AngeloBottone profile
AngeloBottone
AngeloBottone
I am a college lecturer, I teach philosophy. I am also research officer at the Iona Institute in Dublin, Ireland. I write mostly about bioethics, particularly abortion, marriage and religion. I am planning to post an article per week. Here below you can find some examples.
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  • Philosophy, politics, bioethics, pro-life, marriage, religion.

Recent posts

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AngeloBottone

Contrary to popular belief, religious men do more housework than the normIt goes against the lazy...

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AngeloBottone

The morality of Covid vaccines

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AngeloBottone

A new campaign to expand the grounds for abortion in IrelandThe Irish abortion law is to be revie...

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AngeloBottone

Court ruling against eugenics met by violent pro-choice protests

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AngeloBottone

How American bishops are fighting church Covid restrictions

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AngeloBottone

What do euthanasia campaigners mean by "unbearable suffering"? The assisted suicide Bill currentl...

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AngeloBottone

Once euthanasia is introduced, the grounds always expand

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AngeloBottone

New Vatican document sets out clearly the case against assisted suicideLast week, the Congregatio...

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AngeloBottone
Public post
Why leading doctors oppose assisted suicide
A Private Members’ Bill seeking to permit assisted suicide will be debated in the Dáil next week. It is proposed by Socialist TD, Gino Kenny. The last time when this issue was discussed in Leinster House, three years ago, some of the strongest opposition came from the members of the medical profession and disability advocacy groups. It’s worth recalling what they said because it is still completely relevant.
The Joint Committee on Justice and Equality heard from two doctors, Regina Mc Quillan, speaking on behalf of the Irish Association of Palliative Care, and Des O’Neill, professor of Medical Gerontology at Trinity College Dublin. (Here is the final report of the Committee).
Dr Mc Quillan made five main points: “1. A change in the law would put vulnerable people at risk. 2. It is not possible to put adequate safeguards in place. 3. The drive to improve the care of people with life-limiting illnesses by education, service development and research may be compromised. 4. Personal autonomy is not absolute and we are part of a society. 5. Allowing assisted suicide or euthanasia for some populations for example the terminally ill or the disabled, devalues the lives of those compared to those targeted in suicide prevention campaigns.”
Dr Mc Quillan cited research by The National Safeguarding Committee revealing that half of the population has witnessed abuse of an adult, and so she maintained that it is “not prudent to assume vulnerable people can be protected in the context of assisted suicide and euthanasia.“
People are already at risk, even with laws and regulations, and “changing the law to allow assisted suicide and euthanasia will endanger the lives of many”, despite suggestions that abuses of this type of legislation can be prevented.
She referred to research showing failures in the countries where medically assisted killing has been introduced. Even where restrictions were in places, there is evidence that euthanasia was offered to those who were not terminally ill or were suffering from psychiatric problems.
Dr Mc Quillan explained which areas within palliative care need development. She said: “the acceptance of assisted suicide and euthanasia could lead to an underinvestment in palliative care research and service delivery, as assisted suicide and euthanasia may be promoted as cheaper options than appropriate health care provision.”
Doctors who everyday deal with suffering and end of life decisions are rarely heard in public debates on these issues, which tend to concentrate on dramatic, high-profile cases. The experience and the concerns of those who offer palliative care are particularly meaningful as they offer a view that is an alternative to common emotional appeals.
“We do not currently have equitable access to palliative care, disability services, psychiatric or psychological support services and my concern and that of many working in health care is that to move in the direction of euthanasia would be to move away from investment in the appropriate services.”, Dr Mc Quillan said.
She also highlighted that, as women are more likely to live longer with greater disability and more likely to have less social support, they will suffer more if euthanasia or assisted suicide is introduced. Women, she claimed, “are more likely to be a victim of ‘mercy killing’ by a male family member in cases which have come to the criminal courts in different countries.”
Professor Des O’Neill was another firm opponent of medically assisted killing. He told the Oireachtas Committee: “That there might be two forms of suicide – one which is clearly upsetting and worthy of strenuous societal efforts to prevent, and one which might be tolerated and given the support and protection of law – is a deeply challenging and contradictory premise. … The decriminalisation of suicide was a humane initiative, aimed at avoiding stigma and further hurt in terms of both completed suicide and attempted suicide, and emphasising the need for help and support for people in this situation, an impulse that holds true for those seeking assisted suicide as well. It was certainly never seen to be an expression of a societal desire to extend access to suicide as a human right, or to position suicide as an act that equality legislation might facilitate”.
Prof. O’Neill criticised the idea of unlimited choice, based on the assumption “that all patients are independent and autonomous, even at moments of high vulnerability”. Instead, we should remember that decisions are often led by the “potency of prejudice against ageing and disability.”
He said that all the major UK advocacy groups for disability have rejected assisted suicide.
To those proposing ‘death with dignity’ he replied: “Human dignity is not a thing that can be lost through disability, disease, dependency, or suffering, although insensitive treatment or attitudes to those so affected can constitute undignified care.”
The promotion of dignified care, instead, is the best way to contrast assisted suicide. In this respect, health care professionals play a pivotal role. Their opposition to deliberately killing, or facilitating self-killing, is something rarely appreciated and highlighted in the current public debates about the end of life decisions.
Prof. O’Neill expresses this perspective clearly: “Public and private discussion with regard to assisted suicide should be seen to represent concerns over adequacy of treatment and support as well as existential concerns relating to the future: these need to be proactively addressed.
“To ask doctors to run counter to this by killing patients short-circuits and undermines our impetus to care, comfort and support and damages our framework of care. Current and future patients need to be reassured that the response of the healthcare professions to distress and pain is one of compassion and care, addressing the needs at a range of levels – biological, psychological, social and spiritual – while respecting wishes to the greatest extent possible.”
(Many of Prof. O’Neill’s points were reiterated in this recent radio interview: https://tinyurl.com/yymzstb3 )
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AngeloBottone

Countries with liberal legislation have higher rate of abortion for unexpected pregnancies

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AngeloBottone

The vast majority of pro-abortion doctors working in neo-natal units in Flanders, Belgium, suppor...

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AngeloBottone

from 13 Aug, 2020

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AngeloBottone

A debate on how to tackle a shrinking population is long overdue The world population will peak a...

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AngeloBottone
Public post
The purposes of medicine

Medicine has three main purposes: to prevent and cure diseases, and to take care of patients. It is not simply a science but also a practice inspired by ethical values. So, what is the difference with the other sciences? Take for instance mineralogy. It is the description of the chemical and physical properties of minerals. Medicine, instead, aims not simply at describing what a human body is but it is also based on the assumption that there is a natural order, which we call health, and the purpose of the medical practice is to keep or to restore this order. There is an intrinsic good (health) that we discover through science and we preserve and reestablish through practice.
For instance, anatomy and physiology tell us what is the proper function of the eyes, i.e. to see. This is not simply a description but it also contains a prescriptive element because the ideal eye is also the normative model that the doctor uses when she acts to keep the patient’s eyes healthy or to prevent their diseases.
This understanding of medicine doesn’t require a particular religious faith but it is nonetheless intrinsically ethical. It is inspired by a certain conception of the good (health) that we find in human nature through the correct use of reason. The principle of “do not harm”, which has guided health care since ancient times, has the form of an ethical imperative.
Not everything that happens (or might happen) in a hospital or a clinic is medicine, unless it aims at preventing and curing diseases, and also at the same time at taking care of patients. Not all interventions that alter our bodies surgically or chemically are medicine, even if a scientist (medical expert) might be involved. Getting your facial features surgically changed to look more like your music idol is not medicine. Killing the unborn because she was unplanned or is disabled is not medicine. Augmenting your muscles through drugs to win a weightlifting contest is not medicine. Removing a perfectly healthy organ to adjust your body to your perceived gender is not medicine. Facilitating suicide is not medicine.
In all these examples a certain level of scientific knowledge is necessary but they lack what makes medicine more than a science: the ethical value of health. They might involve someone who has a proper knowledge of the human body but his purpose, in these examples, is not to restore or preserve the good of the functioning body. They are instances of scientific techniques without good and true medical ethics.
There is a growing pressure by certain ideologies to transform medicine, which is necessarily led by an objective good that we call health, into the satisfying of the subjective requests and choices of the patient.  If bodily autonomy (my body, my choice), rather than health, is the ultimate value then there is no reason why doctor should not amputate a healthy arm or leg, when requested, or administer a dangerous substance, for recreation or self-harm or death. Without the guiding principle of health, practitioners become simply the executors of someone else’s desires. Obviously, people can do what they want with their bodies but this is not medicine.
There is no good medicine without ethics. Hospitals don’t need to be under church or religious influence but they cannot exist without an ethos, without values. When their core value is not health – an intrinsic good indicated by human nature- they don’t serve medicine anymore but trends, ideologies, business.



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AngeloBottone

For pro-choice campaigners, ignorance about abortion is blissThe

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AngeloBottone

Marriage in Ireland continues its declineMarriage continues to change and decline in Ireland as t...

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AngeloBottone

Safety above all things is not a Christian virtue

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AngeloBottone

Getting the facts right about reversing effects of abortion pills

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AngeloBottone

New video: French and German judges rule against Covid-bans on public worship

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AngeloBottone

Should those in charge get priority treatment in a pandemic?In a previous blog I discussed an arti

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AngeloBottone

Ireland will be one of the last countries in Europe to restore public worshipWhile Ireland plans ...

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AngeloBottone

How religious sisters are the real founders of modern nursingOn Tuesday, we celebrated Internatio...

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AngeloBottone
Public post
On the balance of goods
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AngeloBottone

(ORIGINAL CONTENT)On the balance of goods Risk is the probability that damage happens. In these ...

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AngeloBottone
Public post
Ethical questions in a pandemic

The current epidemic raises a number of profound ethical questions.   We are facing unprecedented events under the pressure of time and of limited resources. In the name of urgency and necessity we are experiencing exceptional restrictions of fundamental liberties, and a significant alteration of our familiar ways of living.



After the initial shock, when energies are inevitably focused on emergency measures, it is now time to address more fundamental issues that this epidemic has highlighted.



Why do we need a debate about ethics now? In the current exceptional circumstances, it seems that many decisions are not free choices, but they are rather dictated by necessity. Nonetheless, practical deliberations are always inspired by values. Either consciously or unconsciously, we all operate within a moral framework. We decide to pursue a certain course of action, rather than another, because we deem certain principles more important than others. This is obvious when we face conflictual duties – for instance, saving lives and preserving freedom – and we ultimately follow a certain road because of our deep philosophical commitments.



Strategic decisions are now led more by the assessments of the experts than the democratic mandate which legitimizes our political representatives. National and international bureaucratic structures define our common tasks in terms of measurable effectiveness to the point that we feel we are living in a tyranny of the specialists, legitimated by their scientific expertise.



Nothing should be done against science, but the problem is that science is not about ends, it is about means. Medicine tell us how to save lives but doesn’t tell us which lives should or shouldn’t be saved, and why they should be saved at all. Experts disagree, not only on purely scientific grounds – for instance, which treatment works better – but also on what we ultimately want to achieve. Different policies are expression of different values and it would be foolish to move through an epoch-defining outbreak without having a debate about what we ultimately want and why.



We need a debate about ends. What are we here for? The good life in a community, says an old tradition that goes back to our Greek philosophical roots.



What clearly emerges in front of our eyes these days is that we can’t understand ourselves as individuals. We are members of a community. My life depends on what other people around me do. My best efforts will count nothing without everybody else’s best efforts. More than ever, this epidemic requires us to think and act in solidarity, which literally means being strong together. This solidarity is necessary not only in action but firstly in the way we frame and approach our problems.



We are operating in fear and isolation, under the pressure of unprecedented events. We hear that we are forced to trade different values against each other.   But to think according to an ethics of solidarity means that conflicts and tensions should be framed not in terms of opposition but as if they all together threaten to the same end, which is the common good.



It would be wrong to present our dilemmas in terms of exclusive interests: for instance, should we care for the sick or for the one who might lose his job? If we address this problem through the prism of solidarity, we will realise that it is the same person who is at risk of getting sick and losing their job, it is the same family, it is the same community.



Roles are now swiftly exchangeable – a health carer becomes a patient – and the same person often embodies many roles – someone who works from home may also be a carer or a patient. There is no family or group that is not potentially impacted. Traditional categories such as social class, gender, ethnicity, are now insignificant. We are all one and should think in solidarity.



In a competitive struggle for scarce resources, we give priority to those we consider more valuable, overlooking the rest. In a solidaristic approach, we give precedence to those who are most in need.



As every epidemic, this one is significantly impairing what constitutes a community, such as the acting physically together. Everything that is communal is currently affected, from mourning our deaths to celebrating sports, from worshipping to travelling. However, the present epidemic is different when compared with the big ones of the past, think of the Black Death, because contemporary means of communication allows us to be united in spirit with those who are distant. Even if only virtually, certain expressions of solidarity are easier to perform.



As part of a community, we have a duty to limit some of our legitimate desires and demands if they put others at risk. And risk should be understood not simply in the sense of physical health. There is a risk of cutting meaningful relationships, of compromising the education of the younger generations, of impairing mental wellbeing, of destroying business and charitable work, of neglecting those who suffer for other reasons, etc.



The wide scope of risk is what makes this epidemic difficult to manage and it is not the role of ethics to identify what is practically appropriate in each circumstance. Our task, instead, is to inquire what goods we want to achieve and what moral principles should guide us.



I will address in a separate article the moral dilemma of prioritizing access to scarce medical resources but the general principle I am proposing, inspired by an ethics of solidarity, is that everyone should be cared according to their needs, rather than ability or, more often, inability to contribute to society.



An ethics of solidarity involves sacrifice. However, the question should not be formulated in terms of who we are willing to sacrifice for the common good. It is rather, what should be sacrificed? No one should be discriminated because is less abled, has less prospect of life, or can’t pay.



Different approaches and strategies employed to tackle this pandemic reflect who we care most. In any assessment of a balance of goods we should remember the dignity of the most vulnerable. Solidarity means that it is precisely those who are weaker that we hold stronger.



Measures have to be proportionate but what is a fair proportion cannot be determined in advance. By definition, this depends on the circumstances. What, instead, can and should be discussed is what society we wish for when promoting public health.



We won’t be able to do all the good we would like to accomplish but have we established what this good is? Let’s have this conversation.

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