Dominic Wilkinson

#IminworkJeremy – the ethics of 24/7 consultant cover

By Dominic Wilkinson @Neonatalethics

 

At the bedside of a critically ill infant at 5am this morning I was tempted to tweet the latest meme, adding my voice to a chorus of NHS clinicians over the weekend. Last week, in a speech to the King’s fund, Health Minister Jeremy Hunt launched a drive towards 7 day NHS. In particular, he focused on consultant contracts, proposing that newly qualified hospital doctors will be required to work weekends as a condition of employment.

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Reincarnation and discrimination

by Dominic Wilkinson @Neonatalethics

In California, in the last week, there have been further motions in a long running lawsuit relating to a brain-dead child. Oakland teenager Jahi McMath died after a tonsillectomy in December 2013. However, her parents rejected the medical diagnosis of brain death, and despite a Californian court providing judicial backing for doctors’ determination, organized for her to have a tracheostomy and be transferred to another medical facility. More than 18 months later it appears that Jahi’s heart is still beating and she is still connected to a breathing machine somewhere in New Jersey. Continue reading

It’s tough to make predictions*

by Dominic Wilkinson, @Neonatalethics

The Court of Protection is due to review very soon the case of a teenager with a relapsed brain tumour. The young man had been diagnosed with the tumour as a baby, but it has apparently come back and spread so that according to his neurosurgeon he has been “going in and out of a coma”. In February, the court heard from medical specialists that he was expected to die within two weeks, and authorized doctors to withhold chemotherapy, neurosurgery and other invasive treatments, against the wishes of the boy’s parents.

However, three months after that ruling, the teenager is still alive, and so the court has been asked to review its decision. What should we make of this case? Were doctors and the court wrong?

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Doing what they want: the ethics of infamy

by Dominic Wilkinson @NeonatalEthics

Over the last week, the media has been f142798388110247ull of the story of Artur Lubas*. Lubas was the co-pilot of a Germanwings flight, and is thought to have deliberately crashed a plane into a mountainside in a form of murder-suicide, killing 149 others in the process.

There are a range of ethical questions in the Germanwings tragedy. Carissa Veliz, writing on this blog yesterday, pointed to the ethics of disclosure of medical information – either in order to prevent a tragedy, or after a tragedy has occurred. There have been questions about screening of pilots for illness. Others have raised concerns about the unfair media attention on depression in the last week.

Here, I wish to draw attention to a separate question. One suggestion in the last week has been that Lubas’ extreme action was driven in part by a desire for attention. He apparently told a former girlfriend that “I will do something that will change the whole system, and then all will know my name and remember it”.

But this raises an interesting question: the intense media focus on the Germanwings tragedy, and on Lubas in particular, appears to have given him exactly what he wanted. Should we be worried about that, and is there anything we can do about it? Continue reading

Shouldering the burden of risk

By Dominic Wilkinson @NeonatalEthics

 

The UK supreme court last week awarded a woman £5 million in compensation after her obstetrician failed to warn her of a risk that she would have difficulty delivering her baby. Over on the JME Blog Kirsty Keywood discusses some interesting and important legal elements of this judgment for the practice of informed consent and how this will be evaluated in negligence claims.

However, the case raises one important ethical issue. Several expert witnesses in the Montgomery case testified that informing women of even very low risks of complications of vaginal birth would likely lead to a significant increase in the number of women choosing elective caesarean section.

If that is true, would it be justified for doctors to deliberately not discuss such risks? Continue reading

An infant-sized ethics: St Cross Ethics Seminar – Dr Richard Hain

by Dominic Wilkinson @NeonatalEthics

On the 29th of January, Paediatric Palliative Care Specialist Dr Richard Hain gave the first St Cross Special Ethics Seminar for Hilary Term.

Dr Hain’s talk was titled “Mere Practicality?  Infants, interests and the value of life”. The talk abstract and a link to a podcast of his talk can be found below.

The main focus of the talk was on contemporary accounts of medical ethics and in particular on the challenge of finding an adequate account that addresses the needs of human infants. Hain drew an analogy with a blood pressure cuff or “sphygmomanometer”. Blood pressure cuffs wrap around the upper arm, and air is pumped in to them until blood flow stops through the arm (this gives a reading of the pressure in the patient’s arteries). Adult-sized blood pressure cuffs don’t work well for children or infants. A too large cuff will usually give a reading that is too low because it doesn’t take as much air to cut off the blood flow. It underestimates a child’s true blood pressure.

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On the Appropriate Place of Self-Interest in Our Actions

Guest Post by Jos Philips

With Christmas and the new year fast approaching, Jos Philips reconsiders what role self-interest may legitimately play in what we are doing.

Recently, a class of students of mine were discussing a well-known article by Peter Singer (‘The Singer Solution to World Poverty,’ New York Times Sunday Magazine, 1999). In that piece, Singer argues that not giving to Oxfam is morally as wrong as Bob’s saving his Bugatti rather than a child who stands to be hit by a train. The case is such that Bob could steer the train towards his expensive car while keeping himself safe, but he isn’t willing to do so.

As usual, the students started to list various supposedly morally relevant differences between Bob’s case and not making a donation to Oxfam. Then one of the students, an elderly man who had been a doctor in Africa, spoke up and said that fighting the great bads that happened to people was much more important a consideration than all the other reasons (excuses) that his fellow students were thinking up. We should make that donation to Oxfam. Continue reading

Should we intervene in nature to help animals?

Guest Post by Catia Faria

 

It is commonly believed that our obligations towards other human beings are not restricted to abstaining from harming them. We should also prevent or alleviate harmful states of affairs for other individuals whenever it is in our power to do something about it. In animal ethics, however, the idea that we may have reasons not only to refrain from harming animals but also to help them is not particularly widespread. Of course, exceptions can be found regarding companion animals. Most people agree that failing to assist them would be wrong if we could otherwise help them. But what about all other animals in need, shouldn’t we also help them? Consider, for example, a case that has recently caught the attention of social media. In Norway, a man rescued a duck trapped under the ice on the surface of a lake. Everyone is celebrating the intervention as a form of heroism. But wasn’t intervening in order to help the duck precisely what he ought to do?

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Should we criminalise robotic rape and robotic child sexual abuse? Maybe

Guest Post by John Danaher (@JohnDanaher)

This article is being cross-posted at Philosophical Disquisitions

I recently published an unusual article. At least, I think it is unusual. It imagines a future in which sophisticated sex robots are used to replicate acts of rape and child sexual abuse, and then asks whether such acts should be criminalised. In the article, I try to provide a framework for evaluating the issue, but I do so in what I think is a provocative fashion. I present an argument for thinking that such acts should be criminalised, even if they have no extrinsically harmful effects on others. I know the argument is likely to be unpalatable to some, and I myself balk at its seemingly anti-liberal/anti-libertarian dimensions, but I thought it was sufficiently interesting to be worth spelling out in some detail. Continue reading

Philosophy and animal experimentation: Animal ethics workshop with Christine Korsgaard.

By Dominic Wilkinson @Neonatalethics

 

On the 3rd December, as part of the Uehiro lecture series, the Centre for Practical Ethics held a workshop on Animal Ethics at the Oxford Martin School.*

The workshop included first a short summary of her Uehiro lectures by Professor Christine Korsgaard, and then a series of responses by invited guest speakers from the University of Oxford and elsewhere including Professor Jeff McMahan, Professor Cecile Fabre, Dr Mark Sheehan, Professor Valentin Muresan, Dr Emilian Mihailov, Dr Caroline Bergmann and Dr James Yeates. Continue reading

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