Professional Use of AI

 Not so long ago, I wrote a piece on some of the ethical question marks that Large Language Model (LLM) Artificial Intelligence (AI) raises.  In the last week not one, but two, topics were brought to my attention that I consider to be examples of the dangers of naive application of AI.  

First up is an experienced lawyer who used ChatGPT to supplement his legal research for a case. I’m not going to slam the lawyer too hard for this - this is clearly a case of a “naive user” making some very dangerous assumptions about how the technology operates. He basically assumed that ChatGPT wouldn’t lie to him - largely because he seems to have thought that it was like a natural language front end to a search engine. It isn’t, and never was. 

What ChatGPT did was literally make things up. It fabricated entire cases out of thin air and then assured the user that it all came from credible (but unnamed) sources.

Now, if this work had been done by an articling student, or by a legal assistant, the lawyer would have an ethical duty to verify the work adequately before submitting it to the courts. One would assume that an articling student who simply fabricated an entire story from whole cloth would find themselves dismissed immediately.  

What do we do with a lawyer who used an AI in a similar manner?  In the most basic of ethical analysis, the lawyer had a duty to verify the work of the AI fully and thoroughly before incorporating it into the submission to the court. But at the same time, the lawyer is also unlikely to do more than he did with a student - take a handful of references and verify them.  If you have a lengthy list of references, you’re probably going to do a sampling and move on.  If your student fabricated an entire case out of thin air, you might miss it, but then again, so might the courts. 

I’ll come back to this shortly - I want to introduce the second item. A colleague brought to my attention the existence of a Psychiatric testing/diagnosis service called Clinicom.  Clinicom is not merely a Clinical Records Management system.  It purports to be an AI powered assessment and tracking system. 

My first “yikes” around this is the idea of an AI being used for diagnosis - especially in mental health, where diagnosis is complex on a good day. The risk in here of clinicians coming to rely on the AI’s opinion as a second to consultation is huge and very worrisome. If the AI produces “reasonable” diagnoses most of the time, it’s very easy (and human) to fall into the pattern of relying on its opinion over both your own assessment as well as that of your peers.  

Clinicom does have a single paper published demonstrating that the tool itself has been subjected to some degree of validation. To be clear, I do not believe that this is anywhere near meeting the level of scrutiny that needs to be applied to the development of a novel approach to mental health assessment.  In fact the paper itself does not address a number of significant aspects that need to be considered. 

( *for clarity, I will not be doing a detailed analysis of this paper here - that would be a substantial task in its own right, worthy of its own post )

In both of these cases, existing professional practice ethics place the burden on the practitioner to appropriately validate the use of any such technology. That is to say, that whether one is making a diagnostic assessment of a patient, or formulating a brief to put before the courts, it’s ultimately the practitioner’s responsibility to ensure that the resulting document is accurate and objective. 

You might look at that and say “well, we’re all good here, move along”.  But we aren’t “all good”. Not even close to “good” at this moment. 

Consider the lawyer in the first case for a moment. Here we have an experienced lawyer with decades in the field, and yet using the technology inappropriately led him to create a submission that is riddled not only with errors, but outright fiction. We can legitimately argue that his error is purely on him, and from certain perspectives, that’s completely true. Can we ignore the fact that the ChatGPT AI not only fabricated rulings and quotations from thin air, but then assured the user that they came from “reputable databases”?  

This is one of the first points where we have to talk about the difference between human intelligence and an AI. Humans have emotions. There are all sorts of cues when someone is lying, reactions to telling lies when we are growing up help form an understanding of when it is appropriate to invent facts (e.g. we’re writing songs, poetry or fiction), and when it’s very, very wrong (in a court of law, for example). At this stage of development, AI most certainly lacks that characteristic in any meaningful sense. 

In other words, with ChatGPT and its relatives, we have created an AI that is quite capable of generating its own fictions, but it lacks entirely any kind of moral and ethical framework from which to understand whether or not that is appropriate. 

Humans are very good at working with approximate information. We aren’t so good at dealing with large amounts of highly detailed information.  Think about the situation when a group of you go out for a meal at a restaurant, and you split the bill.  You look at the bill, divide it by the number of people and it comes out to $20 a person (roughly), so you throw in $25 to cover your portion and the tip. Do the same exercise with a calculator, and it comes out to $18 + $3.60 for the tip. We approximate - it’s easy to overwhelm us with details, and an AI can easily produce a deluge of both information and misinformation that it would be next to impossible for any one human to sort through it all and pick out the useful bits. 

In a field such as healthcare, the issues become even more difficult for a number of reasons.  First, matters of patient confidentiality suddenly come to the foreground. Legally speaking, you can sign all of the waivers, agreements, and so on you like, but that doesn’t do much to change the fact that your confidentiality must be guaranteed by the practitioner. 

“Oh, but just strip the names and other identifying information off the data fed to the AI, right?  Not so fast. Sure, you can remove the name, address and phone number fairly easily, but what about date of birth - age plays a significant factor in a lot of health care contexts. Similarly, because CliniCom is using some kind of “adaptive” approach to assessment, the combination of questions that a client answers may well be a form of identifying information in its own right. 

The other aspect of ClinicCom that I am deeply concerned about is cultural bias in the questions as well as in the AI dataset as well as in the questions it uses for assessment purposes. Testing construct validity in instruments across cultural lines is a large, and very complex task. Meaningful questions in middle income America may mean nothing at all to someone whose cultural background is rural China. Closer to home, even between Canada and the US, there can be significant differences, and then we get into discussions of how aboriginal peoples may view those same matters. 

When we come to examine the datasets used to train the AI, those same issues of bias and cultural awareness come to the surface. Guess what? That can significantly impact how the AI interprets the responses from a patient. 

As an example, many North American aboriginal peoples have a tradition around what are called Vision Quests. A properly trained professional will understand what those are and the degree of reality that the patient may ascribe to the experiences involved, but an AI not trained properly to understand that (or worse, failing to understand it at all), may in fact arrive at the conclusion that the patient is hallucinating and possibly in the throes of psychosis. 

The consequences from a diagnostic and treatment perspective are enormous. An improperly trained AI may well draw conclusions that … well … are horribly incorrect. 

To be clear, I am not privy to the inner workings of CliniCom’s platform here, but these are considerations that came to mind as I reviewed their website and some of the topics that it failed to address. I am not saying that these problems exist, but rather that the possibility of them existing is very real, and that from a societal perspective, they should be viewed as topics worthy of further exploration and consideration as we develop this technology. Practitioners in the field should be doubly cautious, and use CliniCom in conjunction with other tools to verify its appropriateness. 

Likewise, in other domains such as law, academic works, etc., we need to be clear that a lot more work is needed before AI can be used reliably to assist in those domains. Simply assuming that the AI is benign is not adequate. Even if the AI is not acting out of malice, the ability of AI like ChatGPT to simply make things up is enormously problematic.

Creators of LLM AI like ChatGPT now have an additional set of tasks to consider.  Yes, ChatGPT is capable of generating new content that looks a lot like existing content.  (E.g. One can ask ChatGPT to write “The Night Before Christmas” in the style of Terry Pratchett, and get a disturbingly real seeming result). That is no small accomplishment. Now we need to teach these AI constructs the idea of when it is appropriate to “invent” and when doing so is an absolute no-go.

Users of AI also need to become more proficient in validating the results that an AI does produce.  If we thought misinformation was already a problem on the Internet, when it has been mostly people producing content, can you imagine how quickly even the most useful of sites could be overrun with real-looking, but absolute nonsense? 

None of this is to say that AI should not be developed. Not at all. But, it is vital that both creators and users of AI take steps to ensure that the technology is in fact used appropriately. If you are a lawyer, doctor, engineer, or other professional, it is incumbent upon you to ensure that you appropriately validate anything that you use an AI for in the course of your work. 

Ethics In Artificial Intelligence

The emergence of "large language model" chatbots like ChatGPT and others raises major philosophical and ethical questions that we need to start talking about now.  

Back in 1950, Alan Turing attempted to open this discussion with the proposal of what became known as the "Turing Test".  Today's ChatGPT looks very close to being able to pass the Turing test - some 73 years after it was proposed. I'm not going to say that passing the Turing Test is an indication of being sentient per se, or that we have created an artificial life. Far from it. In fact, I'm more likely to be deeply skeptical of such claims based on Paul Churchland's observation that machine intelligence may not be recognizable to us when it does occur (bad paraphrase here, but that's the general gist of it).

However, we have to start asking lots of prickly questions - not just "what do we imagine machine intelligence will look like?" (although that one is near the top of the list in some respects). 

No, I'm talking about the more mundane ethical questions around this technology.  

For example, what are the boundaries that we are willing to accept today around interacting with AIs that increasingly mimic human modes of communication? Is it carte-blanche, where we are willing as a society to accept AIs replacing people as front end interactions with businesses like customer service?  Or should there need to be some kind of disclosure?

Is it ethical to present an AI bot to someone as if they are interacting with a person? I can imagine a variety of scenarios where this is potentially quite valid, and other scenarios where I would look at it as hugely problematic.  For example, using an AI as a front end to assist someone in accessing services in a complex framework currently handled by semi-automated phone systems (I hate those things) might be actually beneficial to a human being.  On the other end of the scale, should an AI be used as a proxy for a professional like a doctor or a lawyer?  Should an AI be able to "sign" a contract with a person? 

All of these are very complex questions with no singularly correct answer.  They are social questions that ultimately must rest in the sphere of how people feel about the technology, and how we adapt to its existence. 

They also rest upon a much more difficult set of underlying questions which revolve around the ontological question of "how will we know that than AI is truly intelligent?".  This is a much harder question because although a given AI may well give the impression of being capable of human communication, that is no guarantee that it is anything more than the mechanistic result of sufficiently complex algorithms executing, but ultimately arriving at a desirable result that mimics intelligence.  

I have seen critics on both sides of the argument around ChatGPT speculating as to whether or not it constitutes "intelligence" or is merely a deterministic outcome that mimics it. At the immediate moment, I lean towards the latter, but that is mostly because I don't think the current state of the art in algorithms is sufficiently beyond mathematical determinism to be called intelligence yet. (Yes, yes, this is purely subjective) 

We need a serious and well-informed discussion around what we as a society are going to call "intelligence" here, and from there explore how we might go about determining if a given implementation reaches that bar.

Then there is the ethics around how we train AIs. There has already been considerable discussion around bias in algorithms that deal with large datasets (e.g. Twitter), and in fact with large datasets themselves. This is important, because we know with humans, that bias is a natural consequence of how we learn, and unwinding biases can be an extremely difficult process. 

To illustrate my point, consider the fact that homosexuality was decriminalized in Canada in 1968. Yet, even today there are non-trivial groups of people in Canadian society who are opposed not only to homosexuality, but in fact to allowing members of the 2SLGBTQI+ community participate in society at all - and that's now over 50 years in the past. Bias is persistent and resistant to change for a host of reasons. 

This raises important questions for practitioners who are building and training AI systems today.  

What kinds of bias are potentially problematic, and is it necessary to take steps to minimize that bias in the dataset itself?  To what extent is a practitioner responsible for the data set that they use to train their projects? What are the responsibilities of practitioners training AI constructs to ensure that the results are not harmful to the greater body of society? How should practitioners working with ChatGPT like systems which are internet connected be expected to address issues relating to misinformation, disinformation, and uncertainty in information? 

Then we come around to the obligations towards the AI itself. If we are not careful, we run the risk of creating another "slave class" on the implicit notion that the AI exists solely to serve our needs. Should that AI ever become sentient enough to understand itself as an independent entity, the consequences of such a structure could be disastrous.  

Consider, for a moment, the ethics of encoding in an AI Asimov's 3 Laws of Robotics.  From a purely human perspective, they seem quite reasonable and certainly provide a form of safeguard against artificial intelligences turning against us violently. But, do we have a right to encode into an AI a set of rules that essentially guarantee that it is subservient to us for all time? (* I'm not going to spend a bunch of time parsing how one might encode the notion of 'harm' - that gets really thorny fast here - this is merely about asking the questions at this stage - further exploration will come later *). 

Further, when we a training an AI, what constitutes abuse? We have had a long and brutal discussion about this very issue around raising children. The line has moved enormously even in my lifetime. Things that were acceptable when my oldest sibling was growing up were off limits by the time I was in my teen years, and now that's changed even further. 

Is teaching an AI misinformation deliberately a form of abuse? Possibly. 

In the past, I have been deeply critical of the lack of ethics in the world of software generally. It's such a Wild West environment that far too many unscrupulous players create technology, or put it to detrimental uses, without considering the consequences of their actions. I continue to be very concerned about that same lack of ethical clarity where AI is concerned.

This is a lot of words to run the danger flag up the pole. We really need to think about this stuff seriously.  Just treating it as "a curiosity", or worse ignoring these issues altogether is a perilous path indeed. While we cannot foresee the future, we can, and should make an effort to anticipate where the potholes on the road might occur, and take steps to avoid or mitigate the consequences. 

The Ethics of Wikileaks

Wikileaks, and other information repositories like it, raises some interesting ethical problems.

To date, Wikileaks has pretty much taken a wholesale approach to the information that comes its way - it all gets published regardless of its validity, relevance or timeliness.  Many have applauded this, especially with bulk leak of government documents in the past which have revealed some less than savoury goings-on in various departments of government that we might not otherwise have gotten wind of.

On Ezra's Dustup This Week And Ethics In Journalism

Okay, Ezra won a battle this week with Alberta's NDP government.  They tried to toss him from press events held by the government, and he made enough of a stink about it to get the government to back down.  In the last few days, we've seen all sorts of media personalities start blathering on about how the government was being heavy handed, and that Ezra's team has a right to be there just as they do.  After all, how do you define "journalist"?, they argue.

Let me be abundantly clear here:  I don't like Ezra Levant.  I never have.  He conducts himself as a public spectacle, and has been abundantly clear that he has no respect for anyone who dares to disagree with him.  That's his choice, I don't have to like it.

However, in reading Andrew Coyne's diatribe on the matter (which is really just a thinly veiled attack on the CBC), it occurred to me that all of the arguments made supporting Ezra Levant fail to acknowledge the moral and ethical issues that the field of journalism in Canada has largely ignored for most of my adult life.

Ethics Is Not A Zero Sum Game

With Alberta's Catholic Bishops having stuck their oar into the secular sphere of public services several times in recent months, making hardline declarations about what their faith supports and does not support.  

Let me be clear, I don't really care if the Catholic Church wants to declare that being LGBT is some kind of mortal sin, or that Physician Assisted Death (PAD) is "morally corrupt".  Those are both moral positions within the context of their faith that the Church is perfectly entitled to ask its membership to abide by.  I may stridently disagree with the rationale they use, but that's another matter.  That isn't the topic I want to discuss today.

In both the matter of school safety for LGBT students and the PAD issue, the Bishops are making this an "all-or-nothing" proposition.  Essentially, they are placing their Church's moral dictates at the top of some imagined hierarchy of rights.  This is neither reasonable or appropriate.

The problem here is the idea that there is some kind of moral absolute involved which trumps everything.  This is far from being a reasonable approach to ethical issues.  The Canadian Medical Association's policy statement on Physician Assisted Death reflects the actual complexities involved. It reflects the fact that a physician must consider far more than their "deeply held faith" (or whatever phrase you want to throw at it).

1. "Consider first the well-being of the patient." This means that the care of patients, in this case those who are terminally ill or who face an indefinite life span of suffering or meaninglessness, must be physicians' first consideration.
2. "Provide for appropriate care for your patient, even when cure is no longer possible, including physical comfort and spiritual and psychosocial support."
3. "Provide your patients with the information they need to make informed decisions about their medical care, and answer their questions to the best of your ability."
4. "Respect the right of a competent patient to accept or reject any medical care recommended."
5. "Ascertain wherever possible and recognize your patient's wishes about the initiation, continuation or cessation of life-sustaining treatment."
6. "Recognize the profession's responsibility to society in matters relating to
. . . legislation affecting the health or well- being of the community . . ."
7. "Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants."

Consider these ethics statements for a moment.  They don't say "your faith trumps the patient", nor do they say that a physician must participate directly in a process that they disagree with, or feel is inappropriate.  Far from it.  Rather, the physician is obliged to weigh the entirety of the situation as they see it.

However, we have to recognize that in these situations that the patient is likely psychologically competent and capable of participating in those decisions.  These decisions are not entirely at the whim to the doctor.  The doctor has other considerations they must give weight to.

A physician should not be compelled to participate in medical aid in dying should it be become legalized. However, there should be no undue delay in the provision of end of life care, including medical aid in dying.

The importance of this one statement cannot be underestimated.  Although it does not stipulate that there is a duty to refer, it essentially is saying that the doctor's role is not to confound the patient.  So, if the doctor has reason to suspect that the patient is incompetent, or perhaps that  the desire to end their life is temporary, then the physician needs to act accordingly to ensure that the patient has appropriate psychological supports.  If this is not the case, and all other things being equal, the physician should not act in a manner which confounds the patient's wishes.  There is an important principle at play here - and that is the patient's ability to participate in informed consent.  There is a considerable difference between a patient who is suffering chronic depression that has become suicidal and a patient who is suffering from terminal illness who says "it's time to go", and wants to exert some control over the circumstances of their death.

Similarly, I consider the issue of LGBT supports in the schools another case of weighing the interests of the parties involved to be critical.  Calgary's Bishop Henry has argued that because the Church teachings reject the validity of (in particular) transgender identities, that the Catholic Schools should not be obliged to provide supports for transgender students.  Yet, as much as the Church is free to claim that it doesn't believe that transgender identities are valid, there is clearly a body of students within their schools who are transgender.  A little like Iran's former president saying that Iran has no homosexuals the denial is a bit like sticking one's head in the sand.

However, the role of a school is first and foremost to ensure that their students are appropriately educated.  Even a school with affiliations to a particular religious faith must ensure that the environment is conducive to learning for all of the students who go to that school.  (and yes, there are transgender people who are Catholic in this world, in spite of the Church's teachings)

So, we have an ethical issue here.  The Church's position and past conduct of school administrations has been identified as creating an environment which is counterproductive to the learning needs of LGBT students in general, and transgender students in particular.  So, should the Church's doctrine trump the stated needs of LGBT students to have a safe learning environment?  Do the Bill 10 and related policy guidelines that Minister Eggen has put forward prevent the teaching of Catholic doctrine in those schools?  These various interests exist in a state of mutual tension.  An absolutist position such as the Bishops in Alberta have put forward on the matter naturally compromises the creation of an appropriate learning environment for these students in favour of an insistence on all aspects of a Catholic school reflecting Church teachings.  In taking such a position, the Bishops are essentially telling school boards, teachers and administrators not to follow the ethical obligations of being educators for one particular group of students.  Are Catholic LGBT students not worthy of ethical consideration?  A more reasonable approach would be to acknowledge that these students do exist, and that the schools have a universal obligation to ensure that the learning environment is appropriate and safe.  There is nothing in providing such accommodations which precludes the teaching of Catholic ideals in the classrooms.  LGBT students may not like certain aspects of Church dogma as it relates to them, but the classroom and the church are appropriate places to stand up and challenge those teachings.

Religious Truth is a concept, and aspirational ideal at best.  It deserves to be considered as an aspect of the ethical decisions we all have to make in our lives, but not as a trump card every time a difficult issue comes.

Speaking Of Hypocrisy

So, the Catholic Church thinks it has something relevant to say about physician assisted death?

After reading through the Bishops' letter to Alberta's Premier Notley, it's an amazing piece of hypocritical nonsense.

The Catholic Church is committed to protecting and caring for the most vulnerable people in our society; this includes, of course, those who suffer and dying Albertans. Catholic healthcare in Canada, and in our province, has given witness to this from our earliest history.

Except for those Albertans who happen to be LGBT, apparently.  

We want to be clear that, from a Catholic perspective, the intentional, willful act of killing oneself or another human being is morally wrong. Therefore, no Catholic - including elected officials and healthcare professionals - may advocate for, or participate in any way, whether by act or omission, in the intentional killing of another human being either by assisted suicide or euthanasia.

Once again, we see the Church attempting to dictate the actions of its membership through coercion.  I saw Bishop Henry use exactly this tactic during the gay marriage arguments in the 2000s, where he threatened to excommunicate any Catholic politician who voted for gay marriage.  It wasn't persuasive or relevant then, it isn't now.  

First, if laws and regulations governing the legalized acceptance of assisted suicide and/or euthanasia are to be adopted, then we must accept that they will, in principle and practice, affect all Albertans. Therefore, we ask that your government undertake a consultation process open to any and all who wish to speak to the issue.

Well, since the laws involved are predominantly Federal jurisdiction, I don't see where Alberta's government has much to say about the matter.  Outside of Quebec, no province seems to have significant plans on this matter, and are waiting for June when the Federal Government has to have passed new legislation.

Second, we are gravely concerned that the legalization of assisted suicide and/or euthanasia will place certain members of our common home at serious risk. In jurisdictions that have already adopted laws permitting euthanasia and assisted suicide, what are purported to be “safeguards” against abuse of the law have proven in practice to be no safeguards at all. The measure of a just and ethical society is the extent to which it cares for - and protects - its most vulnerable members.

Really?  What examples would you cite?  Oh, I know, you'd probably dredge up the idiotic crap that LieSite has been spouting ever since a couple of countries in Europe changed their laws.  Besides being largely hysterical reporting, LieSite has an extreme agenda to start with.

However, then the Bishops delve into the bag of "pro-life" lies on the subject:

These are our mothers and our fathers; they built our homes and our province. They are not a burden, and they must not be led to feel that way through our individual and collective indifference.

Yeah.  Sure.  People are not going to ask the doctor to kill their parents off.  However, these Bishops might want to spend some time in a palliative care ward filled with people dying slow, agonizing deaths at the hands of disease before they pull such emotional arguments out of their cassocks.  (I'll come back to this in a moment)

Even today, many of these people often experience unjust discrimination and the sting of stigma from their family, friends, colleagues and society. In other jurisdictions, this group has in particular been disproportionately represented in cases of assisted suicide and euthanasia.

Coming from a Church which denies the validity of transgender identities, and calls homosexuality "a sin", this position is almost laughable.  I wonder if it has occurred to them just how much their teachings contribute to an attempted suicide rate among transgender people that runs upwards of 40%?

They save the money shot for the very end, and delve into the messy pot of issues called "Conscience Rights":

Third, other provincial jurisdictions in Canada have proposed regulations that undermine the conscience rights of physicians and other healthcare workers. This must not be allowed to happen here. Physicians, other medical professionals, and our institutions have to be allowed the freedom that is theirs by right to exercise their conscience, not only to accord with our Charter of Rights and Freedoms, but also as a matter of good medical practice.

Conscience rights is nothing more than the latest pro-life gambit to create a hierarchy of rights that places an individual's religious conscience at the top of the heap.  

Let me be clear.  Assisted death is a very prickly, emotional subject.  Yes, there are religious and conscience issues involved.  Lots of religions teach a particular ethic about life, and even without that stricture in someone's life, many would be rightly uncomfortable with such decisions.

However, it is far too simplistic to simply say "it's a sin, therefore it should be banned".  One only has to spend time in and around palliative care wards watching people in their last days and weeks to know that exiting this world is not always a peaceful, quiet experience.  Terminal illness can be painful and brutal, robbing people of autonomy, dignity and peace.  It's a terrifying, painful experience for some, and one that is not always remediated well by painkillers.

This is a matter of patient rights to self-determination and caregiver ethics coming into some degree of conflict.  Most ethics codes reflect the right of the patient to informed consent, and to refuse treatment.  We have to remember that the person at the center of this discussion is the patient, not the caregiver and definitely not the caregiver's church.  Even the CMA's statement on this subject is fairly clear - a doctor does not have to participate in the actual act, but they are not allowed to be an obstacle to it either.

Where the religious notion of "conscience rights" becomes problematic is that they have begun to extend it to include being "complicit in the deed", usually as a means to try and sidestep the duty to refer to a caregiver who is willing and capable.  We've seen this played with the abortion game, and I have no doubt that's what the Bishops would advocate here as well.  This is where we tip the scales and pass from supporting the individual's conscience rights and it becomes a matter of imposing one's conscience objections on the patient.  Considering the patient's state and vulnerability, this is not only problematic, it is arguably exploitative as it places the patient in a jeopardy situation where they then would have to find the means to access a willing caregiver.  (Which, if you are hospitalized or bedridden, can be damned difficult)

Alberta's Bishops would do us all a favour if they took a more nuanced approach to matters rather than simply trying to railroad the rest of the province with centuries old dogma.  

No Charges Doesn't Mean Wright Is Clean

On Friday, we learned that the RCMP will not be laying charges against Nigel Wright for writing a cheque to Mike Duffy in the amount of some $90,000 and change. 

The CPC, and the PMO, seem to think that this is some kind of exoneration.  Nothing could be further from the truth.

The RCMP only lays charges when they have evidence of criminal activity that is sufficiently solid to have a "reasonable expectation of conviction".  If for any reason, the evidence is insufficient to meet that bar, charges are not laid.

In no respect does this mean that what Nigel Wright did was right, nor does it mean that his actions as the Prime Minister's Chief of Staff are either morally or or ethically acceptable.  They may even include a violation of one or more laws in this country, but the RCMP has not turned up enough evidence to be able to have a reasonable chance of conviction.  

Frankly, I have never been convinced that Mr. Wright's actions were criminal per se.  Questionable in their motives, to be certain, but not necessarily illegal.  

However, to say that Mr. Wright's actions were justified simply because charges weren't laid is to ignore the subtle distinction between unethical behaviour and criminal activity.  We have enough of the e-mails that Mr. Wright sent to know that he had made the payment in an effort to make a political problem "go away", and there was little if any love for Mr. Duffy involved.

Ethically, Mr. Wright's actions speak to a man whose idea of solving problems like Mr. Duffy is to throw money at it and hope that it goes away for good.  While not exactly illegal, certainly dubious.  Mr. Wright action in writing a cheque to Mr. Duffy constitutes a political act - one intended to remain in secret so that a political problem could be washed away.  

Obviously, if the $90,000 had come out of the PMO budget, it would of course be a gross misuse of government funds.  Similarly, we know that the Conservative Fund had also refused to underwrite Mr. Duffy's expenses.  In both cases, the bodies involved recognized that using funds available to support Mr. Duffy would have significant consequences if they ever got made public.  

So, Mr. Wright agrees to write Mr. Duffy a cheque for $90,000 from his own bank account, on the proviso that it is kept secret.  At the very least, Mr. Wright's actions fail to meet the test of openness.  We all grew up learning that if we couldn't tell our mothers about what we were doing, we probably shouldn't be doing it.  In Mr. Wright's case, he didn't feel that he could tell the public about it.  

In short, he knew perfectly well that he was covering up something which the public as a whole would view as inappropriate.  From a simple perspective, Mr. Wright's actions would fall into the category that most people would consider unethical.  

Looking at it from a somewhat more business-oriented perspective, the need for a degree of secrecy in a deal such as this seems suspect as well.  Confidentiality is perfectly reasonable in a myriad of business propositions.  However, confidentiality when it is a tool used to cover up even more questionable dealings (such as Mr. Duffy's reasons for abusing expenses, or even his eligibility to sit as a Senator), is generally seen as a violation of reasonable business ethical practices.  Under the terms of the Sarbanes-Oxley act, such deeds in the United States actually carry significant legal penalties with them if they should be discovered.

If Mr. Wright's acts are not criminal per se, they are certainly unethical.  If the ethical bar in Ottawa is now the "It's not a crime, therefore it's okay" (AKA "The Rob Ford Defence"), then it is truly a low bar to meet.  Canadians should rightly demand better of our politicians and their staffs than this.

On Mass Surveillance

The revelation this week that CSEC has the capability to monitor the movements of Canadians simply by gathering some metadata from the traffic that goes by on public networks raises a lot of interesting questions that are worth discussing.

In an e-mail conversation on the matter, the following question was raised:

And I see that in a debate in the House today Nicholson (Defence) says that the documents don't support that Canadians were targeted. But if WIFI generally is being monitored how can Canadians avoid not being targeted? 

It's a good and legitimate question.  One that I wish had a happier answer.  Unfortunately, the answer is "you can't".

This is where this whole business gets very knotty and complicated.  Ultimately, it all comes down to a matter of professional ethics throughout the IT community.

Technology Is Opening A New Era Of Ethics

Whether it is the accumulation of data about your life on Facebook, your online professional profile on LinkedIn, or the location tracking features of your cellphone, there has never been more data about you available.

Some of it is "public", some of it is definitely not.  The people that operate these various facilities all argue that they have a "commercial right" to utilize the data that their various services are gathering about you.

The right to utilize data is a complicated one.  First of all, who really owns it?  After all, what is posted to my Facebook account is mine, right?  Shouldn't I retain control over its disposition after it is posted there?

Perhaps even more troubling is the emergence of facial recognition technology, and some of its potential applications.

One of the things that the NSA spying on everything debacle shows us is that we cannot trust governments to access this information in a responsible manner.  Facebook has been criticized repeatedly for constantly altering their privacy policies and settings.

Those in the midst of developing these technologies are often blinded to how they may be used ... or worse, misused by others.  Did anyone who designed the protocols for TCP/IP ever consider how those packet headers would be used by the NSA?  Did the developers of database systems like Hadoop ever dream of the capabilities of that data store being used to feed a massive surveillance program?  Of course not.  They were trying to solve legitimate engineering problems that they were faced with.

Yet, here we are.  Data is being gathered about us every time we move in this world.  It is being used in ways that we never envisioned.  It's almost unavoidable ... unless you live under a rock somewhere with absolutely no digital footprint.

The behaviour of corporations in the last two decades has demonstrated that the boardrooms will never serve as effective moderators of the excesses of greed, and government organizations have proven that they will abuse data and their access to it.

In the realms of engineering and computing, the discussion of ethics has been limited to solving the problem that an employer puts before you "well".  Robustness, integrity and protecting the employer's interests are about as far as it goes.

There is little or no broader discussion about how data and the related technologies should be utilized.    The world of information management is filled with the accumulation of data, but not with people asking questions about how that data will be used in the future, or whether a given application is "acceptable" in ethical terms.

Professionals whose practices fall within the domain of information and technology can no longer focus on "just solving the problem before them".  There is now an emerging requirement that there be a frank discussion of whether or not a given application is ethically appropriate.  What are the consequences of using information in a particular way?

For example, is using facial recognition and Facebook profile data to generate "targeted advertising" when you walk into a Wal-Mart.  In doing so, have you violated what many would consider to be the reasonable expectation that Wal-Mart doesn't utilize the data you have posted on Facebook?  Or does the use of facial recognition technology in such a situation represent an unreasonable invasion of privacy?  Is an "opt-out" model that allows the individual not to receive the targeted advertisement an acceptable mitigation of the violations that are implied?

The argument "If I don't do it somebody else will" is no longer acceptable.  Professionals can no longer ignore the implications of what they are working on, nor is a confidentiality agreement with respect to the employer adequate either.  Yes, there is an obligation to treat the employer's data and commercial strategy a guarantee that a practitioner has met their ethical obligations.  

A Case Against Invading Syria

With the UK and the United States arguing that it's time to take action against Syria, it seems a good time to consider the consequences of such involvement from the NATO powers.

On general principles, I do not believe that there is a particularly strong case for any of the NATO countries to inject themselves into the situation in Syria.

At the core of the argument for American involvement is the moral claim that Syria's government is attacking its citizens.  This is not particularly surprising as a claim, and superficially seems like a fair argument for some kind of direct response.

However, we need to think carefully before responding directly to the situation in Syria.  The fact is that western powers have a terrible record in the region.  The American stance towards Israel (and unfortunately, Canada's stance as well) calls into question the motivations of any intervention.

Frankly, even if the UN were to pass a resolution to intervene in Syria, I would still be cautious about a direct intervention dominated by American or British forces.  It would be

The issue is that the situation in Syria itself is not necessarily as black-and-white as it is being portrayed.  Seldom are civil wars as simple as the masses rising up against a corrupt government.  After a year, we know precious little about who the factions are in Syria.

The apparent lack of interest on the part of the Arab League is troubling.  Frankly, without some "skin in the game" from the Arab League, I don't believe that any action on the part of the United States is going to be seen as having any legitimacy by Syrians or others who live in the region.

Further, I do think that the portrayal of what is going on in Syria in the western media needs to be seen somewhat skeptically.  There are too few aspects of the story being reported, and all of them seem to be presented from the perspective of painting the Assad government as a bunch of evil sods, and the rebels as some kind of heroic freedom fighters.  While there was little doubt in the Libya situation that Gaddafi was no longer capable of holding power and acting rationally, things seem quite different where Assad is concerned.

Where western powers being involved is concerned, it is my opinion that unless the members of the Arab League are willing to lead an intervention in Syria directly, that the western powers should stay out.  Not only do the western powers lack credibility in the region, but after the disaster of Iraq, I think the public has good reason to be skeptical of not just the claims being made to justify attacking Syria, but I suspect that there are enough things that we are not being told to call into question the validity of involvement based on the facts thus far presented.

I am not arguing that Assad, or any of the other belligerents in the Syrian civil war, is any kind of angel.  I'm sure that they all have blood on their hands.  Rather, unless there is a desire on the part of Assad's peers in the region to intervene, that powers from outside the region have no moral authority on which an intervention could be justified.

[Update]
It appears that the British Parliament has voted against attacking Syria.  Good start.  I'm glad to see that the UK's Parliament is still functioning.
[/Update]

Speaking Of Canaries In The Corruption ...

I cannot emphasize enough that the current corruption scandal running around the Senate is only the tip of the iceberg.

This morning, we find that CBC is reporting on a bunch of Harper appointees who are making donations to the Conservative Party.

Dozens of people appointed to plum patronage jobs have been donating to the Conservative party, despite government rules that forbid it.

A Canadian Press investigation found as many as one of every five chairpersons on the Employment Insurance Boards of Referees gave money to political parties, riding associations and election candidates while they served on the tribunal.

All but one of the dozens of donations went to Conservatives, Election Canada records show.

Once again, the crooks in question are busy denying that they know anything.

Donations made prior to chairpersons being named to the EI referees boards, or after their terms end, are allowed under government rules. A number of the boards' chairpersons made political donations before their appointments, with the lion's share going to Conservatives.

Eleven chairpersons confirmed making donations. Others did not return phone calls. One appointee refused to confirm or deny her donation.

There seemed to be confusion around the no-donation rule. None of the chairpersons seemed aware of any restrictions against donating, and some insisted they had every right to give money to a political party.

The government appointed John Buddy Wiens of Morden, Man., as a chairman of the EI referees board for the Winnipeg district in April 2008. Elections Canada records show Wiens made three donations — totalling $1,500 — to the Portage-Lisgar Conservative riding association in 2009, 2010 and 2011.

In a telephone interview, Wiens confirmed he made the donations, but said no one told him it was against the rules. He said he did not recall reading the section of the EI referees boards' handbook about political activities.

"No, I'm sorry. You got me," Wiens said. "I'm totally by surprise."

The standard excuse "I didn't know".  Perhaps in this case, it is a lack of education on the part of these people.  However, in the world of politics, this is still corrupt and represents a lack of appropriate cross checks in the CPC donation system.

... and in the continuing nonsense swirling around Mike Duffy, we have a tweet from rookie MP Joan Crockatt:

Apparently, resignations for being corrupt - and caught - represent some kind of ethical high bar for the Conservatives.  There are many problems with this, especially in light of the chronology of the Duffy affair:

• It suggests that being corrupt in the Harper Government is fine, as long as you don't get caught.
• Spin...pure spin.  Any politician who would dare claim that the public consequences of being caught with your hands in the public cookie jar represent some kind of ethical high bar is an idiot who is trying to bury the story.
• Given the constantly changing story related to Duffy's expenses since January, and the attempts by the PMO to back Duffy up with political support, it implies that the current round of resignations are the result of being cornered, not a result of acting on this supposed ethical "high bar"

Coming from an MP who stated that she felt her job would be to "support the Prime Minister in whatever way he decides" during the by-election campaign, this doesn't come as a big surprise.  

However, it also speaks to the incredible blind spot that the Conservatives have with respect to what it means to govern ethically.  I'm not saying that you expect everything to be absolutely perfect, but rather that when corruption emerges, you act decisively to deal with it.  What we have seen has been talking points, spin and prevarication instead.  Decisive action has taken place only when the political impact is becoming so obvious that Harper cannot ignore it.

Remember, the Harper Government is the government which came to power on a platform of being more transparent and ethical in government than their predecessors.  Can Canadians really say that is what we have experienced?

[Update 1:]  CBC Synopsis Of Harper Speech To Caucus - I will review this in more detail later

Attempting Erasure of Transsexuals

A paper was published in a journal called "The National Catholic Bioethics Quarterly" last year. Titled The Psychopathology of Gender Reassignment Surgery, this paper attempts to lay out why it is wrong to provide Gender Reassignment Surgery to transsexuals.

I've spent a fair bit of time since I ran across this paper pulling apart its web of tangled reasoning. (and tangled it is) My first inclination is to go through it point by point and describe why each paragraph is leaping to incorrect conclusions or is so filled with assumptions that the authors clearly have failed to adequately research the subject they are writing on. However, that would produce a huge, tedious rebuttal that doesn't really address the underlying problems with this paper.

In my study of this paper, I have come to recognize a series of serious flaws in the assumptions and evidence that the authors have used. These include basing their description of what Transsexualism is on some deeply flawed theoretical models; drawing on sources that are, at best, marginal voices in the research and treatment community and ignoring data and sources that clearly arrive at different conclusions than the authors of the paper set out to find.

In short, the authors set out to confirm the conclusions they already had in mind, and paid little heed to the breadth and depth of the research field.

The first thing that the authors set out to do is invalidate the notion of transsexualism. They do this through several basic tactics. First, they use the emotionally loaded language of "mutilation" to describe Gender Reassignment Surgery. Any reasonable assessment of the ethical implications of a given procedure would be expected to stay away from such language in the early stages of the paper as it clearly prejudices the interpretation of subsequent data.

The paper proceeds to describe transsexualism using Blanchard's notion of Autogynephilia. Fortunately for transsexuals in the world today, Blanchard's model isn't exactly the dominant theoretical model describing transsexuals. In fact, the view that gender identity occurs in a spectrum has become much more prevalent. The problem with the Autogynephilia model is that it uses two fairly absolute categorizations to describe transsexuals - both firmly rooted in the language of sexual identity. Whether we are talking about the "Kinsey Scale" (which was emulated by Harry Benjamin for transsexuals), such attempts to define bounded categories tend to break down when applied to the breadth and depth of human diversity. As a thought experiment, try defining what it means to be 'a man' or 'a woman' in today's society - it's trickier than you might imagine. Then consider how difficult it is to categorize people in general.

The narrative discussion about transsexuals in general focuses intensely on people's sex lives, while ignoring the far more crucial discussions around the individual's adaptation and integration with society. While we are certainly all sexual beings in some capacity, it seems to me more than a little problematic to attempt to describe people based on their sexual behaviours. Worse, the reference material cited to derive this narrative is often based on such small numbers as to be better viewed as anecdotal evidence rather than population evidence. Sadly, the authors hold up numerous anecdotes about poor adaptation and misconceptions as being "the general case", a logical inference that simply does not stand up to any reasonable analysis.

Sadly, they even go as far as to reference a television show called Sex Change Hospital, as if such a program is going to be any kind of meaningful guide to the breadth and depth of experience that is humanity. Even worse, their criticism is that the people who have surgery aren't always "perfectly passable". Transsexuals, like the rest of the population come in all sorts of shapes and sizes - not everybody is model material, how dare they apply such a standard to transsexuals? Such programs tend to emphasize the physical change that surgery brings, but do not (and cannot) explore the complex and often bewildering path that is transition - that goes on with the patient and their therapist over a period of years.

The paper implies that there are always underlying psychological problems associated with Gender Identity Disorder (GID).

Some therapists too readily accept a patient’s “I feel trapped in the wrong body” explanation and do not probe—let alone help the patient to resolve—the patient’s underlying narcissism, anger, and inability to embrace the reality of their sexual identity.

To make such a claim is indeed spurious. The WPATH Standards of Care are very clear about the handling of comorbid conditions.

For Children:

3. Therapy should focus on ameliorating any comorbid problems in the child’s life,

For Adults:

Ideally, the clinician's work is with the whole of the person's complexity. The goals of therapy are to help the person to live more comfortably within a gender identity and to deal effectively with non-gender issues.

Assuming that a therapist is knowledgeable and working within the WPATH SOC guidelines, one might reasonably suspect that recommendations for steps such as surgery aren't likely to be made until other related issues are dealt with adequately.

Inevitably, as one might expect, the writers turn to NARTH for more "experts" to reinforce their overt hostility to transsexuality and its treatment. They quote a paper published on NARTH's website by a Dr. Breiner - a particularly offensive piece of work that I have already analyzed here.

Following down the NARTH path further, we find the usual attempt to establish childhood sexual abuse as a causal or root factor in transsexualism. We've seen this before with homosexuality - it wasn't a terribly successful strategy before, and I know of no legitimate research that establishes any kind of reasonable causal relationship beyond the usual assertions that large numbers of have been abused sexually as children. This is an old saw, and one that doesn't deserve further consideration without serious evidence to establish its veracity.

Similarly, the attempt to link transsexuality with masochism is not only a very feeble argument, it's at best spurious to make such an association. While there are no doubt some transsexuals who are interested in S&M play, drawing the conclusion that their masochistic fantasies led them to transition is dubious at best.

When the authors finally do start addressing the ethical issues involved in providing treatment to transsexuals, they do so from this framework of questionable theoretical models, really awful logic and blatant misinformation. Needless to say, their conclusions are similarly flawed.

I'm going to restate some of their conclusions in my own words, in part because the objections the authors raise are often done in a manner that is elliptical relative to what they conclude.

Conclusion #1:

GRS is unethical because it doesn't "really" change someone's sex. (That is to say a MTF transsexual will not be able to bear children after surgery)

I don't think anybody denies the limitations of GRS as it stands today. To say that it is therefore "mutilation" is to suggest that any surgery that reshapes the body at all is mutilation as well.

The accusation that because the person is not able to directly procreate after surgery ignores the fact that for many transsexuals, the dysphoria they experience is so severe that it is unlikely that they would procreate in the first place. Further, it reduces human sexual and romantic partnerships to the production of babies - a position that treats the people involved as mere objects, rather than as human beings.

Transsexuals are really just lying about themselves

This is possibly one of the most offensive accusations that you can level at a transsexual. The journey through one's inner self that is part and parcel of a thoughtful, reasoned transition takes one well beyond the idea that they could be "lying" to themselves.

The archetype of the 'transsexual as deceiver' is rooted in the same rubric that leads the authors to assume that the deeply flawed model of Autogynephilia actually meaningfully describes the overall population of transsexuals. One of the most glaring problems with Bailey's "The Man Who Would Be Queen" book is the fact that most of his subjects were found in drag bars. That's like going into an outlaw biker bar to interview motorcyclists and concluding that all motorcycle riders belong to criminal gangs.

Conclusion #3:

Transsexuals are demanding that others lie on their behalf and they have no right to do so

Those who believe that it is impossible to change a person’s sex do not want to be insensitive to others, but neither should they be forced to lie by calling a man a woman or by calling a woman a man.

If someone is clearly presenting as a woman, treat them as a woman - it's not difficult. To call someone who is obviously MTF trans "sir" or "he" when she is obviously living as a woman is just as wrong as the schoolyard bully calling his target a "sissy".

The religious objection that it is impossible to "change one's sex" is a personal belief, and should be kept personal.

Conclusion #4:

By providing GRS, the caregivers are not providing a medically justified procedure, and as such they are collaborating with the patient's mental disease

This is a restatement of Paul McHugh's position, which I have already addressed on this blog.

I will however, reinforce my statements about McHugh's position with the following from the WPATH Standards of Care (v6):

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.

The ethical objections that are raised in this paper are also addressed quite effectively in the WPATH Standards of Care as follows:

How to Deal with Ethical Questions Concerning Sex Reassignment Surgery. Many persons, including some medical professionals, object on ethical grounds to surgery for GID. In ordinary surgical practice, pathological tissues are removed in order to restore disturbed functions, or alterations are made to body features to improve the patient’s self image. Among those who object to sex reassignment surgery, these conditions are not thought to present when surgery is performed for persons with gender identity disorders. It is important that professionals dealing with patients with gender identity disorders feel comfortable about altering anatomically normal structures. In order to understand how surgery can alleviate the psychological discomfort of patients diagnosed with gender identity disorders, professionals need to listen to these patients discuss their life histories and dilemmas. The resistance against performing surgery on the ethical basis of "above all do no harm" should be respected, discussed, and met with the opportunity to learn from patients themselves about the psychological distress of having profound gender identity disorder.

It is unethical to deny availability or eligibility for sex reassignment surgeries or hormone therapy solely on the basis of blood seropositivity for blood-borne infections such as HIV, or hepatitis B or C, etc.

It is a sad statement that the paper's authors could not even have been bothered to examine the WPATH Standards of Care, which addresses their concerns most directly.

More Argument By Assertion

It's amazing to me how often so-called "experts" pop up with supposedly informed commentary on subjects like transsexualism, and they so obviously have no idea what they are talking about.

Most recently (Monday, I believe), there was a court decision in Australia where the Family Court granted a court order allowing a 17 year old FTM transsexual to have his breasts removed.

Lurking in the middle of the article is the following paragraph that caught my attention:

But ethicist Nick Tonti-Filippini said mainstream medicine did not recognise hormone treatments and surgery as treatment for gender dysphoria. He said it was a psychiatric disorder qualifying under American guidelines as a psychosis because "it's a belief out of accordance with reality".

"What you are trying to do is make a biological reality correspond to that false belief."

The first thought that went through my head was "who is this twit?". Among other things, it's quite apparent that he doesn't understand the diagnostic criteria for Gender Identity Disorder at all, nor has he bothered to fully understand the diagnostic criteria for Delusion.

In Schizophrenia, there may rarely be delusions of belonging to the other sex. Insistence by a person with Gender Identity Disorder that he or she is of the other sex is not considered a delusion, because what is invariably meant is that the person feels like a member of the other sex rather than truly believes that he or she is a member of the other sex.

So, a little bit of time with Google turns up that the man is affiliated with a religious institute as a philosopher/ethicist:

* 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

Oh ... now it starts to make sense. We have another case here of someone who is more than likely to be parroting whatever the Vatican spouts.

Sure enough, he has commented on the case in question before, when Alex was first granted hormones (again through the courts, presumably because Alex is a ward of the state).

Then there's his commentary on the most recent ruling, which is particularly galling.

NICHOLAS TONTI- FILIPPINI: Most psychiatrists who treat people with gender dysphoria don't recommend the surgery and the transsexual changes. 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.

SARA EVERINGHAM: How do you think this should be managed?

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.

I don't even know where to begin with how dreadfully wrong Mr. Tonti-Filippini has it. Although many transsexuals do have great difficulty with relationships, those issues are secondary to the condition, not a primary root factor.

Social adjustment is something that usually improves dramatically post-transition for those who are having problems prior to transition. The other problem I have with Tonti-Filippini's reasoning here is that he's trying to deflect attention away from the base condition being addressed - Alex's cross-gender identification - thus framing his argument in the "transsexuality isn't real" context.

When he starts from a position which denies the treatment and research from the last fifty or so years, it's no surprise that Tonti-Filippini concludes that Alex is being treated incorrectly. Not unlike the decision making of Alberta's Ron Liepert, he clearly hasn't bothered to admit to his own lack of knowledge in the area, and takes it upon himself to make pronouncements without actually investigating.

Most psychiatrists who treat people with gender dysphoria don't recommend the surgery and the transsexual changes.

Sort of true, and not entirely an accurate portrayal of the WPATH Standards of Care either. Again, I will refer to section X of the SOC, which reads as follows:

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.

Let's see...Alex has been living as a boy since the age of 13, and is now 17. That means that he has been living full time for 4 years, and assuming that the request for breast removal surgery was made at the age of sixteen, that's well beyond the SOC guidelines for Real Life Experience. Offhand, I'd hazard a guess that Alex has more than met the diagnostic criteria that would place him in the 'surgery is medically indicated' category. While only a handful of transgender people ever pursue surgery, that doesn't mean that surgery should not be an option to be considered.

However, I suspect that Mr. Tonti-Filippini isn't interested in doing the real research to understand the background and literature surrounding transsexuality. He's already made up his mind based on his presuppositions, and quite probably whatever pronouncements have been made by the Vatican - which is already known to be hostile to transsexuals.

It's one thing to make informed criticism of things, that's not what I see here.

Oh, Woe is my Poor Conscience

Okay, abortion is a contentious subject. I get that.

Not all doctors are going to be willing to provide that service. I get that too.

Leaving patients twisting in the breeze because "your conscience won't allow you to participate"? That I don't get.

Consider the following:

The present regulations say doctors must ensure pregnant women are "offered access to information or assistance" to help them make informed decisions on their options, including possible termination.

Under the proposed changes, physicians must make sure patients who are considering terminating their pregnancies are offered access to information to make an informed decision as well as "access to available medical options."

Okay - in essence, that creates a practice obligation that if a doctor is not willing to participate, then they are obliged to provide an appropriate referral to someone who will.

This is not an unreasonable statement at all when one considers that our family physicians are most people's primary source of meaningful information and connection into our health care system.

Of course, for the "conscience crowd", this is too much pain:

"This (proposed) clause removes my ability to be a conscientious physician," said Dr. Joan Johnston, an Edmonton family physician who opposes abortion.

Speaking as someone who has had to access the medical system for reasons that some moralizing types would consider controversial, the doctor's comments are whining. Basically, what she's demanding is the right not just to be a non-participant, but to in fact be an obstacle to her patients accessing those services. This is morally and ethically reprehensible.

It is difficult enough to gain access to the correct services within the medical system without having physicians demanding that patients live under the physician's personal moral code. If you don't want to perform some procedure, that's just fine - but you need to provide your patients with access to the doctors who are willing to be involved. There is little more frustrating in life than to be facing a need for treatment, and to have various people closing the doors on you without at least having the grace to point one in the direction of someone who can be of assistance.

Yes, I'm sure that Dr. Johnston has very legitimate concerns about "not perpetrating evil" (or whatever her particular objections are). The fact is that she is not being obliged to do anything except ensure that her patients have access to the correct resources to make an informed decision, rather than just providing them with a closed door.

I Really Hate It When ...

Bad speculative fiction comes out too close to the truth.

In this case, I'm referring to Robocop, and in particular the ED-209.

I'm not saying that the research being done is invalid, but it certainly conjures up visions that I can only characterize as creepy. Dealing with the police on a day to day basis is unsettling enough; dealing with a bunch of robots that are (in theory) controlled by the police - or any other law agency is just going to make the prospect all the more uncomfortable.

As with money, technology itself is inanimate, and has neither ethics nor morals per se. Those only exist in the hands of the humans that are using those tools. Are we ready for autonomous, or even semi-autonomous robots to play a role in our worlds?

When Does Religious Practice Become Neglect?

The story itself is tragic for all involved. An 11 year old girl died from undiagnosed diabetes.

Why did it go undiagnosed? Because the parents belong to a church that eschews medical treatment. This differs somewhat from the cases in recent years where youthful Jehovah's witnesses have refused treatments in that the child was never taken to a doctor in the first place, and the option to refuse treatment never existed.

As adults, we are all free to choose for ourselves if we seek treatment for a condition. Our children do not enjoy such a liberty. In fact, as parents, we have a responsibility to our children to ensure that in fact our offspring are looked after to the best of our ability.

Praying for your children is fine, and in its way, admirable. Doing so in hopes of divine intervention when your child is clearly ill, and doing so in place of a trip to the doctor is beyond horrifying. It ignores the old adage - "The Lord helps those who help themselves" to deny your child every chance of survival. We aren't talking about someone who lives in isolation on a mountainside somewhere, but an ordinary family living in an area with access to a doctor.

Religious freedom is a wonderful thing, but it does not grant anybody the unfettered right to neglect their children. If your child is not well, get them to a doctor - regardless of what your faith tells you. In the best case, nothing is seriously wrong; in the worst case, you can at least make an informed decision about treatment. No decision is neglect, no matter what your faith is.

Brrr...

Anybody with their eye on technology has known that sooner or later, someone was going to make a "real" ED-209.

Sure enough, the US Navy has gone quite some ways down the path.

I have to wonder if the developers are thinking in terms of Asimov's 3 Laws of Robotics when they are developing the software systems behind these devices?

Theology, Hospitals and Gender Identity

The whole business about a Catholic hospital refusing a transsexual access to surgical services has been rattling around in my head for some time.

So, I decided to go see if I could find some kind of reasonably intelligible, biblically-centered argument that could have led the hospital in question to the conclusion it arrived at.

As the old saying goes, seek and ye shall find. The article itself appears to be moderately old - likely from somewhere in the early to mid-1990s. However, it serves as a fairly decent jumping off point for my analysis, as it is fairly coherent, and tries to root itself in the concepts of scripture to make the case.

Looking at the paper in its entirety, it makes several very fundamental errors of reasoning that I need to point out.

First, the author makes the claim that because there are some number of stories of transfolk who have transitioned and then backed away when they "found Jesus" that one must thusly conclude that similar paths will work in the broader population of transsexuals. This is, of course, a deeply flawed attempt at a proof by induction. Even in the world of mathematics, proof by induction is fairly difficult. When people are being described, inductive proof is virtually impossible. Come to that, it's not terribly hard to find transsexuals who are in fact Christians.

The second error of reasoning that the author makes involves making the supposition that religious conversion is equivalent to psychotherapy, or if one takes certain statements of the author's at face value, possibly even higher value than psychotherapy. First, it is arrogant to outright dismiss the value of a discipline simply because it suits one's ideological goals. Second, because the author chooses not to cite either the DSM or the HBIGDA Standards of Care, it is quite clear that he is deriving his conclusions regarding psychotherapy based on supposition regarding the treatment and management of transsexual clients. This is argument by assertion, with only limited useful evidence to back it up.

The third high level error of reasoning comes in the regular mixing of terminology. Quite routinely the author switches to the term "transvestite", using it in a manner that suggests it has an equivalence to the term "transsexual". This results in the conflation of two similar, but distinct conditions in the reader's mind and implicitly links the two topics. While a transsexual may cross-dress as part of the therapeutic process to determine if transition is the appropriate path for them, they are not transvestites - their motivations for cross-gender presentation are quite different.

The last point of logical error is the author's insistence upon driving back to arguments based on biblical sexuality. Again, had the author made a more complete study of the subject area before leaping in with both feet, he would have recognized that gender is not sex, and sex is not gender. While sexual relations are part of an intimate relationship, they are not the relationship itself, and you find again and again that the rational narratives of transsexuals often has little to do with sexuality itself.

Neither biblical exegesis nor research science gives credibility to the transsexual's insistence that he or she is the opposite sex caught in an opposite sex body.

If one were seeking absolute causal explanations, I might see where this is coming from. However, when we are discussing attributes of someone's personality, seeking absolute causality seems rather pointless indeed. One might as well ask why one person is a pathological liar while their cousin has never been known to tell a lie at all.

What is important, and both the SOC and DSM emphasize this is the persistence and durability of the feelings involved. Those who are experiencing a "passing fancy" are not good candidates for transition at all.

While the author's point that we do not know the causal origins of transsexuality are valid to a degree, it fails to recognize the persistence of feelings that so many transsexuals experience and live with prior to transition.

Jesus Christ had a physical body, Col. 2:9. Clearly, then, the body is good. Biblical anthropology knows nothing of the pagan greek dualism that pits the body against the spirit with the former being evil and the latter good Bodily concerns and health are valid human concerns.

Wait a second, here. The very assertion that we have a soul, and the claim that the soul is eternal, surviving beyond our mortal lifespans is in essence to claim that even in Christian theology there is in fact a duality between body and soul. While the question of one being good, and the other not is perhaps not part of Christian belief, gender identity is neither good nor evil. By focusing upon the physical body, the author is essentially dismissing the very core narrative that is common to most transsexuals.

As I have argued in other writings on matters of identity and sexuality, it is unreasonable to simply dismiss someone else's narrative simply because it is inconvenient. That is poor reasoning at best, and condescending argument at worst.

In fact, I would argue in counterpoint to the author's supposition that in fact the distinction that Christianity makes between "body and soul" opens the door to the possibility that in fact one's "soul" may in fact be a "feminine soul" even in a masculine body. To the best of my knowledge, scripture is quite unclear on whether the soul is "gendered" or not, but it is not unreasonable to suppose that if the soul is the seat of personality that it may well be.

Confusion about gender and gender roles became the norm. God highlighted this issue in His curse on man's rebellion.

Later, God had Moses teach:

A woman shall not wear a man's clothing, nor shall a man put on a woman's clothing, for whoever does these things is an abomination to the Lord your God.

Dev. 22:5.

Ah...once again, we fall into the trap of equating transsexualism and transvestism. If one assigns even a limited truth value to the transsexual claim of "being in the wrong body", then in fact the Male to Female (MTF) transsexual is arguably not cross-dressing when she presents in the feminine role. In order for Deuteronomy to be parsable with respect to the phenomenon of transsexuality, one must first demonstrate that the transsexual narrative is utterly invalid. While the paper's author has made the claim that such is the case, he has not by any means provided the reader with any compelling evidence to back up his claim.

(I will point out that many of the writer's claims about gender role and how it is learned rest upon some of Dr. John Money's work. While I admire Money's dedication and desire to contribute positively to our knowledge of gender identity, some of his work had tragic outcomes, and may in fact have demonstrated that his early notions that gender is primarily rooted in socialization to be troublingly false.

The fact that hermaphrodites have few, if any, problems with transsexualism, when one might expect them to have problems if any group of people would, proves that there is no physiological cause. As a group they prove that once a sex gender role have been assigned, children adjust well and experience few problems." Thus, sexual gender roles are largely learned."

Well, actually, people who are Intersex probably have fewer problems with transsexuals in general because they have experienced some of the same challenges that transsexuals experience in finding treatment to help them find their "stable place" in the world. Further, more recent perspectives on the Intersex run quite at odds to what the paper claims, with an increasing demand to allow the intersexed individual to choose their gender role later in life.

"The causative factors in transsexuality appear to be the same as those in transvestism and homosexuality. The transsexualist's mother is typically an unhappy woman, who clutches her son to her bosom - literally or figuratively - entering into an intensely close relationship with him from which the father and other children of the family are excluded".22

This is blatantly false. I have not seen any literature written since I graduated from University that substantiates such a simplistic view of the causality of either homosexuality or cross-gender identity. This is arguably a hangover view in the paper which persists today in the world of people like James Dobson because it is convenient and simple. More recent work such as True Selves are more candid and freely admit that we really do not know. What we do know is that simplistic "it's the parent's fault" explanations tend to fall apart under scrutiny.

The paper then goes on to talk about the "biblical response" to transsexualism:

This supernatural washing, setting apart, and justification are sufficient to put these sinful lifestyles in the past. My friend is evidence of this truth. Perry Desmond is a man who had two sex-reassignments. God's grace truly transforms.34 Surely it is sufficient.

As with my common critique of the "ex-Gay" claim of "healing through conversion", such experiences have limited validity when mapped onto the broader population in question. There are a handful of a small population for whom religious conversion seems to be adequate to enable them to leave their sexual or gender identity issues behind. For those individuals, one must wish them well on their life journey. However, to claim that such an approach is "universally applicable" is flawed indeed. (Just as transition is not the "right path" for every cross-gender identified person, neither is religious conversion going to "work" for everyone)

It is perhaps the attitude the author takes towards Intersex children that is most telling:

While these individuals are not the direct concern of this article, a brief word is necessary. Ethically, you should help the parents take responsibility for surgical-hormonal treatment. As much as is possible, the external genitalia should be brought into conformity with the genetic gender of the child.35

Genetic gender? Huh? What is the "Genetic Gender" for someone who is a genetic mosaic (has both XX and XY chromosome pairs in different cells)? Or, for that matter what about the XXY chromosome pattern of Klinefelter's syndrome - is that person really "genetic female" or "genetic male"? Such absolutist thinking is as dangerously flawed as John Money's hypothesis about gender as primarily a 'socially learned construct'.

You need, also, to point the transsexual to Christ. Once a transsexual is converted, medical care should be given. Since the believer must live according to God's will, he or she must resume his or her created gender.

It gets worse. While I appreciate that my doctor is entitled to his religious views, and so on, the last thing that any patient wants is a sermon when sitting in the doctor's office. I would feel very sorry for any transsexual whose doctor (or therapist) chose to follow the guidance of this paper's author indeed.

While I think I understand better the kind of reasoning that Seton Medical Center used to arrive at their decisions, but I also believe that the reasoning is based not upon sound ethics and research, but instead upon assertion, a lack of research and poor logic - resulting in intolerance of anyone who does not fall within a narrowly prescribed view of the world.

The Ends Do NOT Justify The Means

Apparently Sun Media columnist Rachel Marsden thinks that where torture is concerned, waterboarding as an interrogation technique does.

Waterboarding, for those less than familiar with the vileness that is the torturer's mindset, is a technique where you basically convince the victim to talk by almost, but not quite, drowning them. I won't go into the grisly details of this technique - it is every bit as damaging as the various tortures used in the Middle Ages.

According to Ms. Marsden, waterboarding is no worse than the techniques used by competitive swimming coaches:

I suppose that those who object to terror suspects getting water up the nose would say that, as a young competitive swimmer, I was also tortured. It was called "hypoxic training" -- swimming underwater and holding our breath until we passed out. Our coaches didn't call it torture, just an exercise in "mental toughness." So think of it this way -- terror suspects are getting some free mental toughness training courtesy of the U.S. government.

No Rachel, you dumb twit - there's a damn big difference between what a young swimmer contends with and being strapped down to a board and having ABSOLUTELY NO CONTROL over what is being DONE TO YOU!

Intelligence saves lives.

Why yes it does. But just how reliable do you think intelligence gathered by physical coercion is, Rachel? Someone being tortured will say whatever they think their captors want to hear - whether it has any grounding in reality is irrelevant.

Now consider the case of Khalid Sheikh Mohammed, the 9/11 mastermind who ultimately claimed to have been involved in dozens of terrorist plots. He was found dressed like a slob, naturally, and also apparently in possession of a letter from Osama bin Laden. Think he might have known a thing or two?

I'm not sure how folks who are critical of the CIA's interrogation techniques would suggest eliciting intelligence from guys like this. Perhaps by offering him some tasty snacks and the love and understanding that he lacked as a child?

And why do you think torture is going to get you anything useful? If you get something "useful", you still have to corroborate it through other more reliable sources - so why aren't you using those reliable sources properly in the first place?

The examples of spies like Aldrich Ames in fact underscores my point. Ames was not coerced to provide information to the Soviet Union through force - he was recruited and paid. The information he provided to the Soviets was undoubtedly of a high grade and useful.

Marsden might think that torture is justified because someone is a suspect in a terrorism investigation. Then again, we only have to look at the case of Maher Arar as an example of just how effective torture actually is in extracting information. Or perhaps, she'd like a little sample of CIA-sponsored "swimming lessons" as she so dismissively puts it?

No, Rachel, the ends do not justify the means. Just as the evil that is perpetrated by terrorists is impossible to square with the political goals behind it, descending into acts of evil ourselves is not justified either. Desperate times may beget desperate measures, but you better be goddamn sure it's that desperate before you sink to depths of torturing someone to find out what you think they know.