Dominic Wilkinson

Not-so-lethal – the ethics and costs of extraordinary fetal intervention

By Dominic Wilkinson (@Neonatal Ethics)

Late last month, a paper in the US journal Obstetrics and Gynecology reported the extraordinary case of Abigail Beutler. Abigail is now 14 months old. She was born without kidneys, a condition sometimes called ‘Potter’s syndrome’. Potter’s syndrome is normally universally fatal in the newborn period, because without kidneys the fetus does not produce urine and has little or no fluid around them. Without any fluid around the fetus, their lungs do not develop.

Abigail is the first baby to ever survive with this condition. Doctors infused artificial fluid into the uterus around her (amnioinfusion) on five occasions during the pregnancy. This seemed to allow her lungs to grow. Although she was born 3 months prematurely, she had only minor breathing problems at birth. She has received kidney dialysis since soon after birth, was discharged home after 19 weeks and is now reportedly being considered for a kidney transplant. Continue reading

Practical Ethics Bites

This week at the centre we are excited to be launching a new series of podcasts “Practical Ethics Bites

These podcasts have been recorded to support secondary school students (particularly A-level students) who are studying philosophy or religious studies and their teachers. They are available to download (free) from the podcast webpage, and you can subscribe to the series through iTunes U.

The interviews cover a set of core topics in applied ethics, and aim to provide an accessible introduction to key arguments, and concepts. They were recorded by philosophers Nigel Warburton and David Edmonds, the team behind the popular Philosophy Bites series.

We will be releasing more podcasts over the next two months, but the first interview is already available – ‘Should euthanasia be legal?’ – interview with Dr Dominic Wilkinson (@NeonatalEthics), consultant neonatologist and Director of Medical Ethics at the Oxford Uehiro Centre.

We are keen to get feedback on this podcast series from students and their teachers. Are the interviews at the right level? Are they helpful? What topics would be useful for future podcasts to cover? As an incentive, students/teachers who provide feedback will be entered into a draw for a set of the Philosophy Bites books (generously donated by David Edmonds and Nigel Warburton)! For details see here.

“Please randomize me – but don’t tell my family that you did”

Last week various newspapers (see here and here) reported on a planned research study of adrenaline for patients suffering a cardiac arrest outside hospital. The PARAMEDIC 2 trial (full protocol here) involves ambulance officers randomly giving patients either the traditional resuscitation drug adrenaline, or a salt-water solution (placebo). The trial has been strongly criticized by Ruth and Lindsay Stirton, writing in the Journal of Medical Ethics.

There are two main controversial elements to the trial design. The first involves the lack of consent for involvement in the trial, the second involves the researchers’ plan not to inform families of patients who died that their loved one had been in a research trial.

Continue reading

Carbon caps and IVF

by Dominic Wilkinson @NeonatalEthics

Over on the Journal of Medical Ethics blog are a couple of posts that might be of interest to Practical Ethics readers.

Last week, the journal published online an article by Cristina Richie on carbon caps and IVF. She argues that the environmental costs of reproduction should lead to carbon caps on IVF, and more restrictive public access to artificial reproduction.

Iain Brasssington wrote a blog in response, ‘ARTs in a warming world‘. He wrote:

“while reproduction may be a good, it is not the only good at which persons or policies may or should aim; and there are times when two goods conflict.  Neither is it too strange to suggest that there are times when a person should abandon one good because of the greater moral gravity of some other, greater, good.  It’s possible that reproduction is one of those goods.”

I also wrote a blog in response to Richie, arguing that “Gaia doesn’t care where your baby comes from“. From an environmental point of view there seems little reason to place limits on artificial but not natural reproduction, or to restrict publicly funded IVF (as Richie suggests) to the “biologically infertile”.

Finally, Iain wrote a follow-up piece about conflicts of interest and ethical analysis. Some had criticised Richie’s arguments on potentially ad hominem grounds. Brassington argues (persuasively) that what matters are the arguments, not their origins.

[Feel free to comment over on the JME blog]

Economic arguments and assisted dying.

by Dominic Wilkinson (@NeonatalEthics)

Lord Falconer’s assisted dying bill is being debated today in the House of Lords. In the past week or two there has discussion in the media of many of the familiar arguments for and against such a proposal. As Roger Crisp noted in yesterday’s post, there have been relatively few new arguments. Supporters of the bill refer to compassion for the terminally ill, the difficulty of adequately relieving suffering, and patients’ right to make fundamental choices about the last stage of their lives. Opponents of the bill express their compassion for the terminally ill and those with disabilities, fear about coercion, and the omnipresent slippery slope.

One concern that has been raised about the assisted dying bill is the fear of abuse in the setting of an overstretched public health system. For example, Penny Pepper, writing in the Guardian notes that “Cuts to social care are monstrous…How would the enactment of the Falconer bill work if brought to our harassed NHS?”

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JPE 2(1) – The pursuit of sex equality keeps going off the rails

So claims renowned Oxford philosopher and feminist Janet Radcliffe Richards.  Professor Radcliffe Richards is the author of The Sceptical Feminist, Human Nature After Darwin and Careless Thought Costs Lives: the ethics of transplants. She was also listed recently as one of the world’s 50 most important thinkers by Prospect magazine.

Writing in the Journal of Practical Ethics, Radcliffe Richards criticises a common view about sexual equality.
Women hold only 11% of executive positions in top companies in Europe. There are public campaigns to achieve gender balance in public office and top positions in corporations. Political parties are criticised for having low numbers of women in parliament or cabinet.

But Radcliffe Richards argues that society should not be aiming for equal representation of men and women in these ways.

Sex equality sounds self-evident as a requirement of justice, but we need to be clear about exactly what kind of equality is required.

There is much confusion between two quite different kinds of equality, and only one of them is relevant to justice between women and men.

Justice does not require equality of status, wealth, or any other outcome between the sexes.  What matters from a moral point of view is  equal consideration of interests, which is quite different.

Radcliffe Richards agrees that policies to increase the representation of women in influential areas are of great importance.  But she argues that they need a different kind of justification. Recognizing this should make a significant difference to the politics of sex.

See here for the free full text article in the latest issue of the Journal of Practical Ethics.

The Journal of Practical Ethics is a new open access philosophy journal, published by the Oxford Uehiro Centre for Practical Ethics at the University of Oxford. The journal aims to make philosophy relevant to public debate and practical questions. It publishes works by leading academic moral and political philosophers that are accessible to a broader public audience.

 

Telling porkies

by Dominic Wilkinson (@Neonatalethics)

 

One of my registrars asked an interesting question this morning. A commonly used life-saving medicine in newborn intensive care is derived from animal products; should parents be told?

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Morality, science, and Belgium’s child euthanasia law

Originally posted on the OUP blog. Reposted with the permission of the author

Tony Hope is a Uehiro fellow, Emeritus Professor of Medical Ethics at the University of Oxford and the author of Medical Ethics: A Very Short Introduction.
Science and morality are often seen as poles apart. Doesn’t science deal with facts, and morality with, well, opinions? Isn’t science about empirical evidence, and morality about philosophy? In my view this is wrong. Science and morality are neighbours. Both are rational enterprises. Both require a combination of conceptual analysis, and empirical evidence. Many, perhaps most moral disagreements hinge on disagreements over evidence and facts, rather than disagreements over moral principle.

Consider the recent child euthanasia law in Belgium that allows a child to be killed – as a mercy killing – if: (a) the child has a serious and incurable condition with death expected to occur within a brief period; (b) the child is experiencing constant and unbearable suffering; (c) the child requests the euthanasia and has the capacity of discernment – the capacity to understand what he or she is requesting; and, (d) the parents agree to the child’s request for euthanasia. The law excludes children with psychiatric disorders. No one other than the child can make the request.

Is this law immoral?

Continue reading

In praise of organ-ised sport

By Dominic Wilkinson (@NeonatalEthics)

The BBC reports today on a recent organ donation initiative in Brazil. This initiative has led to a 400% increase in the numbers of heart transplants in a local hospital. The waiting list for organs in the city of Recife reportedly dropped to zero in the first year after introduction of this innovation.

What sort of initiative could lead to such a dramatic increase in organ donation numbers? Continue reading

Can we solve the world’s problems by offering a large enough prize?

On the 22nd of October 1707, more than 1400 British sailors died when a British naval fleet sank in stormy weather off the Isles of Scilly. The disaster was later attributed to failings in navigation and sailors’ difficulty in determining their location at sea. This was a perennial problem at the time, and had persisted despite intense scientific research. Seven years later, the UK government passed the Longitude Act, offering 20,000 pounds (more than 2 million pounds in today’s money) to anyone who could develop a method for reliably determining longitude at sea. The longitude prize was eventually won by John Harrison, a self-educated Lincolnshire clockmaker.

Yesterday, 300 years after the original Longitude act, the UK Technology Strategy Board launched a £10 million pound prize competition, a new ‘Longitude prize’. The money will be awarded to a scientist or group of scientists who come up with a solution to one of a set of major global challenges – inadequate food/clean water supply for everyone, antibiotic resistance, spinal cord injury, dementia, the large carbon impact of air-flight.

The new Longitude prize is the latest in a series of innovation inducement competitions over time. These competitions have offered monetary rewards for solving problems as diverse as the development of butter substitutes, the first trans-Atlantic air flight, reusable aircraft for space flight, or an alternative fertilizer to bird poo. One novel feature of the 2014 Longitude prize is that it is seeking public input into the specific challenge to be targeted. Public voting will decide which of the six global challenges above are to be the focus of the prize.

But are innovation prizes an effective or appropriate way to solve major global scientific challenges? Continue reading

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