Healthcare Allocation for Limited Budgets
By Joshua Parker and Ben Davies
Like many public services, the UK’s National Health Service (NHS) is under increasing resource pressure across the service. Acute services are under strain, with every stage between dialling 999 and getting into a hospital bed taking longer. Waiting times are also up for non-urgent care: 7 million people are on a waiting list in England, while General Practitioners (GPs, the UK’s primary care physicians) are exceeding safety limits and still not managing to meet demand. These measures are only proxies; the underlying concern is that failures in these metrics betray failures of quality and safety.
In part this is due to chronic under-investment made worse by a range of factors: greater demand generated by Covid and lockdowns; increasing complexity with an ageing patient population; more medical ability due to developments in medical technologies; and staff shortages that are in part a result of the UK’s departure from the European Union. However, some may argue that the pressure is also a sign that the NHS is trying to do too much in straitened times, and perhaps even that the scope of what a health system is responsible for has been expanded too far.
The New Relevance of Rationing
By Ben Davies
Decisions about how to allocate healthcare resources can be divided, somewhat crudely, into macro– and micro-level choices. Roughly speaking, macro-choices are policy choices, often made outside any clinical setting, e.g., by government. For instance, it is a macro-level choice which treatments to fund to what degree, and how large the health budget should be as a whole. Micro-choices are the choices people make with a particular budget, generally in clinical settings. For instance, it is a micro-level choice which patients to admit to intensive care, and how to prioritise individuals for organ transplants.
We Need To Have A Conversation About “We Need To Have A Conversation”
By Ben Davies
When new technologies emerge, ethical questions inevitably arise about their use. Scientists with relevant expertise will be invited to speak on radio, on television, and in newspapers (sometimes ethicists are asked, too, but this is rarer). In many such cases, a particular phrase gets used when the interview turns to potential ethical issues:
“We need to have a conversation”.
It would make for an interesting qualitative research paper to analyse media interviews with scientists to see how often this phrase comes up (perhaps it seems more prevalent to me than it really is because I’ve become particularly attuned to it). Having not done that research, my suggestion that this is a common response should be taken with a pinch of salt. But it’s undeniably a phrase that gets trotted out. And I want to suggest that there are at least two issues with it. Neither of these issues is necessarily tied together with using this phrase—it’s entirely possible to use it without raising either—but they arise frequently.
In keeping with the stereotype of an Anglophone philosopher, I’m going to pick up on a couple of key terms in a phrase and ask what they mean. First, though, I’ll offer a brief, qualified defence of this phrase. My aim in raising these issues isn’t to attack scientists who use it, but rather to ask that a bit more thought is put into what is, at heart, a reasonable response to ethical complexity.
Healthcare Ethics Has a Gap…
By Ben Davies
Last month, the UK’s Guardian newspaper reported on a healthcare crisis in the country. If you live in the UK, you may have already had an inkling of this crisis from personal experience. But if you don’t live here, and particularly if you are professionally involved in philosophical ethics, see if you can guess: what is the latest crisis to engulf the publicly funded National Health Service (NHS)?
Rethinking ‘Higher’ and ‘Lower’ Pleasures
by Ben Davies
One of John Stuart Mill’s most well-known claims concerns the distinction between higher and lower pleasures. Higher pleasures—which are, roughly, ‘mental’ pleasures—are, says Mill, always preferable to lower pleasures—the pleasures of the body.
In Mill’s rendering, competent judges—those who have experience of both higher and lower pleasures—will choose a higher pleasure over a lower pleasure “even though knowing it to be attended with a greater amount of discontent” and “would not resign it for any quantity of the other [lower] pleasure which their nature is capable of”.
There are two ways we might interpret this claim:
Should Vaccination Status Affect ICU Admission?
By Ben Davies and Joshua Parker
Intensive care units around the country are full, with a disproportionate number of patients who have not had a single COVID-19 vaccination. Doctors have been vocal in describing the emotional cost of caring for critically unwell patients suffering from the effects of a virus for which there is an effective vaccine. Indeed, one doctor has gone so far as to argue that the unvaccinated should contribute financially for their care. It is easy to understand doctors’ frustrations given the relentless pressures and difficult decisions they’ve had to face. In the face of very real dilemmas about how to allocate scarce ICU beds, some might wonder whether the NHS should adopt a policy of ‘no vaccine, no ICU bed’.
Are Electoral Pacts Undemocratic?
By Ben Davies
In the early hours of Friday morning last week, the long-Conservative UK constituency of North Shropshire caused some political upset (and no little political joy) by electing a Liberal Democrat, Helen Morgan.
It is hard to exaggerate quite how significant a swing this was: the previous Conservative MP, Owen Paterson, whose resignation around accusations of corruption promoted the by-election, had a majority of nearly 23,000 when he was re-elected in 2019. Morgan beat the new Conservative candidate by nearly 6,000.
How was all this possible? One factor will likely have been Conservative voters staying at home, and a few switched to other right-wing parties. But at her acceptance speech, Morgan acknowledged that it was highly likely that voters who would have preferred a Labour MP (the party saw a collapse in its vote share) or a Green MP, lent her their support in order to have the best chance of avoiding a Conservative win. This will lead some to call again for a more formal electoral pact at the country’s next General Election, whereby Labour, the Liberal Democrats and the Greens agree to stand down candidates in seats currently occupied by a Conservative, and where there is a reasonable chance of one of these three parties winning if their anti-Tory rivals stand aside.
Paying for the Flu Vaccine
By Ben Davies
As I do every winter, I recently booked an appointment for a flu vaccine. I get it for free in the UK. If I didn’t have asthma, I’d still get vaccinated, but it would cost me between £9 and £14.99. That is both an ethical error on the part of the government, and may be a pragmatic one too.
In Praise of ‘Casual’ Friendship
By Ben Davies
Academics, especially early in our careers, move around quite a lot. Having done my PhD in London, I have also lived or worked in Leeds, Liverpool, Oxford, and rural Pennsylvania; I am far from the most well-travelled academic I know. In many cases, when we arrive at a new job, we know that it is likely to only last a short period, perhaps less than a year.
This blog post isn’t about how hard it is to be an academic (though there are plenty of real problems that arise from the precarity in which many early career researchers find themselves). Instead, I want to consider something which all this moving around necessitates: casual friendship.
Compromising On the Right Not to Know?
Written by Ben Davies
Personal autonomy is the guiding light of contemporary clinical and research practice, at least in the UK. Whether someone is a potential participant in a research trial, or a patient being treated by a medical professional, the gold standard, violated only in extremis, is that they should decide for themselves whether to go ahead with a particular intervention, on the basis of as much relevant information as possible.
Roger Crisp recently discussed Professor Gopal Sreenivasan’s New Cross seminar, which argued against a requirement for informational disclosure in consenting to research participation. Sreenivasan’s argument was, at least in its first part, based on a straightforward appeal to autonomy: if autonomy is what matters most, I should have the right to autonomously refuse information.
I have previously outlined a related argument in a clinical context, in which I sought to undermine arguments against a putative ‘Right Not to Know’ that are themselves based in autonomy. In brief, my argument is, firstly, that a decision can itself be autonomous without promoting the agent’s future or overall autonomy and, second, that even if there is an autonomy-based moral duty to hear relevant information (as scholars such as Rosamond Rhodes argue), we can still have a right that people not force us to hear such information.
In a recent paper, Julian Savulescu and I go further into the details of the Right Not to Know, setting out the scope for a degree of compromise between the two central camps.
Affiliations
Recent Comments