Next week, thousands of final year medical students will sit a Situational Judgement Test (SJT) as part of the application for their first medical jobs. This will be the second year that the Foundation School Application System (FPAS) has used the SJT, which was developed by the Improving Selection to the Foundation Programme group (ISFP), and replaced the resource-intensive and perceived-unreliable short-answer questionnaires of the previous application process. Continue reading
It was announced last week that a new offence of ‘wilful neglect or mistreatment’ is to be created for NHS hospital staff whose conduct amounts to the deliberate or reckless mistreatment of patients. This offence will be modeled on an existing offence under the Mental Capacity Act which punishes the wilful neglect or ill-treatment of patients lacking capacity. Currently, a medical worker convicted of this offence faces a maximum sentence of five years imprisonment, or an unlimited fine. The sanctions for the proposed new offence are likely to be of a similar severity.
The creation of the offence comes in the wake of the inquiry into the widespread negligence that occurred at Mid Staffordshire hospital. Intended principally to deter healthcare workers from mistreating patients, the new offence has been proposed following review of patient safety. The leader of the review, Professor Don Berwick, emphasized that patient safety must become the top priority and that the measure was needed to target the worst cases of a ‘couldn’t care less’ attitude that led to ‘wilful or reckless neglect or mistreatment’.
Concerns about its impact
Whilst most would agree that patient safety should clearly be a priority, there has been concern that the new criminal sanction could create a ‘climate of fear’ amongst healthcare workers and that individual workers will be penalised for mistakes that are the result of inadequate staffing or simple human error, rather than blameworthy acts of malice. Continue reading
In a recent editorial in the British Medical Journal, Tim Kendall draws attention to a recent study that suggests that modest financial incentives can significantly improve adherence in people treated with depot drugs for schizophrenia and other psychoses in the UK. This study looks set to reignite the debate regarding the moral permissibility of offering financial incentives as a part of medical care. Whilst those who support this practice point out that we already offer non-financial rewards to many patients, others have criticised the practice as, among other things, amounting to coercion. In this post, I shall contest this particular objection to the practice of offering financial incentives to patients as part of medical care. Continue reading
There has been a recent storm over the DPP’s decision not to prosecute two doctors in relation to their referral of two women for abortion. The cases were widely represented as cases of abortion on grounds of gender. They came to light in the course of an undercover investigation by the Daily Telegraph of practice in English abortion clinics ( see also here and here).
The DPP has published detailed reasons for his decision. They are well worth reading.
An abortion is only lawful if two medical practitioners are of the opinion, held in good faith, that one of the lawful grounds for abortion is made out. One of the grounds (overwhelmingly the commonest, and the one said to be relevant in both of the cases considered by the DPP), is that ‘the pregnancy has not exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family.’: Abortion Act 1967, s. 1(1)(a).
The Act does not say anywhere that the gender of the fetus is a relevant criterion. But it plainly could be. Take two examples: Continue reading
Announcement: “Brave New Love” – peer commentaries due October 7
Dear Practical Ethics readers,
The paper, “Brave new love: the threat of high-tech ‘conversion’ therapy and the bio-oppression of sexual minorities” by Brian D. Earp, Anders Sandberg, and Julian Savulescu has been accepted for publication in the American Journal of Bioethics: Neuroscience. Proposals for open peer commentaries are due this Monday October 7th.
The article may be accessed here, or at the following link: http://editorial.bioethics.net. Be sure to select AJOB:Neuroscience from the drop-down menu of journals. Here is an abstract of the argument:
Abstract: Our understanding of the neurochemical bases of human love and attachment, as well as of the genetic, epigenetic, hormonal, and experiential factors that conspire to shape an individual’s sexual orientation, is increasing exponentially. This research raises the vexing possibility that we may one day be equipped to modify such variables directly, allowing for the creation of “high-tech” conversion therapies or other suspect interventions. In this paper, we discuss the ethics surrounding such a possibility, and call for the development of legal and procedural safeguards for protecting vulnerable children from the application of such technology. We also consider the more difficult case of voluntary, adult “conversion” and argue that in rare cases, such attempts might be permissible under strict conditions.
Open Peer Commentary articles are typically between 500-1500 words and contain no more than 10 references. A guide to writing an Open Peer Commentary is available under the Resources section “Instructions and Forms” at http://editorial.bioethics.net. AJOB:Neuroscience asks that by Monday, October 7, 2013 you submit a short summary of your proposed Open Peer Commentary (no more than 1-2 paragraphs). Please submit your proposal online via the AJOB:Neuroscience Editorial site, following the instructions provided there. They ask that you do not prepare a full commentary yet. Once they have evaluated your proposal, they will contact you via email to let you know whether or not they were able to include you on the final list of those to be asked to submit an Open Peer Commentary.
You will then have until Friday, October 25, 2013 to submit your full Open Peer Commentary.
Last week, the Daily Mail reported on Dr Anna Smajdor’s paper in which she argues that compassion ‘is not a necessary component’ of healthcare. This claim contrasts interestingly with Jeremy Hunt’s recent proposal that all student nurses should have to prove that they are capable of caring by spending a year on wards carrying out basic tasks. This proposal, along with the suggestion that pay be linked to levels of kindness would, according to Hunt, go some way to improving the standard of NHS care. The motivating idea behind Hunt’s proposals is that lack of compassion amongst NHS staff is partly responsible for poor care and, in some cases, for cultivating a ‘culture of cruelty’.
So is compassion a necessary component of healthcare? Is an adequate standard of care necessarily unattainable when compassion amongst staff is absent? In considering these questions I do not intend to embark on a detailed critique of Dr Smajdor’s paper. Instead, I will begin from her main ideas and use them to motivate a general discussion of the role of compassion in healthcare. According to the report, Dr Smajdor argues for two main claims: 1) that compassion is not a necessary component of healthcare – that acceptable standards can be attained without it – and 2) that compassion can actually be dangerous for healthcare workers, possibly resulting in impaired standards of care. Continue reading
How do you want to die? Quickly, painlessly, peacefully lying in your own bed?
Most people say that. But then, people seem to cling to their lives, even if that could mean a less peaceful end. When asked whether they would want physicians to perform certain interventions to prolong their lives like CPR (cardiopulmonary resuscitation) or mechanical ventilation (‘breathing machine’), people say ‘yes’.
Interestingly, a study discussed in a Radiolab podcast from earlier this year reveals that contrary to lay people, physicians do not want these life-saving interventions they perform on their patients performed on themselves. Continue reading
Dale and Leilani Neumann are Pentecostal Christians. Their 11 year old daughter, Kara, fell ill. In fact she had (undiagnosed) diabetes. Her parents refused to obtain medical help. Instead they prayed.
‘Kara’s father testified that death was never on their minds. He testified that he knew Kara was sick but was “never to the alarm of death,” and even after she died, her father thought that Jesus would bring Kara back from the dead, as he did with Lazarus.
The parents and friends testified that the parents took tangible steps to help Kara. The mother tried to feed Kara soup and water with a syringe, but the liquid just dribbled out of Kara’s mouth. The father tried to sit Kara up, but she was unable to hold herself up. At some point, Kara involuntarily urinated on herself while lying unresponsive on the couch, so they carried her upstairs and gave her a quick sponge bath while she lay on the bathroom floor.
At one point, Kara’s maternal grandfather suggested by telephone that they give Kara Pedialyte, a nutritional supplement, in order to maintain the nutrients in her body. The mother responded that giving Kara Pedialyte would be taking away the glory from God. Kara’s mother had told another visiting friend that she believed that Kara was under “spiritual attack.”
Friends Althea and Randall Wormgoor testified that they arrived at the Neumanns’ home on Sunday at approximately 1:30 p.m. The Wormgoors saw that Kara was extremely ill and nonresponsive. Her eyes were partially open but they believed she needed immediate medical attention. Randall Wormgoor pulled Kara’s father aside and told him that if it was his daughter, he would take her to the hospital. The father responded that the idea had crossed his mind, and he had suggested it to his wife, but she believed Kara’s illness was a test of faith for their family and that the Lord would heal Kara….’ 
But the Lord did not. Or at least not physically. Kara died from diabetic ketoacidosis. The evidence was that, with conventional medical care, she would have lived. Continue reading