As I write this letter in mid-December 2022, the state of the world doesn’t give great cause for optimism. Russia’s brutal invasion of Ukraine and the terrible suffering it has unleashed have reminded us what totalitarian regimes are capable of, even in Europe in 2022. Just one person tortured, losing a family member in a bombing or struggling to survive in an unheated basement in sub-zero temperatures would be one person too many and fully deserving of our empathy. And yet these experiences are widespread, as are countless other sources of intense suffering.
Meanwhile, in the last week or two, many of us living in more privileged conditions have been experimenting with the AI-driven chatbot ChatGPT and been awed by its abilities. While AI is putting the power of rapid, impressive image and text generation in the hands of ordinary people who wouldn’t otherwise have these skills, these developments also signal dramatic change in our societies as AI becomes ever more sophisticated and powerful. It is challenging us in how we as humans can derive meaning from our lives when soulless algorithms seem to be outsmarting us. More tangibly, it threatens people’s ability to generate economic value and earn a living, with the risk of increasing poverty, unless measures such as UBI (universal basic income) are instituted. And perhaps most ominously, it will give unprecedented power to those who own and control it – even if it doesn’t become autonomously powerful itself.
This is why it is so urgent that we strive to relieve the world from the clutches of totalitarianism, and achieve open, peaceful, compassionate and cooperative societies around the globe – ones where the prevention of intense suffering of all sentient beings is a top priority. Uncompassionate governance coupled with powerful AI may lead to dystopian structures that are nearly impossible to dismantle. You can read more of my thoughts on this in my recent post on the Effective Altruism Forum titled “Promoting compassionate longtermism”, which is partly a critique of so-called longtermist thinking that doesn’t sufficiently prioritise addressing suffering or spreading compassionate values in the present.
In the meantime, OPIS has continued to work on specific cause areas and also support our partners who are working on improving access to morphine for cancer patients and psychedelics for cluster headache patients. A brief update:
Access to morphine – Burkina Faso project
In the latest update we received from Burkina Faso, as part of the implementation of the recommendations from the conference we held in December 2019, important steps have been taken by the Ministry of Health, Hospice Burkina and the local WHO office. These include introducing legislation to incorporate palliative care into the country's public health code; a training curriculum developed in January 2022; university teachers trained in February; and health care providers trained on prescribing morphine in June. A workshop in October brought together the WHO, Hospice Burkina, the Ministry of Health and the directors of public hospitals in order to define a roadmap for the practical implementation of palliative care in health services, and a series of training sessions took place in November, with about 100 healthcare workers trained in palliative care. A university diploma in palliative care is currently underway at the University of BOBO Dioulasso in Burkina. Finally – and this is an essential part of the program – WHO Burkina has financed the purchase of 5 kg of morphine powder for local syrup production, and the first production is expected to start in January 2023.
The pace of change has been slow, in large part because of the country's political and security instability, but there has been definite momentum since the conference we held three years ago, and palliative care is now an effective part of the national health program. We expect that the number of patients receiving morphine will start to increase in 2023 and morphine syrup will be available throughout the country.
For those of you who donated to our Burkina Faso crowdfunder, your support really did make a difference!
Psilocybin for cluster headaches
We have been working with our partner TheraPsil to obtain legal exemptions for cluster headache patients to obtain psilocybin in Canada. Despite applications being submitted, Health Canada has stopped providing any legal exemptions for the use of psilocybin, with no indication it is prepared to make it available through its Special Access Program. We now have the absurd situation that it is easier for patients in Canada to access medically assisted dying than to access the medical psilocybin that could improve their conditions and make their lives more bearable. Of course, no one who is suffering intensely should be forced to stay alive against their will, but such a decision should never have to be made because existing treatment options were not made available to them. Our advocacy continues. For example, see this post with a link to a letter to the Canadian Minister of Health, which we worked on with Peter McAllister, a prominent New England neurologist. TheraPsil recently met with many MPs at the Canadian Parliament, and we are now discussing a new advocacy campaign. The ethics and evidence are clearly on our side, and arguably existing law as well – TheraPsil has taken legal action against the Canadian government. Eventual success in Canada could have a ripple effect elsewhere.
We have also continued our collaborations with other organisations in the US (Clusterbusters), UK (Conservative Drug Policy Reform Group) and Finland (Finnish Horton Association) that share our goal of making psychedelics medically available for the treatment of cluster headaches. The overall tide is turning in the acceptance of the use of psychedelics as a medical treatment, and their approval as treatments for cluster headaches is probably now only a matter of time.
Ayahuasca for SUNCT
This brings me to some positive news on a related front. Two years ago I was contacted with a request for support by Juan-Pablo L’Huillier, a Chilean musical artist living in Switzerland who was suffering from SUNCT, a devastating condition with similarities to cluster headaches. He was aware of our work on cluster headaches and tried LSD, which, in fact, drastically reduced the number of attacks, until he ran out. I encouraged him to try to obtain it under official medical supervision, but this would have been prohibitively expensive given that it is not covered by health insurance.
His suffering was so intense that he tried to commit suicide to escape the pain at the end of last year. Shortly thereafter he took ayahuasca – a traditional brew containing the psychedelic DMT, used for ritual and healing purposes by indigenous populations of the Amazon – in order to prepare himself emotionally for assisted suicide. Instead, he discovered that it caused his symptoms to disappear for 3 weeks at a time, literally giving him his life back. We organised a webinar in which he and another patient with SUNA (a closely related disorder) shared their stories. We then helped to publicise his case, and a journalist I contacted featured his story in a front-page article in the high-circulation Swiss daily newspaper 20 Minutes, attracting further interest from the media and other patients. We recently gave a talk together at the University of Geneva, and we are now working to get this case study published in a medical journal. This may lead to many more SUNCT patients becoming aware of ayahuasca as a treatment and, more generally, help normalise the use of psychedelics as a treatment for severe headache disorders. Juan-Pablo has become passionate about preventing humans and animals from experiencing similarly severe suffering, and he has joined the OPIS team as an Ambassador on Pain Relief.
Ending animal exploitation
In October, I joined more than 470 moral and political philosophers from 40+ countries in signing the Montreal Declaration on Animal Exploitation. The Declaration echoes, in ethical terms, the Cambridge Declaration on Consciousness and marks an important step in the philosophically supported recognition of non-human animals. The Declaration points out that many of the differences between human and non-human animals are ethically irrelevant. We condemn the practices that involve treating animals as objects or commodities, and declare that unnecessary violence and harm make animal exploitation unjust and morally indefensible.
My new book: The Tango of Ethics: Intuition, Rationality and the Prevention of Suffering
A book I have been working on intermittently for several years, and which has occupied much of my time this past year, is finally being published on 3 January 2023 by Imprint Academic. To borrow some of the language from the publisher’s website, The Tango of Ethics proposes a deep, rigorous reassessment of how we think about ethics, putting the central emphasis on phenomenological experience and the unique urgency of suffering wherever it occurs. A key paradigm is the conflict and interplay between two fundamentally different ways of seeing and being in the world — that of the intuitive human being who wants to lead a meaningful life and thrive, and that of the detached, rational agent who wants to prevent unbearable suffering from occurring. I aim to reconcile these two stances or motivations within a more holistic framework I label “xNU+”. This approach avoids some of the flaws of classical utilitarianism, including the notion that extreme suffering can be formally balanced out by enough bliss, while maintaining a focus on impact. I explore the implications of this way of thinking for real-world ethical dilemmas and how we might incorporate it into governance, arguing that it is as important as ever to promote these ethics and their implementation while there is still an opportunity for some convergence around what matters.
The book will be available in paperback and as an e-book from the Amazon sites and other retailers, and also directly from the publisher’s website (paperback only). The paperback is already available for pre-order and the e-book should be within a few days as well. The book isn’t overly technical and should be relevant to anyone interested in ethics, what matters and how to decide what to do about it.
OPIS projects: research, advocacy and communication
While we will continue our involvement in our existing project areas and collaborations, our energy is now increasingly focused on promoting compassionate governance in the largest sense, so that all decision-making is grounded in compassionate ethics and the prioritisation of preventing and alleviating suffering. This means documenting and quantifying the various causes of intense suffering and highlighting the best actionable solutions available; proposing key principles for ethical governance and mechanisms for getting there, including concrete steps that people and organisations can take; and promoting all these ideas through films, videos, creative campaigns and various forms of outreach. I am particularly keen to produce a full-length film to set out the vision and inspire people with it, aiming to reach a large worldwide audience.
OPIS is one of the few organisations specifically dedicated to the prevention and alleviation of all forms of intense suffering, and to promoting these ethics in governance. We have managed to operate on mainly modest private donations by keeping our expenses to a minimum, but we will be able to do a lot more if we receive more financial support. I expect we will accomplish some interesting things in 2023 and that you will be hearing more about us.
Volunteer to work/collaborate with us on research, advocacy, creative campaigning, etc. Or share/discuss any ideas you have. You can get in touch with me by replying to this email.
Eating plant-based and not contributing to the horrors of factory farming is a way to be the change you want to see in the world. If you or someone you know is considering making the shift, this OPIS resource provides lots of useful information, with links to many other resources, and is therefore probably one of the better guides available: https://www.preventsuffering.org/eating.
Share this newsletter with anyone who might be interested in our work!
With very best wishes for the holiday season and the start of the new year!
