Marat

In the patient's present state, with what seems like mild, early-stage, type 2 diabetes, I would agree that his concerns seem to express some obsessive-compulsive tendencies. However, in more serious cases of diabetes, such as the patient's will eventually become, patients are positively required to be obsessive-compulsive about blood sugar levels and their measurement, so it becomes impossible to distinguish the compliant diabetic from the obsessive-compulsive diabetic. The patient you describe may be just anticipating that stage, so it is difficult to say that he has just neurotically invented his need to obsess over blood sugar management, since he does have a disease requiring that intervention to at least some degree.

Here is an alternative perspective on the debate: We can all agree that theft is immoral. But most legal systems impose monetary fines on people for violating various social rules, not all of which are universally recognized rules. Thus would we say that those societies which punish certain acts with fines which our own society would not fine are immoral, and indeed, their entire legal system is immoral, since their fining system is 'theft' in our terminology, so their legal code is simply an authorization of state theft? Just to keep things clear, it is useful to operate with a legal definition of 'murder' as 'felonious homicide' within the legal system of some jurisdiction, whether that legal system is valid or invalid when judged from the perspective of another system. This will then permit the useful distinction between killing committed by ordinary citizens for private purposes and killing by the state for a public purpose sanctioned by the state's legal code. The Bible does not forbid killing per se but only a 'murderous act,' which is wrongful killing. Similarly legal codes recognize many types of killing of humans as either legal or less than murder, such as manslaughter, negligent homicide, suicide, assisted suicide, infanticide by a woman during depression in the first year following the birht of the child, killing in self-defense, killing with a defense of necessity, killing with a battered spouse defense, killing in authorized police or military action, killing of the terminally ill by withdrawal of life support, etc.

There is no way that the blood glucose reading of 300 would be associated with tremors, which must have come from some independent problem. Acute effects of hyperglycemia only appear when the blood sugar gets up around 600 and stays there, at which point it can cause somnolence and confusion from hyperosmolar coma, and if persistent for many days, can lead to diabetic ketoacidosis, which causes the patient's breath to smell like nail polish remover and can also cause coma which can be difficult to correct. High blood sugar levels below that will be asymptomatic, aside from increasing thirst and urination. There is considerable debate now on the best diet for diabetics, since a high-protein, high-fat diet, avoiding carbohydrates, can allow the patient to achieve better blood sugar control, but this is exactly the kind of diet which promotes cardiovascular disease, arteriosclerosis, and renal failure, which are also problems associated with diabetes. Frequent snacking is a useful management tool for diabetes since it avoids the sudden spikes in blood sugar which come from taking large amounts of calories all at once in a large meal. Although traditionally diabetic management has focused on blood sugar management, the large-scale ACCORD study of type 2 diabetics recently found that there was a significantly higher death rate among patients whose blood sugars were aggressively managed to keep them close to normal, but that the death rate declined if the blood sugar was moderately elevated. The death rate started to increase again only when blood sugar levels became extremely high. For years studies have shown a disconnect between hyperglycemia and diabetic complications, and it is now becoming accepted that genetic and autoimmune factors are also important in causing these problems. Of course, the more genetic and autoimmune factors contribute to the complications of diabetes, the less important it is to focus on blood sugar control. See M. Centofani, "Diabetes Complications: More than Sugar?" Science News, vol. 149, no. 26/27, p. 421 (1995).

You have to start by asking yourself what your terms mean. Why do you need some reality in back of the reality of everything you see, hear, and feel for it to count as real? Are there really different depths of reality? What would be the use or even the meaning of a phrase like 'it could all be just a dream' if we had no secure access to something which was certainly not a dream? Since we can only first gain access, become aware of, ourselves as a thing which thinks if we are brought into focus and visibility as such a thing by the contrast with other thinking things and objects around us, then the fact that the outside and inside worlds both come into visibility only by the same contrast shows that neither has priority over the other. So the inner world of the mind is no more real than the outer world of objects, since conscious awareness of either depends on the existence of both together. This now means that there is no contrast of inferior and clearly demonstrable realities next to which we could denigrate some experience as being possibly unreal, less real than it should be, or 'just a dream.'

How do we know that we exist as the conscious subject of our experience? If there were no world independent of our minds, we would never find anything determinate in opposition to us, so we would never be able to perceive our own minds as the determinate, continuing, subjects of experience. If there is nothing coherent happening on the stage in front of us, we would lose our bearings and have no awareness of ourselves as a coherent, perdurant perceiver of what was happening on that stage. Instead we would just be lost in a fugue of sensations and have no reason to identify some of those sensations as belonging 'inside' to the perceiver while others belonged 'outside' to the world. So our ability to know our own mind, our own selves, is parasitic on having some stability in things opposed to us outside of us. On this view, self-knowledge is no more primary than knowledge of the world. This is essentially Kant's epistemology. Wittgenstein goes a bit further, saying that unless we were in a community of other people using language, we would never know ourselves as the continuing, inner subjects of experience, since nothing outside and around us would be available to give us any reason to notice ourselves as something equally substantial and real. If I had lived alone on an otherwise deserted island all my life, there would have been no need to distinguish myself as 'I' independent of other 'you's' around me, so I would not even know or be aware of myself as 'I,' as a subject of experience, or as conscious. Instead I would just have sensations of things inside me and outside of me, but I would have no reason to distinguish 'inside' from 'outside,' since I would not be living in a community where only some subjects could see the 'outside,' while I could experience both my own 'internal' experiences and my 'external' experiences which I could expect others to know.

The patient you describe is in the early stages of type 2 diabetes, which is a condition caused by a genetic predisposition in interaction with excess weight and sedentary lifestyle. In the early stages of type 2 diabetes, the patient is still producing insulin from his own pancreas, but his body is resistant to insulin action, so he may need to limit his intake of food and increase his activity to avoid placing excess demands for insulin production on the pancreas. As the excessive demand for insulin gradually wears out the pancreatic beta cells of the type 2 diabetic, these patients will have to progress from managing their condition by diet and exercise to taking drugs which stimulate the pancreas to put out extra insulin, and finally they may wind up having to inject insulin after the pancreatic insulin production capacity is completely exhausted. Since the patient is still at the very early stage of being able to get reasonable blood glucose levels with dietary controls alone, and is even having occasional hypoglycemic episodes (blood sugar in the 80s) which are the opposite of diabetes, the person is being a bit obsessive with testing blood sugar as often as you describe. That said, many endocrinologists are themselves now quite obsessive about blood sugar control, and some would insist on the patient testing blood sugar this many times a day. It would be more sensible if the patient were simply to devote some of the effort involved in excessive blood sugar testing toward the more useful endeavor to lose some weight, since this would make the blood sugar levels much more easily managed, though it would not cure the condition. It is worth noting that there is an increasing amount of evidence that the complications of diabetes may be caused by genetic and autoimmune processes which accompany the condition rather than by the excess blood sugar per se, so the patient's obsessive blood sugar control may not be solving as many problems as he might believe.

Another good example are the various forms of progeria, in which young children are genetically doomed to age with such hideous rapidity that they die of old age in their mid-20s, complete with a bald pate, cataracts, and hearing aids. One consequence of this disease is that the intelligence of these children also develops unnaturally fast, so they can savor the full horror of what is happening to them in a way that ordinary children could not. How can you explain this perfect coincidence of overdevelopment of intellectual response to tragedy and tragedy in the same disease unless there is an evil God designing things to be as terrible as possible? Similarly, another form of progeria is Hurler's Disease, which causes the rapidly aging children to develop the face of a hideous gargoyle, which frightens away the very people the child needs most desperately to provide empathy and loving support. The perfect fit between the need and what keeps the need from being met can't be just a coincidence, so must be produced by an evil Designer.

In the days before Darwin, it used to be stylish to offer proofs of God's existence by noting how beautifully designed the world was or how humanely everything in the natural world was structured. But we could develop an inverse physico-theology which would offer proofs of God's non-existence from how evil the world is, and especially from the evil coincidences in its design which seem possible only because they are designed by an intelligent but profoundly evil creator. The result of these proofs would be either that there would be further evidence for the non-existence of a good God, or positive evidence for the existence of a Gnostic, evil God, both of which would defeat the arguments of contemporary theists. Just from the small area of nephrology I can think of a few evidences of an evil God right away. The main class of drugs used for transplants are also toxic to the kidneys, and the main organ transplanted is the kidney. Surely such a perfectly evil situation as this could not arise just by coincidence, so we must assume an evil God designed the world so this would happen. Or again, on the worst stresses patients on dialysis have to endure is the severe fluid intake restrictions they must accept. But the main cause of patients having to be on dialysis is diabetes, whose main symptom is to make patients constantly terribly thirsty! Surely this couldn't happen just by coincidence, so we must assume an evil Creator.

An important point left unsolved by the symbolism of Christ dying to reconcile God and man after mankind's fall into sin is why further suffering or injury, whether of man, God, Christ, or anything else is able to 'pay' a debt. If under modern tort law I negligently damage your car, no court would regard the injury as made good by my wrecking my own car in return, or the two of us going out and destroying someone else's car. What pays a debt is undoing the damage, like giving you money to repair your car, not causing further damage. The only reason that Christ's suffering and 'death' ever seemed a rational way to reconcile God and mankind by settling the debt is that this was consistent with the irrational superstitions of the Eastern Mediterranean cultures of the time, according to which two neighbors having a feud over some issue could settle it by getting together and slaughtering a sacrificial goat and then consecrating it to some pagan deity. Christ's death is analogous to the death of the sacrificial goat or lamb, so it can seem to solve the problem mythologically, though logically of course the whole concept of damaging X to make good the damage to Y makes no sense.

While I agree that the human mind is predisposed to find familiar patterns and thus discern messages even where there are none, if you've ever actually listened to a lot of electronic voice phenomena you will find that there are some sounds which it would be positively perverse to characterize as the result of strained interpretations. They sound as emphatic, loud, and clear as any normal human speech. If anything, they often sound overly emphatic, more like words spoken in an elocution lesson than natural human speech. Konstantin Raudive, one of the early researchers in this field, knew a number of different languages, and I always suspected that his inclination to 'hear' voices first in Estonian, then in Polish, and then in Finnish merely represented his ability to switch from one language to another to force random sounds to match with meaningful sounds in some language. So no doubt some of what is asserted to be evidence of electronic voice phenomena is just random noise interpreted into artificial congruence with genuine language. It might be an interesting test, however, to determine if the voices heard are usually those of the native language where they are heard or not, since no one knows where they are coming from. A lot of what I have heard has been spoken in the same clipped, mechanical, robotic tone, which almost sounds like someone trying to imitate an artificial speech machine, which I suppose some enthusiasts would interpret as evidence that these voices really come from alien beings on another planet who are unable accurately to imitate human speech. I have also often heard human laughter, which as you can imagine doesn't sound like anything that random electronic noise would produce. In short, the sounds are just too articulate to dismiss as forced interpretations of random signals, like faces seen in clouds, for example. What has to be done is to clarify how they are being produced is to find some way to prove that they have the sound wave characteristics of human voices rather than of background static, amplification phenomena, or some electromagnetic epiphenomena. I think having professional sound engineers interpret the sound wave characteristics of tape recordings of these voices would help resolve this question. I suspect that everything which enthusiasts of electronic voice phenomena have suggested as an explanation -- that these are voices of the spirits of the dead, projected voices from the minds of those listening, or the voices of alien beings from other planets -- is wrong, since it seems just to force this unknown phenomenon to match up with something already existing in popular mythology, which has no independent proof of its reality. No doubt the real explanation of this interesting mystery will have to be specific to the electronic voice phenomenon itself. In the meantime, why not experiment for yourself! All you need is a tape recorder and a Faraday cage to get a reasonably interference-free recording. You may be surprsed at what you hear.

The German medical school system answers many of the problems discussed above. German students enter medical school directly from 'high school' (Abitur) at age 19, and then take a six-year course which includes the American pre-med as well as the American medical school program. They are also required to work in hospitals starting the first summer after their first year in medical school, so that they become familiar with the whole experience of treating patients from the lowest levels of care on up. The most startling difference between Germany and the United States is that German students in high school had already had very advanced lab courses so they found all the lab work in medical school to be quite familiar. In contrast, their knowledge of mathematics was rather poor compared to that of American students planning on a science career, since many did not know any calculus, and the professors had to try to explain concepts from calculus via graphic representations to make them clear to those without the required background. The most stressful difference was that the screening process continued throughout medical school, with both difficult course exams and competitive state exams to pass. It is still difficult to get into medical school in Germany (you need about a 1.3 on the German grade scale, which corresponds to an American A average in the first two years of university, which is how much study an American needs for application to a German school), but it is more difficult to get through to the end.

Cow's milk may well be correlated with type 1 diabetes, but of course the patient has to have the right genetic predisposition to have this reaction to cow's milk for it to have any effect, which is why so many people can drink milk without harm. But interestingly, monozygotic twins are only 50% concordant for type 1 diabetes, suggesting that some subtle environmental influence, which affects one twin and not the other, triggers the disease during childhood. But since twins are usually brought up in the very same household, go to the same school, eat the same things, and inhale the same chemicals in the environment, what could account for the fact that even with identical genes they both develop type 1 diabetes in only half of all cases? I can't imagine that one twin drinks cow's milk and the other doesn't! It is also likely that it is not that cow's milk causes type 1 diabetes, but that drinking cow's milk instead of human milk, with all the vital immunological instructions its chemical composition contains, is what causes the autoimmune processes of type 1 diabetes.

Electronic voice phenomena are sounds which appear to be human voices, sometimes thought to be those of dead people known to the listeners, which can be heard on any sort of sound recording device. If a tape recorder is run where there are no sounds or voices, voices can sometimes be heard when the blank tape is played back. Similar voices have been reported from radios tuned to a frequency on which nothing is being broadcast or from televisions turned to an empty channel. These apparent voices have been heard from sound recording devices which were allowed to record and play back in a room within a Faraday cage, so the possibility of stray transmissions from other signal sources can be ruled out. However, it is possible that the recording devices themselves are producing noise which the human ear is able to interpret as voices, such as from static or over-amplification of the signal. Since these voices seem to manifest specifically from the recording device and are not heard in the room during recording, there would be no way to correct for this effect by trying to pick up the voices from several different devices used in the same place at the same time. Although I have tried experiments with this phenomenon and have occasionally picked up 'voices' which were quite clear and required no interpretation to determine what was being said or that they were 'human,' I don't profess to know what they are or whether they are just some innocuous electrical phenomenon produced by the sound recording machine itself. There was a Ph.D. thesis on this phenomenon started at Cambridge University in 1982, but it was stopped because background noises could not be sufficiently screened off to make it worthwhile to continue experimenting -- though this seems an easily correctable problem. Although tape recordings can be analyzed to determine whether the sound on them is produced by a human voice, so far as I know no one has ever subjected this phenomenon to that test. Can anyone suggest a decisive experiment which would clearly establish whether these 'voices' are artifacts of the recording machinery or something independent of it?

The Yale philosopher Norwood Russell Hanson wrote an excellent article in 1967 entitled "Why I am not an Agnostic" which sheds some light on the discussion above. He pointed out that if someone says "It's raining outside" and there is no good evidence for it, since I am inside and I cannot see out a window, and if there is no particular reason to suspect the person is lying, I would probably just shrug and take his word for it. It is fairly usual for it to rain, so I don't need very good evidence to accept someone's claim that it is raining. But if someone asserts the existence of something truly remarkable, such as the fact that the Abominable Snowman lives in his desk drawer, I don't even need to bother checking the drawer, since I would require remarkably strong evidence to make me even seriously entertain the possibility that something truly remarkable existed. A mere assertion is not remarkably strong evidence, so I don't give the assertion even enough credence to bother checking. So being an agnostic is senseless, for just as I don't seriously doubt whether the Abominable Snowman actually lives in someone's desk drawer just because he says so, I also don't seriously doubt whether a supernatural, eternal, mind-reading, universe-creating, dead-soul-judging, magical being exists in some intangible space just because some Bronze Age nomads said so. I would need extremely good evidence before I would even begin to bother entertaining the possibility that such an extraordinary thing could exist, and that evidence has never been presented. To say that such a being is so mysterious and mind-transcending it is difficult for our poor, limited minds to comprehend him or his existence would only be a reason to give the hypothesis some slack if I already had some very good reason to believe that something of this sort which was also mysterious and mind-transcending existed, and again, there is no evidence to support that abdication of my reason before the existence of something whose existence I cannot comprehend. This is the type of boot-strapping argument which bothered St. Anselm and St. Thomas in the Middle Ages when they worried whether 'a perfect island' would necessarily have to exist, since if it did not exist, it would be defective and not perfect, and we just defined it as perfect, so it must exist. The same is true of the God who is so mysterious and transcendent we cannot comprehend his existence. We define something as having an existence beyond our capacity to comprehend, so the fact that it seems ridiculous and unreal to us cannot impeach its claim to exist, because its mysterious inaccessibility to our intellects protects it from any attempt of our intellects to challenge it. No mere definition can make something exist, since the question always remains, does the definition actually refer to anything outside of itself which qualifies it as the definition of something which actually exists.

But your argument proves too much, since it is ultimately an argument against all law. The state must do nothing unjust, but if a court orders someone to pay damages in negligence and it makes a mistake in judging whether the party was really negligent or not, it does something unjust, so we should get rid of all tort law. If a court assigns one contracting party a penalty for breach of contract, but makes a mistake in doing so, then it acts unjustly, so we should never allow courts to rule on contracts. But if courts could not enforce the terms of contracts, no one would bother making contracts anymore, and with that, the entire capitalist system would collapse, etc. We have to assume that the justice system can be accurate, otherwise organized society would cease to exist. Both Kant and Hegel rightly argue that the only reason for executing anyone must be because he morally deserves it and by this act society vindicates the right against the criminal's breach of it. To try to justify execution by deterrence can never work, since that would also justify picking someone at random, framing him for some capital offense, and then executing him in public in some horrible way, since the deterrent effect of that would be just as powerful as executing someone who really deserved it. If there were a long period when no murders were committed, deterrence would justify society in picking more and more people at random to frame for capital crimes and then executing them, since that would be the only way to reinforce the effect of deterrence during a long period when there was no just way to maintain its effectiveness. Only justice as the sole principle of execution can justify only executing people who truly deserve it; deterrence would justify too many killings for different reasons.

This whole issue is discussed by cosmologists and philosophers under the name of the 'anthropic principle.' Simply put, it states that the universe can only be perceived by the type of perceiving entities which are sufficiently consistent with its design so they can see it. The universe could have developed in such a way that it would have generated no percipients with the ability to perceive it, or no percipients at all, but once it does develop in a way that it generates percipients who can perceive it, they will always be amazed that they can see it, not realizing that there might have been a trillion alternative universes which failed to generate matching images and image-receivers able to reflect them. But these trillion alternative universes cannot be perceived and counted as failures to put our own coincidental matching of perceivers and perceived in context, since there was nothing to see them! There is a biological equivalent of the anthropic principle which states that unless we could see the universe as ordered we could not have survived as a species, since noticing the order of the universe is necessary to deal with survival challenges. Thus the only things that exist have to be things which can see the universe as ordered, since otherwise evolution would have wiped them out. So those perceivers which have survived evolutionary siftings are always amazed at the 'coincidence' that their own minds match the universe so well that they see it as ordered, when in fact that is no coincidence at all, since they would not exist to notice that they could not see the universe as ordered if they did not already see it as ordered.

As a matter of empirical science no two people are ever equal in intellectual capacity, self-discipline, creativity, strength, health, or moral aptitude, but as a matter of law and morality everyone has to be treated as equal to everyone else. Equality is thus a value but not a fact, and our commitment to the notion that all people should be treated equally is always deliberately unrealistic, anti-scientific, and empirically unjustifed. But since both values and facts are important to human life, these two systems, the former moral and the latter scientific, can run parallel to each other and provide us with alternate reasons for treating people equally or not, depending on which perspective we adopt.

The Kantian answer is that the death penalty is just for murderers because imposing it is required to demonstrate our respect for the life of the person murdered. Hegel says that the whole purpose of criminal law punishing people is to vindicate the right -- to declare that the crime of the criminal is without advantage or meaning for him because the society negates its significance by the punishment imposed. You may steal to gain something, but if the society imposes a punishment on you more harmful than your theft was beneficial to you, then it has negated your own negation of the right, and thus upheld the right. The sole justification for criminal punishment is that a negation times a negation is a positive value. Some crimes on this formula are so vicious they can only be negated by the death penalty. Those who worry about whether the death penalty works as a deterrent are simply on the wrong track, since the question about the death penalty is moral, not practical.

Though of the diseases I cite as examples, there is no way to prevent them, no way to cure them, and no way adequately to control them. If the parents who know of the genetic risks in advance but still decide to have children were to impose the same risks or harms on their children after they were born, they would be criminally charged -- as some wanted to do to Michael Jackson after he dangled his child over the edge of a hotel balcony in Berlin. But for some reason our culture not only refuses to regard parents who impose genetic diseases on their children as innocent of all blame, but genetic counsellors even encourage them to do so with the theory that 'your chances of having a sick child are small.' The issue is not, however, whether the parents would be harmed by having a sick child, but how they might harm their child, to whom they owe a duty of care which the child does not owe to them. Another argument we could make would be that since the children do not yet exist when their parents decide to produce them, the parents cannot yet owe any duty not to harm the children, since they still have no rights because they are not yet humans. However, we now generally recognize that we owe a duty to pass on the planetary environment intact to future generations of people, just as we owe a duty not to burden future generations with debt, so to be consistent we would have to recognize a duty not to burden future people with diseases we could avoid by just not breeding.

Society usually defines a criminal act as imposing either injury on another person or being reckless with respect to imposing a injury on another person, as in criminal negligence. Especially if you owe someone a duty of care, you can be found guilty of a crime by acting so as to endanger them. From these principles, it would seem that parents who know that there is a high risk that they will pass on to their children a serious genetic disease should be punished as criminals or criticized as immoral for deciding to have children. Someone might object that the parents give the children a precious gift of life along with the serious risk of inheriting the genes for a serious disease, but perhaps the children would have preferred never to have been born rather than to suffer an especially hideous genetic illness. Also, even if I give someone a million dollars when I shoot him in the foot, I am still guilty of the crime of shooting him in the foot, even though I have also given him a precious gift. But even if we accept that it is criminally immoral for parents to have children if in doing so they impose on their children a very high risk of serious disease, it is difficult to determine how large the risk has to be and how serious the disease has to be for the decision to have children to be immoral. If I impose on future children a 50% chance that they will develop very serious diseases like Huntington's Disease or polycystic kidney disease, that seems to qualify as immoral. But it represents an intermediate case if I decide to impose a 7% risk (as a male parent) or a 4% risk (as a female parent) of a child developing a less horrible disease such as type 1 diabetes. Imposing the risk on the child that he will be short and thus have poorer chances of getting a girlfriend or making a good impression on potential employers to get a good job seems much too minor an injury for the decision to risk having a short child to be immoral. But where do we draw the line?

While all of this discussion about the ultimate significance of the early epidemiological studies suggesting that smoking helped prevent Alzheimer's is scientifically interesting, what is significant for the point of my original comment is that even at the earliest stages of the research, when it seemed that there might be a good case for saying that smoking helped prevent Alzheimer's, this information was suppressed. But on the contrary, data which promote a puritanical ideology, such as smoking causing impotence (the effect is miniscule but the advertising campaign was gigantic and gave no indication of how small the effect actually was), are seized on instantly and promulgated widely. There should really be a public information campaign to let people know that being under normal weight is harmful to health, or that the U.S. government's NHANES study found no evidence that weight increases among young people could explain the rise of type 2 diabetes among children, but you will never hear about these studies, since they do not reinforce the Puritanical message that self-restriction, self-denial, and self-punishment is good for you.

My general point is basically the one I stated at the outset: It is an arbitrary assumption that just because someone has training and experience in medical technology, he must also know all about medical ethics. It is just like leaving the decision to execute someone by electrocution to an electrician rather than to a judge and jury: the technical dimension simply has nothing to do with the ethical dimension. Of course a medical ethicist should have some basic knowledge of medicine or access to a medical advisor on certain technical points, such as whether certain conjoined twins can safely be separated (as in the case of (Re A (Children) House of Lords, 2000), but the focus of expertise on these matters should be on ethics, not on medicine.

The senile old woman at the dialysis clinic I was discussing had no living relatives and was being kept alive by orders of the chief of nephrology, who at 65 was still the champion of making the fastest rounds of anyone on staff. This was because the payment schedule gave each nephrologist $60 per patient visited, and the only way to increase hourly rates was to see as many patients as possible per hour. He was so bad at rushing past patients in desperate need of a consultation that the nurses used to interpose themselves in front of him to prevent him walking away from patients without answering their questions. During rounds the clinic looked more like a football blocking practice session than an exercise in renal medicine.

Just be glad you don't live in your friendly little police state north of the border, because Canada's version of the Miranda warning allows the police to continue browbeating you with at least 18 additional demands that you talk to them after you have already emphatically invoked your 'right' to silence. The Canadian Supreme Court found this perfectly consistent with the general level of contempt for human rights in Canada today. The case is R. v. Singh (2007).

Since religions are not rational, it is impossible to predict what they may have to insist on being allowed to do in public in order to express themselves. The Dukobors, for example, insisted on parading around naked every now and then, and were often prosecuted for this. What is disruptive of society and what is not is usually not objectively determined. Thus even though church bells can disturb people who have to sleep late, who are ill, or are hypersensitive to loud noises or certain tones, we allow them, simply because they are so usual in our culture that we regard them as a necessary and harmless background irritation which everyone has to endure. But because women wearing a veil are so culturally unusual, the objective difficulties they cause to our use of identity cards, driver's licenses, bank security, etc., are regarded as too high a social cost to pay. However, from a purely objective perspective, is the social disruption of Islamic garb for women worse or less serious than the disruption caused by Christian ringing of church bells?