Bioethics

Coronavirus: Dark Clouds, But Some Silver Linings?

By Charles Foster

Cross posted from The Conversation

To be clear, and in the hope of heading off some trolls, two observations. First: of course I don’t welcome the epidemic. It will cause death, worry, inconvenience and great physical and economic suffering. Lives and livelihoods will be destroyed. The burden will fall disproportionately on the old, the weak and the poor.

And second: these suggestions are rather trite. They should be obvious to reasonably reflective people of average moral sensibility.

That said, here goes:

1. It will make us realise that national boundaries are artificial

The virus doesn’t carry a passport or recognise frontiers. The only way of stopping its spread would be to shut borders wholly, and not even the most rabid nationalists advocate that. It would mean declaring that nations were prisons, with no one coming in or out – or at least not coming back once they’d left. In a world where we too casually assume that frontiers are significant, it doesn’t do any harm to be reminded of the basic fact that humans occupy an indivisible world.

Cooperation between nations is essential to combating the epidemic. That cooperation is likely to undermine nationalist rhetoric.

2. It will make us realise that people are not islands

The atomistic billiard-ball model of the person – a model that dominates political and ethical thinking in the west – is biologically ludicrous and sociologically unsustainable. Our individual boundaries are porous. We bleed into one another and infect one another with both ills and joys. Infectious disease is a salutary reminder of our interconnectedness. It might help us to recover a sense of society.

3. It may encourage a proper sort of localism

Internationalism may be boosted. I hope so. But if we’re all locked up with one another in local quarantine, we might get to know the neighbours and the family members we’ve always ignored. We might distribute ourselves less widely, and so be more present to the people around us.

We might even find out that our local woods are more beautiful than foreign beaches, and that local farmers grow better and cheaper food than that which is shipped (with the associated harm to the climate) across the globe.

4. It may encourage altruism

Exigencies tend to bring out the best and the worst in us. An epidemic may engender and foster altruistic heroes.

5. It may remind us of some neglected constituencies

Mortality and serious illness are far higher among the old, the very young, and those suffering from other diseases. We tend to think about – and legislate for – the healthy and robust. The epidemic should remind us that they are not the only stakeholders.

6. It may make future epidemics less likely

The lessons learned from the coronavirus epidemic will pay dividends in the future. We will be more realistic about the dangers of viruses crossing the barriers between species. The whole notion of public health (a Cinderella speciality in medicine in most jurisdictions) has been rehabilitated. It is plain that private healthcare can’t be the whole answer. Much has been learned about the containment and mitigation of infectious disease. There are strenuous competitive and cooperative efforts afoot to develop a vaccine, and vaccines against future viral challenges are likely to be developed faster as a result.

7. It might make us more realistic about medicine

Medicine is not omnipotent. Recognising this might make us more aware of our vulnerabilities. The consequences of that are difficult to predict, but living in the world as it really is, rather than in an illusory world, is probably a good thing. And recognising our own vulnerability might make us more humble and less presumptuous.

8. Wildlife may benefit

China has announced a permanent ban on trade in and consumption of wildlife. That in itself is hugely significant from a conservation, an animal welfare, and a human health perspective. Hopefully other nations will follow suit.

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Pandemic Ethics: Infectious Pathogen Control Measures and Moral Philosophy

By Jonathan Pugh and Tom Douglas

Listen to Jonathan Pugh and Tom Douglas on Philosophical Disquisitions  discussing  Covid 19 and the Ethics of Infectious Disease Control, a podcast interview that was inspired by this blog.

Following the outbreak of the SARS-CoV-2 coronavirus, a number of jurisdictions have implemented restrictive measures to prevent the spread of this highly contagious pathogen. In January, Chinese authorities effectively quarantined the entire city of Wuhan, the epicentre of the outbreak, which has a population of around 11 million people. There has since been much discussion of various measures that might be implemented now or in the future to counter the spread, including various forms of social distancing, further mass quarantines and lockdowns, closed borders, mandatory testing and screening and even potentially forced treatment.

There are important questions about the lawfulness of infectious pathogen control (IPC) measures. Here, though, we focus on the moral justification of IPC. How can moral philosophy help us to think through when and whether different IPC measures ought to be employed?

To do so, we will briefly summarise our analysis of the different ways non-consensual medical interventions can be justified in infectious diseases control and criminal justice settings, which we originally published open access here.

 

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Heritable Human Genome Editing Can Cure or Prevent Diseases

By César Palacios-González

@CPalaciosG 

More than a year after the fallout from He Jiankui’s announcement to the world that he had edited human embryos in order to made them resistant to HIV, the debate on whether we should move ahead with heritable human genome editing has given no signs of slowing down. For example, just a couple of days ago the UK House of Lords was debating this issue, and the WHO’s advisory committee on genome editing is running a consultation on the governance framework that should rule over human genome editing. While there are many ethical questions surrounding human genome editing, there is a question that recently has gained prominence: is heritable human genome editing therapeutic? Continue reading

Mutilation or Enhancement? What is Morally at Stake in Body Alterations

By Brian D. Earp (@briandavidearp)

 

Those who follow my work will know that I have published a number of papers on the ethics of medically unnecessary genital cutting practices affecting children of all sexes and genders (a partial bibliography is at the end of this post). When my writing touches on the sub-set of these practices that affect persons with characteristically female genitalia, primarily women and girls, I have on occasion received some pushback for using the term ‘FGC’ for female genital cutting rather than ‘FGM’ for female genital mutilation (though I have also received words of appreciation, so, I cannot please everyone).

A recent instance of such pushback came from a respected colleague in response to a forthcoming paper of mine in Archives of Sexual Behavior, in which I explicitly argue against the use of ‘mutilation’ in certain contexts, as there is evidence that such stigmatizing language may have adverse effects on the very people who are meant to be helped. The paper, “Protecting Children from Medically Unnecessary Genital Cutting Without Stigmatizing Women’s Bodies: Implications for Sexual Pleasure and Pain” is available as a pre-print here.

Given that this terminological issue is likely to keep coming up, I thought I would share parts of the reply I wrote to my colleague (lightly edited). I certainly don’t expect that everyone will agree with what I say below, but I hope it can shed some light on at least one plausible way of thinking about such difficult matters.

One last thing. In order to understand my reply, you need to know that my colleague argued that my use of ‘FGC’ rather than ‘FGM’ is disrespectful because it goes against the recommendation of the 2005 Bamako Declaration adopted by the Inter-African Committee (IAC) on Traditional Practices Affecting the Health of Women and Children. My answer is immediately below.

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Video Interview: Peter Singer on The Global Kidney Exchange Programme

In this interview with Katrien Devolder, Peter Singer defends the Global Kidney Exchange (GKE) programme, which matches donor–recipient pairs across high-income, medium-income, and low-income countries. The GKE has been accused of being a form of organ trafficking, exploiting the poor, and involving coercion and commodification of donors. Peter Singer refutes these claims, and argues that the GKE promotes global justice and reduces the potential for people in need of kidneys in low-income and medium-income countries to be exploited.

Lifesaving Treatment for Babies Born at 22 weeks Doesn’t Mean Abortion Law Should Change.

Recommendation for life support from 22 weeks.
Kristina Bessolova/Shutterstock

Dominic Wilkinson, University of Oxford

When new guidance relating to the outcome and medical care of babies born extremely prematurely was recently released, it led some to call for UK abortion law to be revised.

This was because one of the new recommendations from the British Association of Perinatal Medicine is that it is sometimes appropriate to provide resuscitation and active medical treatment for babies born at 22 weeks gestation (four and a half months before their due date). This is a week earlier than was recommended in the last version of the framework, published in 2008.

The argument goes that the new guidance creates a “contradiction in British law” because extremely premature infants can now be resuscitated before the point in pregnancy where abortion law changes.
A spokesperson for campaign group Right to Life UK said: “In one room of a hospital, doctors could be working to save a baby born alive before 24 weeks whilst in another room a doctor could perform an abortion which would end the life of a baby at the same age. Surely this contradiction needs to end?” Continue reading

An Ambitious Vision for Bioethics – Some Reflections on Professor Jing-Bao Nie’s St Cross Seminar

Written by Ben Davies

Many readers of the Practical Ethics blog will remember the astounding announcement last November by Chinese researcher He Jiankui that he had used CRISPR-cas9 technology to edit into two healthy embryos a resistance to developing HIV, later resulting in the birth of twins Lulu and Nana. As Professor Julian Savulescu expressed in several posts on this blog, the announcement spurred widespread ethical condemnation.

The first in this year’s series of St Cross Special Ethics seminars saw the University of Otago’s Professor Jing-Bao Nie (who is also currently a 2019/20 Fellow of Durham University’s Institute of Advanced Study) get behind the headlines to consider the political and social context of He’s experiment. At the core of Professor Nie’s presentation was that the decision to engage in genetic editing of healthy embryos could neither be written off as the act of a ‘rogue researcher’, nor dismissed as merely the product of a uniquely Chinese disregard for ethics, as some have argued.

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Press Release: Tafida Raqeeb

Professor Dominic Wilkinson, Professor of Medical Ethics, University of Oxford. Consultant Neonatologist

 

This morning, the High Court judgement around medical treatment for five-year old Tafida Raqeeb was published. Tafida sustained severe brain damage from bleeding in the brain eight months ago. Her parents wish to take her to a hospital in Italy to continue life support, while the doctors at the London hospital caring for her believe that it would be best to stop life support and allow Tafida to die.

 

Justice MacDonald concluded today that life sustaining treatment for Tafida must continue and her parents should be allowed to take her to Italy. Continue reading

The Doctor-Knows-Best NHS Foundation Trust: a Business Proposal for the Health Secretary

By Charles Foster

Informed consent, in practice, is a bad joke. It’s a notion created by lawyers, and like many such notions it bears little relationship to the concerns that real humans have when they’re left to themselves, but it creates many artificial, lucrative, and expensive concerns.

Of course there are a few clinical situations where it is important that the patient reflects deeply and independently on the risks and benefits of the possible options, and there are a few people (I hope never to meet them: they would be icily un-Falstaffian) whose sole ethical lodestone is their own neatly and indelibly drafted life-plan. But those situations and those people are fortunately rare. Continue reading

The Ethics of Social Prescribing: An Overview

Written by Rebecca Brown, Stephanie Tierney, Amadea Turk.

This post was originally published on the NIHR School for Primary Care Research website which can be accessed here

Health problems often co-occur with social and personal factors (e.g. isolation, debt, insecure housing, unemployment, relationship breakdown and bereavement). Such factors can be particularly important in the context of non-communicable diseases (NCDs), where they might contribute causally to disease, or reduce that capacity of patients to self-manage their conditions (leading to worse outcomes). This results in the suffering of individuals and a greater burden being placed on healthcare resources.

A potential point of intervention is at the level of addressing these upstream contributors to poor health. A suggested tool – gaining momentum amongst those involved in health policy – is the use of ‘social prescribing’. Social prescribing focuses on addressing people’s non-medical needs, which it is hoped will subsequently reduce their medical needs. In primary care, social prescribing can take a range of forms. For example, it may involve upskilling existing members of staff (e.g. receptionists) to signpost patients to relevant local assets (e.g. organisations, groups, charities) to address their non-medical needs. It is also becoming common for GPs to refer patients (or people may self-refer) to a link worker (sometimes called a care navigator) who can work with them to identify their broader social and personal needs. Together, they then develop a plan for how those needs could be met through engagement with activities, services or events in the local community. The resources that link workers direct people towards are often run by voluntary organisations and might include, among other things, sports groups, arts and crafts, drama, gardening, cookery, volunteering, housing advice, debt management, and welfare rights.

Supporting people to establish more stable and fulfilling social lives whilst at the same time reducing healthcare costs seems like a win-win. However, it is essential to evaluate the justifications for the introduction of social prescribing schemes, including their effectiveness. This raises a number of complicating factors, including some questions that require not just a consideration of empirical evidence, but a commitment to certain philosophical and ethical positions.

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