Ageing

Oxford Uehiro Prize in Practical Ethics: In light of the value of personal relationships, is immortality desirable? by Fionn O’Donovan

This essay, by Oxford undergraduate student Fionn O’Donovan, is one of the four shortlisted essays in the undergraduate category of the inaugural Oxford Uehiro Prize in Practical Ethics.

In light of the value of personal relationships, is immortality desirable?

In the future it is likely that advances in medicine will grant us the opportunity to prevent the process of ageing. The question of whether eternal life would be a good thing will then be of the utmost practical importance to humanity. In this essay, I claim that it would be, and that Williams’ concerns about immortality[1] can be assuaged with consideration of how life always gives us at least an opportunity to realise something commonly held to be incommensurably valuable, namely good relationships with others. I note here that, for the purposes of this essay, I assume there is no afterlife. I also want to note that the issues of immortality and euthanasia are linked: a similar question about whether death is ever desirable is central to debate on both. Therefore, many of the considerations I present below could also be used to support a more pro-life view on euthanasia. Continue reading

Paying GPs for Dementia Diagnoses

A GP in Guildford has recently revealed that the NHS is to pay GPs £55 each time they diagnose dementia in a patient. Writing on the medical website Pulse, Dr Martin Brunet, called the incentive scheme a “bribe,” put in place so that the government can “hit its target to raise diagnosis rates.”

The ‘Dementia Identification Scheme’ requires GPs to count how many patients with a dementia diagnosis there were on their register at the end of September, and to compare this with the number at the end of March 2015. They will then receive £55 for every extra patient. The full service specifications can be found here.

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Assisted Suicide in Scotland

Kevin McKenna offers a spirited critique (http://www.theguardian.com/commentisfree/2014/feb/01/assisted-suicide-bill-scotland) of Margo MacDonald’s bill on assisted suicide, proposed recently to the Scottish Parliament.

 Behind the rhetorical references to the ‘culture of death’ MacDonald is seeking to introduce in Scotland, and her ‘deathly obsession’, there are some old arguments, which remain as weak as ever. Continue reading

Should exceptional people receive exceptional medical treatment?

There are approximately 150,000 human deaths each day around the world. Most of those deaths pass without much notice, yet in the last ten days one death has received enormous, perhaps unprecedented, attention. The death and funeral of Nelson Mandela have been accompanied by countless pages of newsprint and hours of radio and television coverage. Much has been made of what was, by any account, an extraordinary life. There has been less attention, though, on Mandela’s last months and days. One uncomfortable question has not been asked. Was it ethical for this exceptional individual to receive treatment that would be denied to almost everyone else? Continue reading

Let’s Talk About Death: Millennials and Advance Directives

Sarah Riad, College of Nursing and Health Sciences, University of Massachusetts Boston

Melissa Hickey, School of Nursing, Avila University 

Kyle Edwards, Uehiro Centre for Practical Ethics, University of Oxford

As advances in medical technology have greatly increased our ability to extend life, the conversation on end-of-life care ethics has become exceedingly complex. With greater options both to end life early and extend it artificially, advance directives have arisen in an effort to preserve patient autonomy in situations in which he or she becomes incapable of making a medical decision. However, most people—especially young adults—do not think to plan for such moments of incapacity and the potentiality of an untimely death. With a youthful sense of invincibility comes a lack of foresight that prevents us from confronting these issues. The reality is that unexpected events happen. When they do, it is often very difficult to imagine what a person would have wanted and make medical decisions accordingly on his or her behalf. In this post, we suggest both a transition from action-based to value-based advance directives and an interactive website that would make the contemplation of these issues and the construction of a value-based advance directive appealing to and accessible for Millennials, the 20-somethings of today.  Continue reading

Enhanced punishment: can technology make life sentences longer?

by Rebecca Roache

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Edit 26th March 2014: It’s been pointed out to me by various people that this blog post does not make adequately clear that I don’t advocate the punishment methods described here. For a clarification of my views on the subject, please go here. For a Q&A, see here.

Today, the mother and stepfather of Daniel Pelka each received a life sentence for his murder. Daniel was four when he died in March last year. In the last few months of his short life, he was beaten, starved, held under water until he lost consciousness so that his mother could enjoy some ‘quiet time’, denied medical treatment, locked in a tiny room containing only a mattress on which he was expected both to sleep and defecate, humiliated and denied affection, and subjected to grotesquely creative abuse such as being force-fed salt when he asked for a drink of water. His young sibling, who secretly tried to feed and comfort Daniel, was forced to witness much of this; and neighbours reported hearing Daniel’s screams at night.

Daniel’s mother, Magdelena Luczak, and stepfather, Mariusz Krezolek, will each serve a minimum of thirty years in prison. This is the most severe punishment available in the current UK legal system. Even so, in a case like this, it seems almost laughably inadequate. The conditions in which Luczak and Krezolek will spend the next thirty years must, by law, meet certain standards. They will, for example, be fed and watered, housed in clean cells, allowed access to a toilet and washing facilities, allowed out of their cells for exercise and recreation, allowed access to medical treatment, and allowed access to a complaints procedure through which they can seek justice if those responsible for their care treat them cruelly or sadistically or fail to meet the basic needs to which they are entitled. All of these things were denied to Daniel. Further, after thirty years—when Luczak is 57 and Krezolek 64—they will have their freedom returned to them. Compared to the brutality they inflicted on vulnerable and defenceless Daniel, this all seems like a walk in the park. What can be done about this? How can we ensure that those who commit crimes of this magnitude are sufficiently punished? Continue reading

Global Positioning Systems and Dementia: An Ethical Analysis

Sussex police have announced a scheme to fit people suffering from dementia with GPS tracking systems. These small devices will allow police to locate the wearer, and also allow the wearer to reach a 24 hour helpline by pressing a small button on the device. It has been claimed that these devices will save police time and resources, as well as reducing both the potential risk to dementia patients who go missing, and the anxiety that relatives of the missing person will feel when their loved one goes missing.

However, some parties have decried the introduction of this scheme as barbaric and inhumane. For example, Neil Duncan-Jordan, the national officer of the National Pensioners’ Convention, claimed that the scheme serves to stigmatise sufferers of dementia by equating them with people who have committed a criminal act. Continue reading

The last sweet years or bad romance? Handling infidelity in the nursing home

Ulf suffers dementia and lives in a nursing home. He often interacts with Lena, who also has dementia. They seek each other out, invite each other to their rooms, hold hands and kiss. They can clearly express what they prefer (or not). The staff think they enjoy life and each other’s company. There is just one problem for the happy couple: Ulf is married, and his wife is not happy. She and their children strongly dislikes the relation between Ulf and Lena and asks the staff to keep them apart. They argue that if Ulf had been free of dementia he would not have desired contact with Lena; he might sometimes even be confused and think Lena is his wife.

The situation was posed as a question to the ethics committee of the National Board of Health and Welfare in Sweden, and it recently responded that the staff should not try to interfere in the relationship: the welfare and autonomy of Ulf is prior to the wishes of the family. An earlier question dealt with a somewhat similar case, where the cuckolded wife demanded that her husband be both separated from the other woman and medicated to “dampen” him. The committee found that it would be against the autonomy of the man to be medicated against his will, and the staff did not have a right (legally or morally) to prevent patients from seeing each other.

The interesting question is what to make of romances that come about due to dementia. Are they authentic? How do they relate to the interests expressed earlier in life?

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A Puzzle about Dementia

 

Dementia is one of the biggest challenges facing the British NHS, with one in three people developing the disease after the age of 65. This partly explains why there has been such excitement in scientific circles over intravenous immunoglobulin (IVIg), which appears to slow the rate of mental decline in sufferers from Alzheimer’s.

Obviously, from the societal point of view, dementia is a bad thing, and so this news is good. But from the personal point of view, should I be concerned about dementia – at least in its more severe forms? Epicurus famously claimed that we shouldn’t fear death, since when it arrives we won’t be around any more. Many seem to think the same about severe dementia, despite the fact that many – often the same people – also fear such a state.

Here’s how that view might arise. Imagine some extremely unpleasant experience, such as a very painful operation for which anaesthetic is for some reason unavailable. If you’re told you’re about to have such an operation, you will be very afraid, because you think the person under the knife will be you – it is you who will be feeling all that pain. But severe dementia can also be extremely unpleasant, so why isn’t it just like the operation?

There is one big difference. When the surgeon approaches you with her knife, you will have many of the same memories, beliefs, desires, and so on that you have right now. There will be a great deal of what Derek Parfit calls psychological connectedness and continuity between your mental states now and those you’ll have just before the operation. But that isn’t the case with dementia. You will have lost nearly all your memories, and so on. All that will be left is the capacity for conscious experience. And though that conscious experience might be deeply unpleasant, the line of thought goes, that doesn’t matter especially to you, since ‘you’ won’t be around any more, and there will be no important psychological continuity and connectedness between that individual and you now.

My own response to the prospect of dementia, however, is different. I can’t see why it matters very much whether, during the unpleasant experience, I have the same memories, beliefs, and so on that I do now. Consider the painful operation again. It might be so painful that you can’t *think* of anything else while it’s going on – so your memories, beliefs, and so on are entirely inaccessible. Does that somehow make it less bad? What I care about is what will be experienced by the capacity for consciousness I now possess, and if that capacity is going to be exercised in the future in such a way that there is consciousness of seriously unpleasant experiences – whether through some operation, or dementia – that concerns me now whatever memories, beliefs, and so on I am going to have, or indeed lack, in the future.

The immorality of public consolation in the face of ageing

In case you didn’t know: The EU is currently celebrating the “European Year for Active Ageing and Solidarity between Generations”. The paramount aim of this initiative is to increase the well-being of the elderly by raising awareness that they can still contribute to society by ageing actively, that is, utilising their abilities for their own good and the good of society. In the best case, according to this initiative, not only older people will benefit from ageing actively but also younger ones who do not have the experience and wisdom of earlier generations. Although this is a noble aim, the answer to the question why there should be such a European Year is a gross and seriously immoral distortion of reality: “Because, too often, getting old is perceived as a threat instead of an achievement, both for individuals and for societies. […] Staying active as we grow older is key to tackling the challenge of ageing.” Continue reading

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