Care for the Dying and Cost-effectiveness
Yesterday’s news reports the launch of the Government’s End of Life Care Strategy for England. This strategy will dedicate in excess of £250 million allowing patients who are dying to decide, as the Times puts it, “where and how to die.” This is part of a programme to provide better care for the dying. According to the BBC, only one in five deaths takes place at home despite a comfortable majority expressing a preference for such familiar surroundings. This prioritisation raises some interesting ethical issues particularly in the light of cost-effectiveness considerations.
Comprehensive treatment for all: The NHS Constitution
The proposed NHS Constitution was published on Monday as a part of a consultation process to shape the future direction of the NHS. Daniel Finklestein in today’s Times suggests that the new constitution is an irresponsible document. Some of his criticisms, however, are wide of the mark.
Saviour Siblings Saved!
Two attempts to amend the Human Fertilisation and Embryology Bill’s provision to allow ‘saviour siblings’ failed in the House of Commons yesterday. The first attempt was to block the practice and failed 342 to 163. The second attempt was to limit the provision to life-threatening cases. It was defeated 318 to 149. As it stands the Bill allows embryo testing and hence selection for ‘saviour siblings’ provided that “there is a significant risk that a person [the sibling ‘to be saved’] … will have or develop a serious physical or mental disability, serious illness or any other serious medical condition.”
Towards Ethical Foie Gras?
Often the source of our worries about eating animals and the basis of arguments against it seems to turn on the pain and suffering of the animal in question. With advances in biotechnology such as cloning and genetic manipulation it may at some point be possible to engineer animals that do not feel pain or suffer but still produce meat of the kind that we are accustomed to eating. Producing such animals on a large scale would significantly reduce the total amount of suffering and may enable us to eat meat with a clear conscience.
Academic Integrity and Vioxx
Drug company Merck and its product Vioxx are in the news again. An article in the Journal of the American Medical Association (JAMA) has examined the documents from the legal proceedings against Merck in connection with the withdrawal of Vioxx from the market in 2004. From their analysis, a significant number of journal articles – mostly review articles rather than articles reporting clinical trials – were written in-house and senior academics were brought in late to be lead named author. At least one of these academics has disputed the accusations made in the JAMA article.
Catholic Conscience and Hybrid Embryos
The first hybrid embryo was created yesterday and the debate about it and the HFEA Bill continues. Recently, the most senior Catholic scientist Sir Leszek Borysiewicz has criticised the Church for its position. Sir Leszek is quoted in The Times as saying:
I was brought up as a Catholic at home, both my parents are Catholics and I have continued to be a member of the Church … I go to church but I have had considerable issues with some of the stances the Church has taken on a variety of health-related issues. My conscience tells me very firmly that I should support the Bill as it stands.
The Transparency of Clinical Trials
An article in the current issue of Science examines the extent to which new policies regarding the governance of clinical trials promote transparency. It goes on to suggest further issues that remain unaddressed and require attention. The authors suggest that recent policy changes have improved the extent of public access to clinical trial data. In particular, they suggest that Section 801 of the FDA Amendments Act “should go a long way in ensuring that all patients and all data are publicly accounted for.” However, with the Editor-in-Chief of the New England Journal of Medicine, they do worry that some patients “are left on the cutting room floor to make a drug look better than it really is.”
The Rogue Senator and the Protection of Genetic Information
The editors of Nature have today called for the US Senate to bypass Senator Tom Coburn’s (Republican,
Hybrid Embryos and Dying Children
The BBC yesterday reported that the government is looking into calls to remove the ban on creating human-animal hybrid embryos using cells from dying children. As things stand the Human Fertilisation and Embryology (HFE) Bill being considered in parliament would forbid such research without the consent of the child. In a letter to health minister Lord Darzi, a group led by the Genetic Interest Group (GIG) has argued that the Bill as it stands “imposes a barrier to one of the most potent tools for research into the most severe childhood diseases.” Our understanding of diseases such as Tay Sachs and Spinal Muscular Atrophy stands to be greatly enhanced by the use of stem cells obtained from such hybrid embryos.
Our Obligations to the Poor
The relationship between the rich and the poor countries of the world has been questioned in a number of ways today. Oxfam have released a report, Investing for Life, which suggests that pharmaceutical companies are missing an important opportunity by not focussing their attention on the large health problems of the poorest countries. At the same time, in the US, apparently significant developments have been made in the production of drought–resistant crops and, in the UK, the government’s chief scientific adviser will call for a rethink on GM crops.
These two issues pull in interestingly different ways. In the first case, the challenging question is how best to balance the value of a market-based research industry with the need to provide assistance to the poorest countries. In the second, the challenge is the price we are prepared to pay for our worries about genetically modified crops. In both cases our obligations to the poor sheds important light on the values of our society.
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