Dominic Wilkinson @NeonatalEthics
In the news this morning, the NHS has released data on individual surgeons’ performance, so called “surgeon report cards”. This represents the latest move towards increased transparency and accountability in the National Health Service. Elsewhere in the media today, there are numerous reports of the UK couple who were apparently charged £100 after posting a negative hotel review on an online website.
These parallel stories highlight one concern about certain types of health accountability: sensitivity to the negative impact of reviews (or poor performance figures) could lead to harmful changes in behaviour. For surgeon report cards, one frequently cited concern is that publishing report cards could lead surgeons to avoid high-risk cases. If surgeons choose patients with lower risk of dying, they will potentially end up with a better report card. However, then the results would be misleading (it would be the equivalent of someone getting a higher mark by choosing to sit an easier test). More worrying, it may mean that some high-risk patients are unable to access surgery.
Should we be worried about the negative effect of report cards on surgeons behaviour? Continue reading
“Now we must wait, wait. These hours…. The gurgling starts again — but how slowly a man dies! …By noon I am groping on the outer limits of reason. …every gasp lays my heart bare.” Erich Maria Remarque, All Quiet on the Western Front
In Remarque’s novel, the agony of the German soldier, witnessing the slow death of an enemy combatant, is heightened by his own guilt (the narrator had stabbed another soldier in self defense). However, his powerful evocation of distress (and guilt) at witnessing a slow dying is very close to the expressed concerns of parents and clinicians who are watching the death of a child.
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
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.
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.
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]
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?”
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.
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?