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
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.
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?
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
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
Guest Post by Kasper Lippert-Rasmussen
Professor Lippert-Rasmussen’s paper on indirect discrimination is part of the latest issue of the JPE
December 3, 2014, the US Supreme Court held its first hearing on the case of a former UPS driver, Peggy Young (Young v UPS, 12-1226): “In 2006, UPS forced Young to take an unpaid leave after refusing to accommodate her doctor’s order that she not lift heavy packages during her pregnancy… Young lost not just her income, but her health insurance as well” (http://www.latimes.com/local/abcarian/la-me-ra-supreme-court-pregnancy-discrimination-20141203-column.html#page=1). While UPS requires delivery drivers “to be able to lift packages as heavy as 70 pounds. Young said she rarely handled anything over 20 pounds and dealt almost exclusively with letters that sat on the passenger seat of her van”. Interestingly, however, at the time UPS also had a policy of providing temporary light-duty work to, but also only to, ”employees who had on-the-job injuries, were disabled under federal law or lost their federal driver certification” (http://www.theguardian.com/us-news/2014/dec/01/ups-employee-pregnancy-discrimination-supreme-court). Before taking her case to the Supreme Court, lower courts had dismissed Young’s lawsuit twice. Continue reading
by Dominic Wilkinson, Managing editor JPE, @Neonatalethics
The latest issue of the journal is out this week:
Valerie Tiberius examines the relevance of different theories of wellbeing for the important practical task of providing life-advice to friends. She has posted a short blog on the topic. You can also listen to a great podcast interview with Professor Tiberius about her paper here.
The subject of wellbeing is also covered by a paper by Edward Skidelsky. He argues that happiness surveys give us some information (albeit imperfect) about whether or not people are happy; however, we cannot avoid the need to address the fundamental question of what counts as a good (or happy life).
“nothing that surveys might tell us can upset our common-sense conviction that health, love, freedom, security and respect all standardly contribute to happiness.”
Finally, Kasper Lippert-Rasmussen tackles the rights and wrongs of a pervasive form of discrimination. Lippert-Rasmussen contends that indirect discrimination (rules or behaviour that disproportionately disadvantages a group non-intentionally) isn’t necessarily unjust. He argues that only a strict egalitarian view (with uncomfortable implications) would make indirect discrimination always unjust. See also his blog above.
by Karamvir Chadha @karamvirchadha
What are our moral obligations to animals? This was the subject of Christine Korsgaard’s Uehiro lecture on 2 December 2014, the second of a three-lecture series on the moral and legal standing of animals. (To listen to the lecture follow this link)
Korsgaard argued for the conclusion that animals have moral standing. Her argument for this conclusion was characteristically Korsgaardian: it was both extremely ambitious and grounded in a distinctive interpretation of Kant. Continue reading
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.