More Massive Criticism of Article Claiming Abortion to Cause Mental Health Problems

The article by Priscilla Coleman purporting to demonstrate a causal link between abortion and mental health problems has been the subject of posts on this blog two times already: here and here. In summary: Coleman's attempt at meta-analysis seems to suffer from all the flaws one may imagine and it is a mystery how the peer review of the British Journal of Psychiatry can have let it pass, lest the integrity of the referee and editorial procedures of this journal is put into question.

The other day, six further so-called rapid responses to Coleman's article appeared on the BJP site. Of these, all but one expand and further develops the criticism. One response (Koch et al) tries to make the point that the recommendation to inform abortion seeking women about a risk that an abortion may endanger their mental health may still hold, even if the scientific criticism is sound. This is the exact claim that I questioned in my first posting even assuming that Coleman were to be right in her conclusion (which now seems highly unlikely). Let me quote:

...suppose that Coleman indeed is right in the strongest sense, is the most obvious conclusion then that we should move to restrict access to legal abortion? Actually not, since there is strong scientific support for the claim that such actions lead to no good (in particular, they do not prevent abortions). How about informing about the risk then? Well this looks more sensible, although, if the underlying explanation of abortion being a risk factor is that a certain portion of abortion seeking women are already burdened by mental health problems that threaten to become more serious if they are exposed to trauma of some kind, one may doubt the efficacy of such actions.

Instead, the practical conclusion that would seem to be gaining the most support would be this: Researchers like Coleman should rapidly proceed to develop instruments to identify those at risk, and abortion services should offer these women special post-abortion care and counseling, or even preventive actions before the procedure is undertaken that may serve to decrease the risk. If such an instrument proves difficult to develop, such care and counseling should become a standard ingredient of good clinical abortion practice all across the board. I must say that I find it a bit odd and worrying that Coleman's own practical suggestion does not focus on this. After all, if women's mental health is what you care about, practical implications should focus on actions directed at promoting that aim.

Koch and colleagues (one of which has a bioethics affiliation) try to make their point using the precautionary principle, and since this is the subject of a recent book of mine (likewise a forthcoming article in the forthcoming International Encyclopedia of Ethics) you may imagine that I'm tempted to enter the rapidly growing rapid response community myself. For that reason, I will wait a bit commenting on that particular thing until I decide whether or not to address to BJP what is, in several elementary senses, either severe misuse of the notion of this principle or the use of an obviously implausible version of it.

Petition Against the Participation of Psychologists in Torture

A Call for Annulment of APA’s PENS Report

(www.ethicalpsychology.org/pens)

Over the decade since the horrendous attacks of 9/11, the world has been shocked by the specter of abusive interrogations and the torture of national security prisoners by agents of the United States government. Although psychologists in the U.S. have made significant contributions to societal welfare on many fronts during this period, the profession tragically has also witnessed psychologists acting as planners, consultants, researchers, and overseers to these abusive interrogations. Moreover, in the guise of keeping interrogations “safe, legal, ethical and effective," psychologists were used to provide legal protection for otherwise illegal treatment of prisoners.

The American Psychological Association’s (APA) 2005 Report of the Presidential Task Force on Psychological Ethics and National Security (the PENS Report) is the defining document endorsing psychologists’ engagement in detainee interrogations. Despite evidence that psychologists were involved in abusive interrogations, the PENS Task Force concluded that psychologists play a critical role in keeping interrogations “safe, legal, ethical and effective.” With this stance, the APA, the largest association of psychologists worldwide, became the sole major professional healthcare organization to support practices contrary to the international human rights standards that ought to be the benchmark against which professional codes of ethics are judged.

The PENS Report remains highly influential today. Negating efforts by APA members to limit the damages – including passage of an unprecedented member-initiated referendum in 2008 – the Department of Defense continues to disseminate the PENS Report in its instructions to psychologists involved in intelligence operations. The Report also has been adopted, at least informally, as the foundational ethics document for “operational psychology” as an area of specialization involving psychologists in counterintelligence and counterterrorism operations. And the PENS Report is repeatedly cited as a resource for ethical decision-making in the APA Ethics Committee’s new National Security Commentary, a “casebook” for which the APA is currently soliciting feedback.

Equally troubling, the PENS Report was the result of institutional processes that were illegitimate, inconsistent with APA’s own standards, and far outside the norms of transparency, independence, diversity, and deliberation for similar task forces established by professional associations. Deeply problematic aspects include the inherent bias in the Task Force membership (e.g., six of the nine voting members were on the payroll of the U.S. military and/or intelligence agencies, with five having served in chains of command accused of prisoner abuses); significant conflicts of interest (e.g., unacknowledged participants included the spouse of a Guantánamo intelligence psychologist and several high-level lobbyists for Department of Defense and CIA funding for psychologists); irregularities in the report approval process (e.g., the Board’s use of emergency powers that preempted standard review mechanisms); and unwarranted secrecy associated with the Report (e.g., unusual prohibitions on Task Force members’ freedom to discuss the Report). These realities point to the impossibility and inadequacy of merely updating or correcting deficiencies in the PENS Report.

We the undersigned organizations and individuals – health professionals, social scientists, social justice and human rights scholars and activists, and concerned military and intelligence professionals – therefore declare that the PENS Report is illegitimate. We call upon the American Psychological Association to take immediate steps to annul the PENS Report.  At the same time, in our own efforts, we aim to make the illegitimacy of the PENS Report more broadly known within our communities.

(Visit www.ethicalpsychology.org/pens to add your signature)

Update on the European Court Ban on Patenting Embryonic Stem Cell Lines

Alas, I haven't had the time or energy yet to carefully read the entire decision of the European Court to ban the patenting on human embryonic stem cell (hESC) lines, that I posted about the other day. However, some of my colleagues have indeed made more extensive comments:

Julian Savulescu (Uheiro Centre for Practical Ethics, University of Oxford). I made some input in the commentary thread there as well.

Kenan Malik (writer, lecturer, broadcaster, a presenter of Analysis, on BBC Radio 4, and a panelist on The Moral Maze, also on Radio 4).

Other commentators so far make more predictable and less reflective responses, such as those of hESC scientists and overt or covert pro-life campaign organisations. To me, these are of less interest since they mainly repeat dogmatic stances that were set in stone decades back.

Hopefully, I'll be back with my own analysis and comments not too soon.