Jox-WMA EoL Presentation Vatican-Nov2017

R. J. Jox: WMA Meeting Vatican 2017
1
Dealing with public and published opinions
Ralf J. Jox
Institute of Ethics, History and Theory of Medicine
Ludwig-Maximilians University Munich, Germany
WMA European Region Meeting
On End-of-Life Questions
Vatican, 16-17 November 2017
Outline
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1. Why public and published opinion?
2. What are the public opinions?
3. Conclusions for the political debate
Death
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§ Death does not only constitute a challenge for every
individual person, but also a threat to society
§ Public practices: death announcements, funerals,
cemeteries, obituaries, art & culture about death…
§ Modern taboo around death creates anxiety and
impedes our coping with death
§ Death as the “great equalizer” calls for considering
each person’s voice on the same level
Death calls for public discourse!
Ethics
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§ The essence of ethics is about the right way to live
together as a community and society
§ Core ethical concepts of respect, dignity and fairness
require giving a voice to every person
§ The historical origins of ethics in the European
Antiquity were on the “agora” (Sokrates), in the
synagogues and churches
§ Today, ethics is both a scientific discipline (academia)
and an everyday activity (agora)
Ethics calls for public discourse!
Biopolitics
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§ Bioethical issues are increasingly becoming political
§ Political history is full of warning examples of moral
authoritarianism
§ Open, plural societies are based on the competition of
value systems using debate and argument
§ Discourse is no supreme epistemological way to truth,
but the best political way to compensate for the lack of
a supreme way to truth
Biopolitics calls for public discourse!
Forms of discourse
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Involving every citizen,
esp. those affected
Promoting a well-informed,
balanced, rich discourse
+
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Biases in the
discourse
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§ Opinion leaders often motivated by moral ideology
(strong motivation, interest in a recognizable profile)
§ Many media formats favor pure, provocative theses
(disfavor argumentation & scientific evidence)
§ Some tend to confound ethical argumentation with
personal storytelling
§ Opinions of ordinary people and those affected only taken
into account as selective case examples
§ Patient advocacy groups do not represent all patients
§ Sound opinion polls and empirical research needed
Outline
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1. Why public and published opinion?
2. What are the public opinions?
3. Conclusions for the political debate
Opinion polls
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Opinion polls
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§ Critique: undefined, vague terms, emotionally
charged language, sponsoring, selective reporting
§ Yet: The lying polls are indeed a caricature and an
easy way to disregard unwanted results
§ Professional activity with decades of experience,
staffed with social scientists, employing rigorous
procedures
§ Results are often highly consistent with each other
and concordant with scientific attitude research
Example Germany
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0
10
20
30
40
50
60
70
80
90
100
Emnid (EKD) Infratest dimap
(ARD MoMa)
Emnid (N24) Emnid (EKD) infratest dimap
(ARD
HartaberFair)
Allensbach Forsa Infratest dimap
(Jauch)
TNS Infratest
(DHS)
IsoPublic/Gallup
% of the surveyed
PAS
AS+aAID
PAS
PAS
aAID aAID
PAS
AS
PAS
PAS = physician-assisted suicide
AS = assisted suicide
aAID= „active aid in dying“
(termination of life on request)
AS
Protestant church or link to catholic church
State TV with a tendency to the political left
April 2015 Sep 2012
Example Germany
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§ Higher support rates among:
– Eastern Germans
– Less religious ones
– Citizens with a higher education
– Younger/Middle-aged citizens
Known factors from the
European Values Study
Cohen J et al. Eur J Public Health 2006
Cohen J et al. Soc Scie Med 2006
§ 75% of bereaved relatives of cancer patients in favor of AS
Köhler N et al. Z Psychosom Med Psychother 2014
§ Polls played a marginal role in the debate 2014-2015
(often just used as an introduction to talk shows etc.)
§ Moral lobbyists usually mocked or ignored public opinion
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Attitude research
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§ Wording effects:
context-rich, personal description → more permissive attitudes
theoretical, impersonal description → more restrictive attitudes
§ Order effects (e.g. contrast effect):
Magelssen M et al. BMC Med Ethics 2015
Assisted suicide
in patients with a
terminal disease?
Uncontroversial question:
withholding treatment?
Highly controversial question:
euthanasia for health elderly?
Rather
NO
Rather
YES
§ Impact moderate (intensifying, not inverting opinions)
International research
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Cohen J et al. Eur J Public Health 2012
Acceptance of euthanasia 1981-2008 (range 0-10)
International research
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§ Trend of liberalization in laws and public opinion in
Western Europe, opposite trend in Eastern Europe
§ Best data for the UK: 75%-84% in favor of assisted dying
(1983-2012)
§ Most robust correlation: Higher approval rates of
assisted dying AND affiliation to religious institutions
§ Questionable correlation with higher education, younger
age, male gender
Emanuel EJ et al. 2016, Attell BK 2017, Terkamo-Moisio A et al. 2017, Magelssen et al.
2016, Danyliv A et al. 2015, Cohen J et al. 2013 and 2014, Cox K et al. 2013
Outline
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1. Why public and published opinion?
2. What are the public opinions?
3. Conclusions for the political debate
Conclusions
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§ End-of-life ethical issues should be publicly debated
§ Public discourse should satisfy quality criteria, but
should also involve as many citizens as possible
§ Opinion polls and attitude research are indispensable,
but should be carefully done
§ Majority of Western Europeans are increasingly in favor
of assisted dying (↔ Eastern Europe)
§ How should parliaments, churches and professions
take into account this changing moral landscapes?
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Thank you for
your attention!
ralf.jox@med.lmu.de