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Welcome to the nexus of ethics, psychology, morality, philosophy and health care

Tuesday, July 25, 2017

Should a rapist get Viagra or a robber get a cataracts op?

Tom Douglas
Aeon Magazine
Originally published on July 7, 2017

Suppose a physician is about to treat a patient for diminished sex drive when she discovers that the patient – let’s call him Abe – has raped several women in the past. Fearing that boosting his sex drive might lead Abe to commit further sex offences, she declines to offer the treatment. Refusal to provide medical treatment in this case strikes many as reasonable. It might not be entirely unproblematic, since some will argue that he has a human right to medical treatment, but many of us would probably think the physician is within her rights – she’s not obliged to treat Abe. At least, not if her fears about further offending are well-founded.

But now consider a different case. Suppose an eye surgeon is about to book Bert in for a cataract operation when she discovers that he is a serial bank robber. Fearing that treating his developing blindness might help Bert to carry off further heists, she declines to offer the operation. In many ways, this case mirrors that of Abe. But morally, it seems different. In this case, refusing treatment does not seem reasonable, no matter how well-founded the surgeon’s fear. What’s puzzling is why. Why is Bert’s surgeon obliged to treat his blindness, while Abe’s physician has no similar obligation to boost his libido?

Here’s an initial suggestion: diminished libido, it might be said, is not a ‘real disease’. An inconvenience, certainly. A disability, perhaps. But a genuine pathology? No. By contrast, cataract disease clearly is a true pathology. So – the argument might go – Bert has a stronger claim to treatment than Abe. But even if reduced libido is not itself a disease – a view that could be contested – it could have pathological origins. Suppose Abe has a disease that suppresses testosterone production, and thus libido. And suppose that the physician’s treatment would restore his libido by correcting this disease. Still, it would seem reasonable for her to refuse the treatment, if she had good grounds to believe providing it could result in further sex offences.

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