By Dominic Wilkinson, @Neonatalethics
Earlier this year, the Lancet published a trial (the ‘ACT’ trial) involving 100,000 babies at risk of being born prematurely in developing countries. Half of the mothers in the ACT trial did not receive a simple cheap medicine that has been previously shown in multiple trials and meta-analysis to reduce the risk of death for premature babies. From the ACT trial results, it appears that 89 additional babies died as a result of their mothers taking part in the trial.
Surely this is an egregious example of unethical research? It appears to be in breach of the World Medical Association Declaration of Helsinki standards. Why did ethics committees allow the research? Why did a major journal like the Lancet publish it? Why aren’t bioethicists and activist and advocacy groups like Public Citizen jumping up and down in outrage?
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.
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
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?
by Dominic Wilkinson @NeonatalEthics
Over the last week, the media has been full 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
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 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
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