Missing the point in the debate about abortion: An open letter to my MP, Marc Garneau


Dear Marc Garneau MP,

Recently Stephen Woodworth, a Conservative MP, has made a push to open a debate about when it is that human life begins. He wants parliament to consider granting personhood to foetuses. This is surprising for a couple reasons: First, this is a very transparent attempt to re-open the debate on abortion (something that Stephen Harper promised would not happen) and second, a debate on the issue of the personhood of foetuses seems to miss the point in the issue of abortion completely.

I don’t know what sort of training in ethics you have had in your career as a space-man, but among philosophers, there is a reasonably famous argument by Judith Jarvis Thomson, which I have linked to. I recommend that you read it in full.

The argument is based on a thought experiment. You imagine that you wake up one day, having been attached against your will to the kidneys of a famous unconscious violinist, and you are told that if you disconnect yourself at any time, the violinist will die.

“Tough luck. I agree. but now you’ve got to stay in bed, with the violinist plugged into you, for the rest of your life. Because remember this. All persons have a right to life, and violinists are persons. Granted you have a right to decide what happens in and to your body, but a person’s right to life outweighs your right to decide what happens in and to your body. So you cannot ever be unplugged from him.”

Thomson, JJ, “A defense of abortion,” Philosophy & Public Affairs, Vol. 1, no. 1 (Fall 1971)

You can probably see how the argument goes from there. She argues that even if it is conceded that a foetus is fully a person (not just a human being, but a person who has a serious moral and legal claim to a right to life), abortions may still be morally permissible in certain cases, and laws against abortions would be inappropriate. I am reasonably convinced by this line of reasoning, and think that Thomson offers a fairly nuanced framework for thinking about this issue.

Since the debate has been re-opened, I have heard a great deal of noise and bother about whether or not a foetus is a legal person. I have yet to hear any MP’s ask the question about whether or not this matters. A debate seems unavoidable at this time, so could you propose that parliament asks whether the personhood of foetuses matters to the issue of abortion, instead of asking whether foetuses are people? I look forward to your response.

Best regards,
Benjamin Carlisle MA (Biomedical ethics)

Cc: The Rt. Honourable Stephen Harper, Stephen Woodworth MP, Niki Ashton MP


    title = {Missing the point in the debate about abortion: An open letter to my MP, Marc Garneau},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2012-04-26,
    url = {http://www.bgcarlisle.com/blog/2012/04/26/missing-the-point-in-the-debate-about-abortion-an-open-letter-to-my-mp-marc-garneau/}


Carlisle, Benjamin Gregory. "Missing the point in the debate about abortion: An open letter to my MP, Marc Garneau" Web blog post. The Grey Literature. 26 Apr 2012. Web. 30 Sep 2016. <http://www.bgcarlisle.com/blog/2012/04/26/missing-the-point-in-the-debate-about-abortion-an-open-letter-to-my-mp-marc-garneau/>


Carlisle, Benjamin Gregory. (2012, Apr 26). Missing the point in the debate about abortion: An open letter to my MP, Marc Garneau [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2012/04/26/missing-the-point-in-the-debate-about-abortion-an-open-letter-to-my-mp-marc-garneau/

Game theory and medical research


I recently learned what exactly a Nash equilibrium is, and I’m really excited to start applying the idea in my everyday life. Hence, I will apply what I’ve learned in Game Theory so far to the field of medical research ethics.

First, some definitions: A Nash equilibrium is a set of strategies that the players in a formalised game adopt such that the utility that each player receives for her chosen strategy is the greatest, given the choices of strategies of all the other players in the game.

This could be formalised as follows:

A Nash equilibrium exists when ui (ai, a-i) ≥ ui (ai′, a-i) for all ai′ and all i, where:

  • ui is a function whose range is utility values for player i and whose domain is an ordered n-tuple of strategies taken by all the players in the game
  • ai is the chosen strategy of player i
  • a-i is the set of chosen strategies for all the other players, and
  • ai′ is some alternate strategy that player i might adopt.

What’s interesting about Nash equilibria is that given a particular formalised game, other non-Nash sets of strategies are “unstable”—that is, if a player finds out that given the strategy choices of the other players, she could have made a better decision, she will change her strategy accordingly.

The famous Prisoner’s Dilemma (look it up if you haven’t heard of it) is a great example of a Nash equilibrium where the outcome for each of the players is not optimal, even though they are in equilibrium.

What’s interesting to me about things like this is how it can be applied to medical research, if we make certain simplifying assumptions. Let’s imagine that medical research is like a two-player game. The players are the pharmaceutical industry on the one hand and some other participant in human research on the other.

In the tables below, Big Pharma has two strategies open to it—developing a “seeding” study or developing a “quality” study. The other participant (who could be a research subject or a physician-investigator or a journal that publishes medical research papers) also has two strategies available—participating in the study developed by Big Pharma, or not participating.

If the other stakeholder in the research project doesn’t participate, neither Big Pharma nor the participant receive any benefit. The utility outcomes for Big Pharma and the other stakeholder are 0, 0, respectively.

If the other stakeholder participates and the study is a high-quality study that provides socially valuable medical information, Big Pharma and the other stakeholder receive utilities of 1, 1, respectively.

But, if it turns out that the pharmaceutical company has produced a “seeding” study—one that is designed for narrow ends, namely those of being a marketing tool to get physicians used to prescribing a drug that has already received licensure—the pharmaceutical company receives a utility of 2 and the other stakeholder receives a utility of -1. That is to say, Big Pharma gets a big payout, because hundreds of doctors are now prescribing the drug, but the other stakeholder incurs a net harm in some way. (If she is a study participant, he may feel used or cheated. If she is a doctor, it may be a source of professional embarrassment. If it is a journal that published a “seeding” study, that journal will lose some of its reputation, etc.)

Participate Not
“Seeding” study 2, -1 0, 0 *
“Quality” study 1, 1 0, 0
Table 1. Asterisk (*) indicates Nash equilibrium.

So if we go through each set of strategies that the players in this game can take, we find that the one with the asterisk is the only one that is a Nash equilibrium. This is because if you are Big Pharma in this game, given that the other stakeholder has chosen not to participate, you are indifferent between strategies, and if you are the other stakeholder, given that Big Pharma has chosen to develop a “seeding” study, your best choice is to not participate.

It’s interesting to note that this setup is analogous to markets for financial products and other “confidence goods,” where the buyer has a really hard time telling the difference between high and low quality products.

But what if no one caught on that the study was a “seeding” study? Let’s imagine that Big Pharma got away with running a seeding study and no one ever figured out that that’s what it was. We would end up with a game that can be represented as follows:

Participate Not
“Seeding” study 2, 1 * 0, 0
“Quality” study 1, 1 0, 0
Table 2. Asterisk (*) indicates Nash equilibrium.

Here, the equilibrium has shifted. This explains why pharmaceutical companies try to develop “seeding” studies, and why they try to hide it.

So the question becomes, how can we set up the “rules of the game” of medical research in order to shift the equilibrium such that other stakeholders will participate and the pharmaceutical company will develop quality studies?

Or to put it another way, if we assume that the utility for non-participation for all players is 0, and that both the pharmaceutical company and the other stakeholder should both come away from a quality study having received some utility, what value for x will put the Nash equilibrium where the asterisk is in the table below?

Participate Not
“Seeding” study x, -1 0, 0
“Quality” study 1, 1 * 0, 0
Table 3. Asterisk (*) indicates Nash equilibrium.

The value of x must be less than 1 in order for the Nash equilibrium to fall where the pharmaceutical company develops a “quality” study and the other stakeholder participates. This is because if x = 1, Big Pharma will be indifferent between its strategies, given the choice of the other player, and if x > 1, as we saw in Table 1, the equilibrium will shift to where Big Pharma produces a “seeding” study and the other stakeholder declines to participate.

So in real life, how do we make x to be less than 1? There has to be some sort of sanction or penalty for pharmaceutical companies for producing seeding studies that makes their expected utility less than that of a quality study. This can be done by either putting a tax on seeding studies or by making regulations against seeding studies outright.


    title = {Game theory and medical research},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2012-04-1,
    url = {http://www.bgcarlisle.com/blog/2012/04/01/game-theory-and-medical-research/}


Carlisle, Benjamin Gregory. "Game theory and medical research" Web blog post. The Grey Literature. 01 Apr 2012. Web. 30 Sep 2016. <http://www.bgcarlisle.com/blog/2012/04/01/game-theory-and-medical-research/>


Carlisle, Benjamin Gregory. (2012, Apr 01). Game theory and medical research [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2012/04/01/game-theory-and-medical-research/

Free online game theory course


So a few months ago I signed up for a free online course in Game Theory, taught by two professors at Stanford. I like Stanford. Ever since I discovered the Stanford Encyclopaedia of Philosophy as an undergrad (the one website that philosophy profs will allow you to cite in your papers), I had a profound respect for this institution’s free online offerings.

The course isn’t for credit at all—there’s just video lectures, and “quizzes” integrated into the videos. I guess I’m sort of interested in it because it relates to my thesis subject. Ever since I wrote my thesis on it, I find the whole idea of collaborative enterprises fascinating, and I would love to be able to more rigorously analyse what regulations would make a complex system with multiple stakeholders work best.

The course was supposed to start in “late February 2012,” so I waited until today—I was going to send the professors an email, since February 29th is about as late in February as you can get. So I opened up the site for the course to find a contact email address, and found the following message:

Regarding the start-date of the Game Theory Online course: The University is still finalizing policies to cover its new online courses, and so there has been some delay in the launching of the courses. We anticipate being able to launch the course soon, and will keep you informed of any news on the starting date. Matt and Yoav

I’ll let you know if anything interesting comes of this. Let me know if you sign up for the course yourself. :)


    title = {Free online game theory course},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2012-02-29,
    url = {http://www.bgcarlisle.com/blog/2012/02/29/free-online-game-theory-course/}


Carlisle, Benjamin Gregory. "Free online game theory course" Web blog post. The Grey Literature. 29 Feb 2012. Web. 30 Sep 2016. <http://www.bgcarlisle.com/blog/2012/02/29/free-online-game-theory-course/>


Carlisle, Benjamin Gregory. (2012, Feb 29). Free online game theory course [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2012/02/29/free-online-game-theory-course/

Back to school


Today is the first day back to school after the break! Hooray! I’m feeling good about it. Things are actually going well for me for right now. Here’s all the good things happening to me that I can think of:

  • I got a notice saying that the paper I helped to write last year made it past 2 of 3 rounds of cuts for the journal Science, and so it stands a good chance of making it in and being published.
  • Also, there are now curtains in my bedroom, so I will be able to sleep better!
  • The weird red patches of skin on my face and hands have pretty much disappeared. I attribute their existence to dry skin and their disappearance to the turning on of the humidifier in my apartment.
  • The School of Nursing at McGill assures me that the OIIQ situation will be resolved, and that I don’t need to do anything about it. McGill is probably not a cash-for-degrees scam.
  • I’m starting two brand-new clinical rotations! Anything could happen!
  • OSAP has formally apologised for their treatment of me last semester.
  • Actually that last one was a joke. They still haven’t sent me my student loan yet, but I have been given every assurance that they will.

I have decided that this semester is going to be wonderful, and that none of the bad things from last semester will happen. I’m going to enjoy my new bunch of classes and I’m not going to stress out over money.


    title = {Back to school},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2012-01-9,
    url = {http://www.bgcarlisle.com/blog/2012/01/09/back-to-school/}


Carlisle, Benjamin Gregory. "Back to school" Web blog post. The Grey Literature. 09 Jan 2012. Web. 30 Sep 2016. <http://www.bgcarlisle.com/blog/2012/01/09/back-to-school/>


Carlisle, Benjamin Gregory. (2012, Jan 09). Back to school [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2012/01/09/back-to-school/

I graduated this week


Backward compatibility

I'm getting hit by a tube

I'm getting hit by a tube

I like graduation ceremonies. Don’t get me wrong—hearing the names of a couple hundred students read in order of academic programme isn’t my idea of a wild party, but I’m glad such things exist. There’s a couple things that I like about graduations.

Convocation is the ultimate example of backward compatibility. There’s something positively medieval about them. As the Principal said, the tradition of graduation ceremonies at McGill predates Canadian Confederation. If a person from even ten centuries ago was magically transported to Place-des-Arts on the morning of November 23rd, 2011, that person would probably be able to recognise what is going on, just by seeing all these acamedics in their robes and the giving of certificates.

When I graduated from Western, the procession of professors, chancellors, etc was preceded by a guy carrying a big gold mace. Maces are symbols of power, and historically speaking, they were there to serve the purpose of keeping everyone in line, in case the meeting got out of hand. And at some point in history, someone thought, “Carrying around an implement for bludgeoning rabble-rousers is something that we have to keep doing forever. Just in case.”

When I got the actual paper with my degree printed on it, I discovered that it was all written in Latin. According to the paper, I have a “Magistrum Artium” now. I’m going to take a picture of my degree and get my little sister (whose Latin is much better than mine) to read it at Christmas break.

At McGill by tradition, undergrads are tapped on the head by an academic cap as they graduate. Grad students used to have their hands shaken by the Chancellor, however in the wake of the Swine Flu scare, hand-shaking fell out of fashion. (Not based on any evidence, mind you—Swine Flu is not transmitted by hand-to-hand contact.) Hence, the Chancellor hits graduate students with a tube as they pass him on the stage.

That was the weirdest thing. It was like a knighting (“I dub thee “Magistrum Artium”) except it would have been a whole lot awesomer if they had tapped me on the shoulder with the sword of Gryffindor or something. Actually, I’d settle for the sword of James McGill.

Academic regalia

Hood and robe for MA at McGill

Hood and robe for MA at McGill

What’s also fun (but expensive) is the academic regalia. This time, they let me keep the hat, at least!

I can wear it whenever I want to look smart and make people pay attention to my ideas.

Every programme/faculty/level of achievement has a different robe/hood/hat that they wear to graduate. For a MA at McGill, you get a black robe with funny sleeves that you can’t actually put your arms through, a mortar board and a baby blue hood that goes around the neck. In the attached photo, I’m trying to show what the hood looks like a bit. That’s the interesting part.

Not only do the students all wear different things, but because each professor wears the academic regalia of the school where she earned her PhD (not the school she works at), many professors will have different robes/hoods/hats. Some are boring, some are very eye-catching. The profs who did their PhD at McGill all have funny black McGill hats.

Framing my degree

I looked at the prices of the fancy “McGill” frames that were for sale just outside the theatre and asked them how much they cost. They said they were $200 apiece.

When I stopped laughing, I realised that they were serious and moved on.

Part of me wants to go out and find a “Dora the Explorer” frame for my degree. Something really tacky to keep it in, at least while I’m looking for a frame that won’t require another student loan for me to buy. The only problem with that is that if I do that as a joke while I’m looking for the “real frame,” it might become the “real frame.”


    title = {I graduated this week},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2011-11-25,
    url = {http://www.bgcarlisle.com/blog/2011/11/25/i-graduated-this-week/}


Carlisle, Benjamin Gregory. "I graduated this week" Web blog post. The Grey Literature. 25 Nov 2011. Web. 30 Sep 2016. <http://www.bgcarlisle.com/blog/2011/11/25/i-graduated-this-week/>


Carlisle, Benjamin Gregory. (2011, Nov 25). I graduated this week [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2011/11/25/i-graduated-this-week/

I will be clean-shaven this Movember


“Movember” is the name of a movement that emphasises men’s health, specifically prostate cancer awareness during the month of November, by encouraging men to grow moustaches. There are two main reasons why I will be clean-shaven this November.

Screening for prostate cancer

When is it rational to be screened for a condition?

When is it rational to be screened for a condition?

The first major problem I have with Movember is the emphasis that is placed on prostate cancer screening for men—even men who are not in a high risk group for this type of cancer.

Not every test is completely reliable. Think about it this way: If you put a toothpick into something you baked and it comes out dry, it’s likely that your baking is done. But it’s also possible that you just poked the wrong part of your banana bread, and the rest of it is all gooey. If that happens, it’s called a “false positive” result for your test, or a “Type I error.”

This isn’t just a problem for bakers. It’s a problem with pretty much all medical tests (or any test at all for that matter) that there is a non-zero chance that you will get a false positive (“Type I error”) or a false negative (“Type II error”) result.

For prostate cancer, there are two methods of screening: a digital rectal exam (DRE) or a prostate-specific antigen test (PSA). The DRE is a physical examination of your rectum by palpation and the PSA is a chemical assay performed on a blood draw. Neither of these tests can be relied upon to give perfectly accurate results all the time.

The problem is that if a doctor finds what he takes to be evidence of a tumour growth in the prostate, he may order a biopsy of the prostate. This is an invasive, expensive, painful (and in the case of Type I errors, unnecessary) procedure that brings its own set of medical risks. A biopsy carries the risk of infection, for example.

Please examine the decision tree I have attached to this post. I have tried to make it as general as possible. If you wanted to be really rigorous, you would assign dollar values to each of the outcomes, and then for each of the branches off a probability node (a circle), calculate the probability of that branch. Then if you multiply the probability value of that branch and the dollar value of the outcome for that branch, and take the sum of all the branches, it will give you the value of that node. Repeat the process from right to left, until you come to a decision node (a square). The branch that carries the highest value as calculated using the algorithm I outlined is the decision that one has most reason to take.

I haven’t done the research to find out what the rates of Type I and II errors are for PSA tests, but they are pretty high, and you can see that if the probability of an inaccurate test result is high enough, and the consequences for having a bad test result are dire enough, that might give you reason to go without testing, provided you aren’t in a high risk group for prostate cancer. Further, a randomised control trial of men showed that there is no significant difference in mortality between a group of men who were screened for prostate cancer and those who weren’t. The evidence shows that prostate cancer screening doesn’t help reduce mortality.

If you are in a high risk group, like if there is a history of it in your family, and you are in a certain age range, then by all means, you should be tested for prostate cancer regularly—but don’t start encouraging young healthy men who are not at high risk for developing this sort of cancer to go looking for it. They may find more trouble than is actually there.

Emphasis on men’s health

The second major problem I have with Movember is their condescending and naive position on “men’s health” generally. Let’s consider a quote from the Movember Canada website:

Let’s face it – men are known to be a little more indifferent towards their health … The reasons for the poor state of men’s health in the Canada and around the world are numerous and complex and this is primarily due to a lack of awareness of the health issues men face. This can largely be attributed to the reluctance of men to openly discuss the subject, the old ‘it’ll be alright’ attitude. Men are less likely to schedule doctors’ appointments when they feel ill or to go for an annual physical, thereby denying them the chance of early detection and effective treatment of common diseases.

(From Men’s health—Movember Canada)

Movember Canada is stating here that it is “reluctance of men,” an “‘it’ll be all right’ attitude” and the general indifference toward issues of health that make men less likely to schedule a doctor’s appointment when they feel ill, or to make an appointment for a regular physical exam.

This is not the case. In Canada, men don’t schedule doctor’s appointments largely because they don’t have a doctor that they can call to make an appointment. I have been on my CLSC’s waiting list for a doctor for over a year now, and unless I go to the hospital or a walk-in clinic, I think it unlikely that I will see a doctor any time soon. This is not because I’m indifferent toward my health. This is because I don’t have a doctor.

It is not men being “too macho for doctors” that’s the problem. It’s that we as a country have made decisions regarding health care in Canada based on economics and politics that have brought about a doctor shortage. I hesitate to call it a “doctor shortage,” because the word “shortage” makes it sound like it was something unavoidable or unforeseeable—not something that was engineered and implemented as a matter of public policy.

The reason men aren’t seeing doctors in Canada is because we have chosen to limit our health care spending by decreasing the number of doctors in Canada who will order expensive tests and procedures. So don’t you dare turn around and chide men for failing to see a doctor regularly, when that is exactly what we have decided we want.

Is Movember all bad?

No probably not, and insofar as it is a fundraiser for prostate cancer research and survivor programmes, I think it is probably a good thing. That said, the message of Movember needs to be changed before I can support it.


    title = {I will be clean-shaven this Movember},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2011-11-1,
    url = {http://www.bgcarlisle.com/blog/2011/11/01/i-will-be-clean-shaven-this-movember/}


Carlisle, Benjamin Gregory. "I will be clean-shaven this Movember" Web blog post. The Grey Literature. 01 Nov 2011. Web. 30 Sep 2016. <http://www.bgcarlisle.com/blog/2011/11/01/i-will-be-clean-shaven-this-movember/>


Carlisle, Benjamin Gregory. (2011, Nov 01). I will be clean-shaven this Movember [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2011/11/01/i-will-be-clean-shaven-this-movember/

A scary email to receive less than a week before the thesis submission deadline


I bet you thought I was done posting about my thesis. Last Friday (6 days ago), I received this email after I had the pleasure of submitting my thesis electronically.

[Your supervisor] approved your e-thesis on September 23, 2011 at 11:51.

If your thesis has been accepted by all your supervisor(s), it has been sent to GPSO for processing.

If your thesis has been rejected, please make the changes requested by your supervisor(s) to your original document*, and create a new pdf, delete the file on the server, and upload the new file.

You can track the progress of your thesis on Minerva.

Hooray! It was good news to receive this email, and I tweeted about it immediately, of course.

Then, this morning, I received the following email.

Dear Benjamin, … We [at the philosophy department] have been told that you haven’t submitted your thesis electronically, and this is one of the graduation conditions. Can you do this immediately? The conditions have to be met by Tuesday, 4 October. Best wishes.

October 4th is on Tuesday (5 days from now). I’m pretty sure that my thesis has been submitted electronically. Here is my evidence:

  • Minerva lists my thesis as being uploaded and approved
  • I received the aforementioned email from the e-thesis computer

So I really don’t know what this fuss from the philosophy department is all about, but now I’m nervous that something’s messed up.


    title = {A scary email to receive less than a week before the thesis submission deadline},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2011-09-30,
    url = {http://www.bgcarlisle.com/blog/2011/09/30/a-scary-email-to-receive-less-than-a-week-before-the-thesis-submission-deadline/}


Carlisle, Benjamin Gregory. "A scary email to receive less than a week before the thesis submission deadline" Web blog post. The Grey Literature. 30 Sep 2011. Web. 30 Sep 2016. <http://www.bgcarlisle.com/blog/2011/09/30/a-scary-email-to-receive-less-than-a-week-before-the-thesis-submission-deadline/>


Carlisle, Benjamin Gregory. (2011, Sep 30). A scary email to receive less than a week before the thesis submission deadline [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2011/09/30/a-scary-email-to-receive-less-than-a-week-before-the-thesis-submission-deadline/

Moral dilemmas generated by a nurse’s professional obligations


In loose and general terms, a moral dilemma is what happens when someone is caught between two (or more) conflicting legitimate moral claims.

A resolvable moral dilemma, on the one hand, is one in which one moral claim on the agent in question is more important than the other. In such a case, the agent is in the position of having to choose between a greater and a lesser evil.

An irresolvable a moral dilemma, on the other hand, occurs when someone has to make a decision between two (or more) options, where morality gives absolutely no guidance regarding which decision to make.

I find moral dilemmas utterly fascinating, and one came up in class last week. We were talking about professionalism in nursing, and this case was never resolved in class (to my satisfaction, at least).

As a nurse, there are certain obligations that arise just by virtue of the fact that a nurse is a professional. For example, a nurse is bound by confidentiality, just because she is a nurse. (And not necessarily because she offers a promise of confidentiality to any particular client.) It would be severely unprofessional for a nurse to disclose the physical condition of one of her clients to someone who is not directly involved in the client’s care.

Conversely, a nurse sometimes has a duty to share certain pieces of information regardless of the wishes of the client for the information to be kept confidential, and this duty arises just because she is a nurse.

It’s really easy to see how these two professional obligations in particular could result in incompatible but legitimate moral claims on a nurse’s conduct. There are some examples where it’s clear what a nurse should do, but then there are a lot of cases where it’s not so clear. I’ll lay out a number of such examples to illustrate.

The child molester

In this case, a client is sexually molesting his nine-year-old niece, and he tells the nurse, but asks her to keep it a secret. Here, it is clear that regardless of the wishes of the client to keep his conduct secret, the nurse has a professional obligation to tell certain people (the niece’s parents, the police) about the molestation because of the degree of harm to the niece. I think it is non-controversial that we could characterise this as a classic resolvable dilemma—the nurse should break confidentiality, which is a legitimate moral constraint on her actions, but because the nurse also acts to prevent harm to the patient, she chooses the lesser evil.

This case is clear. The wrong of breaking confidentiality is clearly outweighed by preventing the wrong of further sexual exploitation. But what about cases that are otherwise parallel, but in which there is less harm to the child? Here’s a few other cases with decreasing harm to the niece.

The enabler

In this case, a client is saving his pain medication and giving it to his nine-year-old niece because she likes the way it makes her feel. He tells the nurse, in full expectation of confidentiality.


Here, the client reveals that he is buying cigarettes and giving them to his nine-year-old niece. He has not told the niece’s parents, and indicates that he wants the nurse to keep this quiet.


A client says that he is buying beer for his niece. The parents don’t know, and he indicates that he expects the nurse to respect confidentiality in this matter.

Lots of candy

This is the same situation as the previous, but instead of alcohol, the client is giving his niece an unhealthy amount of candy.

Bad TV shows

This is the same situation as the previous, but instead of candy, the worst thing that the client does that has an impact on his niece’s health is that sometimes he lets his niece watch cartoons on the television. He doesn’t want the nurse to tell his sister (the niece’s mother) because he is a somewhat insecure man and he is afraid that if his sister found out that he and his niece were bonding over Looney Tunes, he would be teased.

In the last case, Bad TV shows, I think most people would say that the nurse should respect the client’s wish to keep the matter secret, since the harm to the child is minimal. That is, if a nurse spoke to the niece’s parents, it might even be seen as an unprofessional breach of trust.

So at either extreme, it is very clear what the nurse should do. In The child molester, we think the nurse ought to say something and break confidence. In Bad TV shows, we think the nurse really doesn’t have good enough reason to break confidentiality. It’s the cases in between where there is some uncertainty. Where do we draw the line?

Probably The enabler is a case where confidence should be broken. To be honest, I’m not sure about Alcohol.

Here’s another consideration: for some moral dilemmas moral philosophers will say that they are only resolvable “with remainder.” That is, even if the moral agent correctly identifies and takes the horn of the dilemma that is the lesser evil, the option that is not taken still retains some of its moral force, and requires something on the part of the moral agent to resolve it, like remorse, regret or apology.

In a case like The child molester, if the nurse breaks confidentiality to tell the parents and the police about the exploitation, most people won’t think that anything (like an apology) is owed to the molester. In the less extreme cases, this becomes less clear, I think, and especially if we don’t make the assumption that the client in question is doing something that she knows to be wrong.

I don’t have answers to the questions here. I’m not even sure if this “balancing” of interests is the best way to conceive of the problem.

The “correct” answer that we were given in class is that before the client offers us a secret, we should disclose to the client that, depending on what the secret is, we might have to tell someone. The problem with that answer is that a nurse does not just come by incompatible moral obligations by virtue of poorly thought-through promises she makes. Confidentiality and concern for the well-being of others are obligations that bear on nurses regardless of whether they say that they will keep a secret or not, and so a more fine-grained and nuanced approach to this problem is needed.


    title = {Moral dilemmas generated by a nurse’s professional obligations},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2011-09-29,
    url = {http://www.bgcarlisle.com/blog/2011/09/29/moral-dilemmas-generated-by-a-nurses-professional-obligations/}


Carlisle, Benjamin Gregory. "Moral dilemmas generated by a nurse’s professional obligations" Web blog post. The Grey Literature. 29 Sep 2011. Web. 30 Sep 2016. <http://www.bgcarlisle.com/blog/2011/09/29/moral-dilemmas-generated-by-a-nurses-professional-obligations/>


Carlisle, Benjamin Gregory. (2011, Sep 29). Moral dilemmas generated by a nurse’s professional obligations [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2011/09/29/moral-dilemmas-generated-by-a-nurses-professional-obligations/

But what do we call them?


In school this year, we have spent a good deal of time talking about our relationship to our patients. Actually, that’s not true. We have actually spent more time talking about our relationship to our “clients.” It’s surprisingly difficult to find any reference to “patients” in our readings or texts.

There has apparently been a movement away from referring to someone as a patient, because of the meaning of the word, I suppose. In philosophy, the word “patient” is sometimes used in opposition to the word “agent.” For example, a moral agent is someone for whom her actions, character or the results of her actions are the proper subject of moral evaluation. By contrast, a moral patient is someone for whom her treatment by others is the proper subject of moral evaluation. (So a human being would be a moral patient. An inanimate object would not be a moral patient, since you can treat an inanimate object any way you please without it being even slightly wrong, as far as the object itself is concerned.)

If that is the way that we conceive of a patient—someone who is acted upon, then we make an implicit divide between “us nurses” (the agents) and “those patients” (the patients). On this conception, it is we who act upon the patient to bring about health. By labelling her a “patient,” we take away her agency.

I can understand this concern. This is why the language has changed. We now interact with “clients.” On this model, the client comes and uses the services of the nurse. I think this word is better than the word “consumer,” but only just. It has a very economic feel, I think. When I call someone my “client,” it sounds like I see them as someone with whom I am about to have a business transaction.

What’s funny about this is that I’ve had some instructors at McGill who disapprove of the word “patient,” and others who disapprove of the word “client.”

I’m tempted to just use the word “buddy.” E.g. “I’m going to give my buddy his meds.” It’s non-gendered, it doesn’t imply a lack of agency, and it doesn’t sound like I mainly have a business transaction in mind.


    title = {But what do we call them?},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2011-09-22,
    url = {http://www.bgcarlisle.com/blog/2011/09/22/but-what-do-we-call-them/}


Carlisle, Benjamin Gregory. "But what do we call them?" Web blog post. The Grey Literature. 22 Sep 2011. Web. 30 Sep 2016. <http://www.bgcarlisle.com/blog/2011/09/22/but-what-do-we-call-them/>


Carlisle, Benjamin Gregory. (2011, Sep 22). But what do we call them? [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2011/09/22/but-what-do-we-call-them/

An alternate ending to Captain America (or “Captain America and the Therapeutic Misconception”)


The therapeutic misconception

In medical practice, the efforts of the medical team are directed toward therapy. That is to say, when a doctor or a nurse or some other medical professional performs some action on a patient, her actions are morally underwritten by the benefit she hopes to provide to the patient.

For example, a blood draw is somewhat uncomfortable. But we allow medical professionals to take blood if it is done for the purposes of diagnosis. Same thing with setting a bone—very painful, but it is allowed because it is aimed at providing some direct medical benefit to the patient.

In human research, this is not the case.

In human medical research, the efforts of the research team are directed toward gaining useful and generalisable knowledge. That is to say, when a doctor or a nurse or some other medical researcher performs some action on a patient, her actions are not morally underwritten by the benefit she hopes to provide to the patient. Rather, her actions are morally underwritten by the benefit she hopes to provide through the use of generalisable knowledge in informing medical practice.

Blood draws are very common in many kinds of medical research as well. But they are allowed in human research, but not because the patient will necessarily receive any benefit. Instead, it is the benefit to others that makes drawing blood from the patient permissible.

To put it simply, medical researchers are not necessarily trying to help their subjects. That is not what they are doing. This is probably pretty clear at this point.

But what about cases where the patient-subject is receiving some new “experimental” therapy? Perhaps our hypothetical example patient-subject has already been through multiple therapies, none of which worked, and this therapy is the patient-subject’s last best hope.

It’s in cases like these where the line between therapy and research becomes fuzzier.

The therapeutic misconception is something that happens when patients regard medical research as medical therapy. Often, patients will have an exaggerated idea of the chances of success of the procedure. In other cases, patients will full-out not understand that it’s possible that they would be randomised to a control group and not receive any treatment other than a placebo.

The therapeutic misconception is a major problem in human research ethics, and different ethicists have had different ideas on how to deal with it. Some have suggested that doctors should wear red labcoats when they are working in their capacity as a researcher, in contrast with their normal white ones. Others have suggested that patient-subjects always be compensated financially for their participation in a trial, so that the patient regards the money she receives as the benefit from the trial, rather than the “treatment.”

I saw Captain America on Friday night. While it is a fun movie, it doesn’t help things too much in terms of the therapeutic misconception. I know it wasn’t written with human research ethics in mind, but really, we’ve got a guy who is a subject of a medical experiment, but who receives tremendous medical benefit.

People who are participating in medical research watch films like this and even though they know that they won’t come out of the research protocol standing a full two feet taller with rippling muscles not having spent a minute at the gym, they still get the wrong idea—that when you’re recruited to human research, one of the researcher’s goals is direct medical benefit to you.

Alternate ending to Captain America

Most of the movie would be the same, but just as Captain America is about to save the world, we find out that Steve Rogers was actually randomised to the placebo group. Captain America crashes the evil airplane into the ice and everyone says, “No wonder! It was just a placebo all along.” The body is never found.

See how that’s so much better than the original? :P


    title = {An alternate ending to Captain America (or “Captain America and the Therapeutic Misconception”)},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2011-08-29,
    url = {http://www.bgcarlisle.com/blog/2011/08/29/an-alternate-ending-to-captain-america/}


Carlisle, Benjamin Gregory. "An alternate ending to Captain America (or “Captain America and the Therapeutic Misconception”)" Web blog post. The Grey Literature. 29 Aug 2011. Web. 30 Sep 2016. <http://www.bgcarlisle.com/blog/2011/08/29/an-alternate-ending-to-captain-america/>


Carlisle, Benjamin Gregory. (2011, Aug 29). An alternate ending to Captain America (or “Captain America and the Therapeutic Misconception”) [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2011/08/29/an-alternate-ending-to-captain-america/


A word from our sponsors

Tag bag

Recent comments

Old posts

All content © Benjamin Carlisle