Julian Savulescu

Lord Falconer’s Assisted Dying Bill: Is Slow Assisted Dying Legal?

In 2005, the NZ Herald reported. “A man with motor neurone disease plans to starve himself to death rather than wait to die.

“Thirty-nine-year-old Andrew Morris of Hamilton has limited movement and can barely speak. He has gone public with his decision because he wants law changes to allow voluntary euthanasia.”

Such cases occur not infrequently, around the world. Last month, John Rehm took his life by dehydration. NBC News reported:

Diane Rehm and her husband John had been married for 54 years when he knew he didn’t want to live another day.

His Parkinson’s disease had become unbearable. “He just kept getting weaker,” the NPR host told NBC News. “We called in the doctor and John said to him: ‘I am ready today.’ He said ‘I can no longer use my legs, I can no longer use my arms, I can no longer feed myself.’ And knowing with Parkinson’s it is going to get worse rather than better, he said ‘I wanted to die.’” He asked the doctor for help.

The answer they got surprised and disappointed both of them. “The doctor said ‘I cannot do that legally, morally or ethically’,” Rehm said. “He said ‘I don’t disagree with your wish that you could die with the help of a physician but I cannot do it in the state of Maryland.’”

John Rehm had to deliberately die by dehydration. It took nine days.

“John said he felt betrayed,” Rehm said. He said, ‘I felt that when the time came, you would be able to help me.’”

In a recent, short commentary on the sad case of Tony Nicklinson, I argued that two basic moral rights effectively equate to a legal right to slow assisted dying. In one sense, Rhem’s doctor was wrong.

Firstly, everyone, including Mr Hamilton, has a basic right to control what goes into their bodies, including food and fluids. Everyone has a basic right to refuse to eat and drink, even if this results in their death.

Secondly, everyone has a basic right to health care, including the relief of pain and suffering. As someone is dying, they have a right to palliative care to achieve that end. This includes the administration of narcotics and sedatives, as necessary to relieve their suffering and as requested by the patient. This is so, regardless of whether their suffering is self-inflicted or not.

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Geoengineering: Lessons from Human Bioengineering

[W]e have no non-radical solutions left to deal with climate change… either we face a radical climate catastrophe or we must radically shift our economy and modes of social organisation away from the current fossil fuel economy

That was the message given by David Spratt, author of Climate Code Red, and Ian Dunlop, who formerly chaired the Australian Coal Association but has since become a climate activist, at the Breakthrough 2014, National Climate Restoration Forum, last month in Melbourne, reported by Green Left Weekly.

One source of radical solutions is the growing geoengineering industry. Recently proposed methods for the sequestering of carbon dioxide include  ants, iron sulfate  and artificial trees .

Debate continues about when and how geoengineering might ever be deployed. Amongst environmentalists, support for geoengineering methods is low. Green Left Weekly explains:

as Clive Hamilton describes in his book Earthmasters, geoengineering technologies are supported by leading climate denial organisations and by the fossil fuel industry. This is because they seem to offer a way that fossil fuel use can continue unabated. The side effects of these technologies could be brutal: for example, severe drought in Africa and Asia. Moreover, if spraying was stopped, temperatures would rise rapidly, leading to even more devastating impacts.

Will regulation help? Green Left Weekly argues that governments have been unable to regulate fossil fuel industries effectively, and that they will be unlikely to succeed more here.

It is fruitful to look at comparisons with human genetic or biological modification, or human bioengineering.

Both are complex systems affecting life processes. There has been considerable debate and reflection on human bioengineering, human bioenhancement or genetic selection. Could the results of this reflection be of use in considering the ethics of geoengineering?

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Essendon, Doping and Bad Arguments

By Julian Savulescu. @juliansavulescu

The Australian newspaper ‘The Sunday Age’ reports today that “The Australian Sports Anti-Doping Authority has built a ”non-presence” drug case against 34 Essendon footballers, adopting a strategy similar to the one used to ban Lance Armstrong without a positive test.”

1. What should we think about this latest drugs “scandal” at Essendon, the so called “war on doping” in the Australian Football League (AFL), and in sport in general?

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Is Home Birth Really As Safe As Hospital Birth? “Woman-centred Care” vs “Baby-centred Care”

Imagine that you and your partner are having a baby in hospital. Tragically something goes wrong unexpectedly during birth and the baby is born blue. He urgently needs resuscitation if there is to be a chance of preventing permanent severe brain damage. How long would it be reasonable for doctors to wait before starting resuscitation? 15 minutes? 5 minutes? 1 minute?

What would be a reasonable excuse for delaying the commencement of resuscitation? They wanted to get a cup of coffee? The mother wanted to hold the baby first? The mother had catastrophic bleeding and this needed urgent attention?

If it were my baby, I would not want any delay in starting resuscitation. And there would be no justification for delaying resuscitation except some more serious, more urgent problem for another patient, such as the mother.

Yet when people choose homebirth, delay is precisely what they choose. It is simply not possible to start advanced resuscitation in the home within minutes. And their reason is not typically some relevant competing health concern that necessitates delivery at home.

Choosing home birth is choosing delay if some serious problem arises which requires immediate resuscitation.

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Moral Enhancement and Violence

In recent years, I’ve written a lot on moral enhancement, including moral bioenhancement (e.g., here, here and here), and argued that we should not reject its potential benefits out of hand. One common objection has been to say something along the lines of “sure, this would be good in theory, but the science behind it is so far off that you may as well be talking about the number of angels on a pinhead”.

But recent research suggests our moral behavior is already improving in some respects. In the UK, admissions to hospital due to violent crime fell by 12% . And in the US, a recent survey revealed a decline in violence experienced by children over the past decade, particularly assault and sexual violence.  This is also a major theme of Stephen Pinker’s “Better Angels of Our Nature.” Pinker documents the widespread reduction in violence over centuries.

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Trouble Brewing? The Ethical Significance of Synthetic Yeast

Back in 2010, I blogged about Craig Venter’s creation of the first synthetic organism, Synthia, a bacteria.

Now, in 2014, the next step has been made by a team at John Hopkins University, the use of synthetic biology in yeast, which, whilst still a simple organism, has a similar cell structure to humans (and other more complex organisms): a nuclei, chromosomes and organelles. The engineered yeast has been reproduced to over 100 generations, passing on its new DNA.

The pace is breathtaking. Moore’s law describes a phenomenon in computing, where computer capacity (so far) doubles every two years. Kurzweil uses Moore’s law to predict the ‘singularity’: a state where humans no longer control, or even comprehend, the progress that technology continues to make.

It’s difficult to measure scientific progress in the same way as computer power, but it’s clear that leaps in progress are now measured in years, not decades. Yet still we wait until technology is upon us before we act.

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Ethics of Editing the Book of Life

It’s got Nobel Prize written all over it. The scientific innovation, CRISPR, which enables accurate ‘editing’ of DNA (compared to current techniques where a viral vector introduces the DNA at random), has had one team member “jumping out of my skin with excitement”. Still at basic science level, it has already been hailed as a potential new treatment for Huntington’s Disease, HIV and other disorders. It is apparently so easy to use that Professor Mello, who was involved in the project, has said, “a total novice in my lab got it to work”.

One possible application that has been suggested is ‘correcting’ the germline: changing the genetics of sperm, eggs and embryos, to eliminate diseases not just in individuals, but in future generations. The designer baby is in production.

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The Tragedy of Moral Mistakes

A tragic case was recently reported of a man who died following botched care via the NHS’ telephone helpline. Suffering from blood poisoning, a series of errors, mis-recording and failure to listen meant that he was told simply to take the remedy ‘Gaviscon’. He died shortly afterwards.  This was rightly widely reported in the press as a major failing of the health system. Many such catastrophic errors in medicine are reported in the press, and wherever possible safeguards put in place to prevent their re-occurrence.

However, we seem to accept deaths that occur not through medical mistakes but through what I will call moral mistakes. For example, each day 3 people die on the waiting list to receive organ transplants. Many of those could be saved if all those eligible and consenting to give organs did so. But instead, organs are withheld even when those who have opted in to organ donation die, because their families decide against it. Others are withheld because we have failed to introduce an opt out system of consent, meaning that those who simply never got around to signing up are excluded from bringing life to another person.

This is just one example of how mistakes in medical ethics can kill people. There are many more.

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Winchester Lectures: Kamm’s Trolleyology and Is There a Morally Relevant Difference Between Killing and Letting Die?

The Winchester Visiting Lecturerships were established in 1995 for the purpose of inviting visiting lecturers in the fields of International Relations, History, Philosophy, Religion, Theology or Law. We are grateful to the committee for this opportunity to bring Professor Frances Kamm to Oxford for this series of two lectures October 21 – 22, 2013.  

Over the series, Frances Kamm considered a kaleidoscope of cases in which one innocent person must be killed to prevent 5 innocent people being killed. She argued in some situations, killing one is permissible to prevent 5 other people being killed, yet in other cases it is impermissible to kill one to save 5. Or so go her intuitions. She points to what she finds are morally relevant considerations that distinguish permissible from impermissible killing.

The most straight forward case of impermissible killing, and the one in which she and many others have a clear intuitions, is Transplant.

In Transplant, a doctor contemplates killing one innocent person and harvesting his/her organs to save 5 people with organ failure. This is John Harris’ survival lottery.

But this is a dirty example. Transplant imports many intutions. For example, that doctors should not kill their patients, that those with organ failure are old while the healthy donor is young, that those with organ failure are somehow responsible for their illness, that this will lead to a slippery slope of more widespread killings, that this will induce widespread terror at the prospect of being chosen, etc, etc

A better version of Transplant is Epidemic.

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Should athletes be allowed to use performance enhancing drugs?

Press Release: British Medical Journal Head to Head: Should athletes be allowed to use performance enhancing drugs?

Stories about illegal doping in sport are a regular occurrence. On bmj.com today, experts debate whether athletes should be allowed to use performance enhancing drugs.

Professor of ethics Julian Savulescu, from the University of Oxford, argues that rather than banning performance enhancing drugs we should regulate their use.
He points out that, since Ben Johnson in 1988, only 10 men have ever run under 9.8 seconds – and only two (including Usain Bolt) are currently untainted by doping. “The zero tolerance ban on doping has failed,” he says. “It is time for a different approach.”

He argues that regulation could improve safety and says “we should assess each substance on an individual basis” and “set enforceable, fair, and safe physiological limits.”
He acknowledges that, if a substance came to dominate or corrupt performance, there would be good reason to ban it. But says, if a substance allows safer, faster recovery from training or injury, “then it does not corrupt sport or remove essential human contribution.”

And he dismisses the argument that allowing elite athletes to take drugs under medical supervision will encourage children and amateurs to imitate their heroes, pointing out that amateur doping “is already happening in an unsupervised manner.”

“Over time the rules of the sport have evolved,” he says. “They must evolve as humans and their technology evolve and the rules begin to create more problems than they solve. It is time to rethink the absolute ban and instead to pick limits that are safe and enforceable.”

But hospital doctors, Leon Creaney and Anna Vondy believe this would lead to escalating use and call for tougher enforcement.

“The argument against doping in sport is moral, not medical,” they write.

“Athletes who wanted to live a healthy existence would be pushed out altogether. Soon, the only competition that would matter would be the one to develop the most powerful drugs, and athletic opponents would enter into an exchange of ever escalating doses to stay ahead of each other.”

They warn that, in some nations, “we might see a return of the state sponsored doping programmes of the 70s and 80s” and say without the anti-doping programme “the use of performance enhancing drugs would expand exponentially and filter deeper into our society.”

Legitimising performance enhancing drugs in elite and professional sport would also change the message sport sends to society, they add. “Would a bioengineered athlete be able to inspire in the same way?”

They dismiss the argument that because we will never be able to catch every cheat, we should give up trying, saying the answer is “to make the anti-doping system more effective.”
If testing was ubiquitous, they say, “it would be virtually impossible to evade detection, and the equilibrium would be reset in favour of not cheating.”

And if a first offence led to a lifetime ban, “the risks involved would become much greater, such that fewer people would take the gamble of getting caught in the first place,” they conclude.
Contacts:
Professor Julian Savulescu, Uehiro Chair in Practical Ethics & Director, Oxford Centre for Neuroethics, University of Oxford, UK
Tel: +44 (0)1865 286 888
Email: Julian.savulescu@philosophy.ox.ac.uk
Leon Creaney, Trauma and Orthopaedics, University Hospital Birmingham, UK
Email: leoncreaney@hotmail.com

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