admin

Press Release: UK Approves COVID-19 Challenge Studies

Responses to the UK COVID-19 Challenge Studies: 

“In a pandemic, time is lives.  So far, over a million people have died.

“There is a moral imperative to develop to a safe and effective vaccine – and to do so as quickly as possible.  Challenge studies are one way of accelerating vaccine research.  They are ethical if the risks are fully disclosed and they are reasonable.  The chance of someone aged 20-30 dying of COVID-19 is about the same as the annual risk of dying in a car accident.  That is a reasonable risk to take, especially to save hundreds of thousands of lives.  It is surprising challenge studies were not done sooner.  Given the stakes, it is unethical not to do challenge studies.”

Prof Julian Savulescu, Uehiro Chair in Practical Ethics, and Director of the Oxford Uehiro Centre for Practical Ethics, and Co-Director of the Wellcome Centre for Ethics and Humanities, University of Oxford

“Human challenge studies are an important and powerful research tool to help accelerate our understanding of infectious diseases and vaccine development.  They have been used for many years for a range of different infections.

“The announcement of the UK Human Challenge Program is a vital step forward for the UK and the world in our shared objective of bringing the COVID-19 pandemic to an end.  With cases climbing across Europe, and more than 1.2 million deaths worldwide, there is an urgent ethical imperative to explore and establish COVID-19 challenge trials.

“All research needs ethical safeguards.  Challenge trials need to be carefully designed to ensure that those who take part are fully informed of the risks, and that the risks to volunteers are minimised.  Not everyone could take part in a challenge trial (only young, healthy volunteers are likely to be able to take part).  Not everyone would choose to take part.  But there are hundreds of young people in the UK and elsewhere who have already signed up to take part in COVID challenge studies.  They deserve our admiration, our support and our thanks.”

Prof Dominic Wilkinson, Professor of Medical Ethics, Oxford Uehiro Centre for Practical Ethics, University of Oxford

Further Research

Read more about the ethics of challenge studies:

Continue reading

Some Questions for the University of Oxford about their Covid-19 Advice

Written by University of Oxford DPhil Student, Tena Thau

 

Yesterday, Oxford sent out an email to students, informing us that we would be asked to sign this Covid-19 Student Responsibility Agreement, before the start of term in October. The email also linked to some further Covid-19 guidance. Here are some questions that I had, while reading through these materials.

  1. Given that much, if not most, transmission is asymptomatic or pre-symptomatic, what is the rationale for only testing those with symptoms, rather than frequently testing everyone (as some universities are doing, and as this recent BMJ editorial advocates)?
  2. Ventilation is important – yet it was not mentioned in the student agreement. What steps is the university taking to increase ventilation in shared indoor spaces?
  3. Given that nearly all ‘superspreader’ incidents have occurred indoors, why not emphasise the importance of moving social activities outdoors?
  4. Given that the risk of transmission via contaminated surfaces is vanishingly low, why do the guidelines emphasise wiping down surfaces? (Promoting ineffective measures, besides not being helpful, can cause net harm, if they deflect our attention from those measures that are actually useful.)
  5. The situation playing out now in the US should be warning sign for UK universities. Some universities in the US have over a thousand cases already – and classes there have only just begun. What is Oxford doing differently to prevent something like that from unfolding here?

Guest Post- Pandemic Ethics: Your Freedom Really Matters. So What?

Written by Farbod Akhlaghi (University of Oxford)

The coronavirus pandemic rages on. To the surprise of many, the enforcement of mask wearing, imposition of lockdowns, and other measures taken to try to halt the pandemic’s march have been met with some heavy and vocal resistance. Such resistance has materialised into protests in various countries against these measures taken by states, companies, and other organisations to prevent the spread of the novel coronavirus.

There are a range of reasons one might object to these measures. One reason that has repeatedly been voiced – sometimes shouted through angry un-masked mouths – is that these measures unjustly affect the freedom of those subject to them. The thought is that, for example, being forced to wear a mask, or denied entry into somewhere without a mask, is an unjust restriction of one’s freedom, presumably either to wear whatever they choose or to be free from the interference of others in going about one’s business.

Whatever good reasons there may be to object to these pandemic mitigating measures, I believe this one is simply a mistake. It is certainly true that our freedom, both to do things and from unjust interference, matter morally – they matter a lot too. But the moral significance of freedom, and the mere fact that measures like enforcing mask wearing, imposing lockdowns, and restricting movement do curtail such freedom, does not show that these measures unjustly restrict the freedom of those subject to them during this pandemic.

Failure to see this may be due to a failure to recognise the distinction, drawn by the moral philosopher Judith Jarvis Thomson, between the infringement and the violation of a right.

Continue reading

Pandemic Ethics: Testing times: An ethical framework and practical recommendations for COVID-19 testing for NHS workers

Dr Alberto Giubilini, Senior Research Fellow at the Oxford Uehiro  Centre for Practical Ethics and Wellcome Centre for Ethics and Humanities was part of an independent rapid-response project to develop an ethical framework for COVID-19 swab testing for NHS workers. Following a stakeholder consultation, the expert group have published a report identifying ethical considerations and providing practical guidance and recommendations to identify good practice and support improvement.

The report is available online. 

Guest Post: Is it Wrong to Lower Your Chances of Doing What You Ought to Do?

Written by Farbod Akhlaghi (University of Oxford)

Suppose you have a moral obligation to take care of your ailing parent tomorrow. If you did something that would lower your chances of fulfilling that moral obligation – like going out partying all night tonight – would you thereby have done something morally wrong?

We do things that affect our chances of fulfilling our moral obligations all the time. They range from the most mundane, like taking a specific route from one place to another where you ought to be doing something at the latter place, to acts like smoking, abusing drugs, or severely neglecting one’s physical and mental well-being. Call actions that affect our chances of fulfilling our moral obligations in the future chance-affecting actions.

Whilst moral obligations are hotly debated in moral philosophy, there has been little to no direct discussion of the moral status of affecting the chances of fulfilling such obligations. This should surprise us. For they are a pervasive feature of our lives: many daily choices we make affect our chances of ultimately doing what we ought to do in the future. And the mere fact that it is, other things being equal, right to do what we are obligated to and wrong not to does not settle whether it is right or wrong to affect our chances of meeting our obligations. So, it seems morally urgent to ask: might we, for example, act wrongly when we make it less likely that we will fulfil an obligation in the future?

Continue reading

Pandemic Ethics: Moral Reasoning in a Pandemic [Guest Post]

Cross-Posted with The Boston Review

By Professor Frances Kamm, Harvard University

Policy discussions during the pandemic have raised concerns for me, as a moral philosopher, about how policy analysts and policy makers are thinking about deaths from COVID-19 and the right way to combat them. The policy discussions I have in mind have ranged from broad issues about how and when to open the economy to more focused concerns about how Intensive Care Units in hospitals should allocate scarce medical equipment (including ventilators). I will here consider three areas of concern about how people are reasoning about what is morally right in the pandemic.

Interpersonal Aggregation 
How should we weigh the economic costs of keeping the economy shut down versus the lives lost to COVID-19 from opening it up? Speaking on the PBS evening News Hour June 18, economist Nick Bloom calculated that the experience of being shut in and suffering economic trauma could result in the loss of a year of life for a person. I do not want to second guess his estimate, but to ask about the use it might be put to in reasoning about what to do.

Read  the full article

Podcast and Event Summary: New St Cross Special Ethics Seminar: Medically Assisted Dying in Canada: from where we’ve come; to where we’re heading, presented by Professor Arthur Schafer (Centre for Professional and Applied Ethics, University of Manitoba)

Written by: Dr Amna Whiston

In this seminar (available on podcast), Professor Arthur Schafer discussed the ethical challenges involved in the Canadian euthanasia debate at the New St Cross Special Ethics Seminar (online). Professor Schafer, who has written extensively over the last thirty years about a range of topics that includes professional and bio-medical ethics, having been a long-standing proponent of the view that allowing people to die with dignity enriches our rights as humans, critically addressed the question of whether Canada is currently heading in the right direction regarding the legalization of medical assistance in dying.

Autonomy, as Professor Schafer reminds us, is one of the core Canadian values, and this is reflected through the public battle against the prohibition of assisted suicide.  Back in 1993, (Rodriguez v. British Columbia [Attorney General]), the majority of the Supreme Court of Canada urged that at that time there was no public consensus among Canadians that the autonomy interest of people wishing to end their lives is paramount to the state interest in protecting the lives of its citizens. In recent years, Canadian public opinion has undergone a significant shift in favour of the autonomy interest of irredeemably suffering patients who, with no hope of recovery, wish to end their lives with dignity. In June 2016 the Canadian Parliament passed a legislation bill legalizing medical assistance in dying, which has now become legally permissible in several American states (Oregon, Washington State and Montana) and in a number of European nations (the Netherlands, Belgium, Switzerland, and Luxemburg). Today more than two-thirds of Canadians support the new legislation which makes it legally permissible for doctors to help the terminally ill to end their lives. This fact, nonetheless, leaves open a more general question (beyond the Canada context) of whether constitutional rights should be settled by opinion poll.

Continue reading

Pandemic Ethics: Compulsory treatment or vaccination versus quarantine

By Thomas Douglas, Jonathan Pugh and Lisa Forsberg

Governments worldwide have responded to the Covid-19 pandemic with sweeping constraints on freedom of movement, including various forms of isolation, quarantine, and ‘lockdown’. Governments have also introduced new legal instruments to guarantee the lawfulness of their measures. In the UK, the Coronavirus Act 2020 gives the government new powers to detain individuals in order to prevent them from infecting others.

Interestingly, one measure that recent legislative changes in the UK leave off the table, at least for the time being, is the use of compulsory medical interventions—whether treatments or vaccinations. We surmise, however, that once treatments or vaccines for Covid-19 become available, there will be political interest in making them mandatory, since this may allow for the quickest and safest route out of the lockdown. In the case of vaccines, there will be a need to ensure that enough people are vaccinated to confer herd immunity. There may also be an argument for mandating vaccination of people who have contact with many others, such as teachers, retail staff and health care workers. In the case of treatments, we might hope that widespread use of anti-viral therapies will lighten the burden on the NHS by reducing the number of infected individuals who require intensive care. And there may be a need to ensure that people take the treatment even after their symptoms have resolved, to reduce their infectiousness.

From a legal point of view, there are clear barriers to compulsory treatments and vaccinations in the UK. The right of individuals with decision-making capacity to refuse any medical intervention that involves interference with their bodies is, for instance, robust and well-established in English law. This right persists even when the individual’s reasons for refusing the intervention are bizarre, irrational, or non-existent, and when the refusal would certainly lead to her death. The individual’s right to make her own medical decisions, and in particular to refuse interventions that interfere with her body, also enjoys robust protection in human rights law.
Continue reading

Announcement: Online Short Courses Open. Philosophy, Psychiatry and Mental Health, and Neuroethics

Applications are open to join our two June short courses on the ethics and philosophy of neuroscience, psychiatry, and mental health which will be run online this year.

For details and how to apply:

 

Guest Post: Pandemic Ethics. Social Justice Demands Mass Surveillance: Social Distancing, Contact Tracing and COVID-19

Written by: Bryce Goodman

The spread of COVID-19 presents a number of ethical dilemmas. Should ventilators only be used to treat those who are most likely to recover from infection? How should violators of quarantine be punished? What is the right balance between protecting individual privacy and reducing the virus’ spread?

Most of the mitigation strategies pursued today (including in the US and UK) rely primarily on lock-downs or “social distancing” and not enough on contact tracing — the use of location data to identify who an infected individual may have come into contact with and infected. This balance prioritizes individual privacy above public health. But contact tracing will not only protect our overall welfare. It can also help address the disproportionately negative impact social distancing is having on our least well off.
Contact tracing “can achieve epidemic control if used by enough people,” says a recent paper published in Science. “By targeting recommendations to only those at risk, epidemics could be contained without need for mass quarantines (‘lock-downs’) that are harmful to society.” Once someone has tested positive for a virus, we can use that person’s location history to deduce whom they may have “contacted” and infected. For example, we might find that 20 people were in close proximity and 15 have now tested positive for the virus. Contact tracing would allow us to identify and test the other 5 before they spread the virus further.
The success of contact tracing will largely depend on the accuracy and ubiquity of a widespread testing program. Evidence thus far suggests that countries with extensive testing and contact tracing are able to avoid or relax social distancing restrictions in favor of more targeted quarantines.

Continue reading

Authors

Affiliations