiding premature death and escapable morbidity.” But what counts as ‘premature’ death, or ‘escapable’ morbidity? Both Venkatapuram and Prah Ruger avoid the topic of aging, scarcely mentioning the word. What happens when we turn the Health Justice lens to aging?

The elderly are often expected to endure a loss of capacity that is not imposed on other demographics. The reason for this is clear, technologically it has been beyond our capability to address the root causes of aging. But instead of acknowledging this as a tragedy, the common reaction is to call it natural and put it out of mind.

By extending the idea of Health Justice we can see the involuntary deterioration of health and end of life as a social justice issue. Aging is already heavily influenced by human choices and social practices; this is most notable in our increasing longevity. This human control is only going to increase, and we must choose how to respond. While achieving a completely just society and perpetual capacity for health is likely impossible, the pursuit of these ends is a worthy goal.

Silenced and Coerced Speech in Psychiatry
Alex James Miller Tate, Independent Scholar

Status-based statutes (e.g. the Mental Health Act 2007 in the UK) that permit the involuntary detention and treatment of otherwise legally competent psychiatric service users are common worldwide. This makes seeking psychiatric care in crisis a risky enterprise; an individual with mental health difficulties is at significantly greater risk of the harms involved in detention and compulsion than someone presenting to primary care with a physical ailment. Since many service users are keen to avoid such outcomes, they are motivated to downplay the severity of their symptoms, especially if these include suicidal ideation, completed or intended self-harm, or psychosis.

There is, however, a further source of risk in psychiatric encounters which pulls in the other direction. If individuals do not receive any help, then they are liable to experience extreme distress, perhaps engage in serious acts of self-injury, or even attempt or complete suicide. Service users who wish to avoid these outcomes in an era of grossly under-resourced mental health services must make it clear that their situation requires urgent prioritisation.

In this paper, I argue that the phenomena above amount to various forms of unjust silencing and coerced speech, which in turn may amount to violations of a patient’s right to healthcare, and the physician’s duty of non-maleficence. Since self-report is a mandatory precursor to effective psychiatric care, this means that suffering serious wrongs is a common, indeed typical, precondition of receiving psychiatric care. I survey various proposals to remedy this situation, concluding that the problem cannot be solved at the clinical level; it requires significant legal reform of mental health systems to reduce or eliminate compulsion.