Cross Post

National Ethics Framework For Use in Acute Paediatric Settings During COVID-19 Pandemic

This ethical framework is a modification of guidance developed for treatment decisions relating to adults. The principles relating to decisions for children in the setting of the pandemic are the same as those for adults. The framework emphasises that decisions should be ethically consistent and apply to patients both with COVID-related and non-COVID related illness.
The focus of the ethical framework provides guidance for a situation where there is extremely high demand and limited critical care capacity. However, it is important to note that at the time of writing (14 April 2020) there is enough paediatric critical care capacity across the UK. At the present time decisions about children in need of critical care should reflect the same fundamental ethical considerations as apply in normal times. Those decisions should be focused on the best interests of the child, and actively involve parents in decision-making.
The framework is available to read in full on the  Royal College of Paediatric and Child Health website.

Cross Post: Boris Johnson Will Be Receiving The Same Special Treatment Other Patients Do In NHS Intensive Care

Written by Dominic Wilkinson, University of Oxford

This article originally appeared in The Conversation

In a world where the adjective “unprecedented” has become commonplace, the news of British Prime Minister Boris Johnson being admitted to the intensive care unit of St Thomas’ Hospital with COVID-19 seemed to take it to a new level.

There is little information in the public domain about Johnson’s medical condition, but this is clearly a very serious step. He will only have been transferred to intensive care because it is perceived that his condition is potentially life threatening and there is a possibility that he would need urgent medical attention, including the possible use of mechanical ventilation.

What would happen if that became necessary? Would Johnson’s treatment be any different from anyone else with the same condition? Would he receive special treatment because of his political position, because of his importance for the country? Would he be prioritised for a ventilator? Continue reading

Cross Post: Flouting Quarantine

Written by Dr Thomas Douglas

Dr Tom Douglas has recently published a fascinating article on the Stockholm Centre, For the Ethics of War and Peace blog:

As I write this, COVID-19, an illness caused by the new coronavirus SARS-CoV-2, is sweeping the globe. Over 15,000 people have died, and it is likely that at least one hundred times this many have been infected with the virus.[2]

The outbreak has brought the ethics of quarantine, isolation and enforced social distancing to public attention. Singapore, Hong Kong, Taiwan, South Korea and China have been praised in the press for their rigorous deployment of quarantine and other liberty-restricting measures. By contrast, the US and UK have been widely criticised for their relatively lax approach.

There are differences between quarantine (which applies to individuals who may have been exposed to an infection), isolation (which applies to individuals who are ill) and enforced social distancing (which largely preserves freedom of movement), but for the purposes of this post, I’ll treat all three together under the heading of ‘quarantine’. I’ll use this term loosely to refer to all interventions that significantly constrain a person’s freedom of movement and/or association in order to lower the risk that the person will infect others.

See here to read the full article, and to join in the conversation.

Human Genetic Enhancement Might Soon Be Possible – But Where Do We Draw the Line?

Written by Tess Johnson, University of Oxford

 

How far will we allow genetic enhancement to go?
vchal/ Shutterstock

The first genetically edited children were born in China in late 2018. Twins Lulu and Nana had a particular gene – known as CCR5 – modified during embryonic development. The aim was to make them (and their descendants) resistant to HIV. By some definitions, this would be an example of human enhancement.

Although there is still a long way to go before the technology is safe, this example has shown it’s possible to edit genes that will continue being inherited by genetic offspring for generations. However, we don’t yet know what effect these genetic changes will have on the overall health of the twins throughout life. Potential unintended changes to other genes is a grave concern which is limiting our use of gene editing technology at the moment – but this limit won’t always be present. Continue reading

Cross Post: Privacy is a Collective Concern: When We Tell Companies About Ourselves, We Give Away Details About Others, Too.

BY CARISSA VÉLIZ

This article was originally published in New Statesman America

Cross Post: Is Mandatory Vaccination the Best Way to Tackle Falling Rates of Childhood Immunisation?

Written by Dr Alberto Giubilini and Dr Samantha Vanderslott

This article was originally published on the Oxford Martin School website.

Following the publication of figures showing UK childhood vaccination rates have fallen for the fifth year in a row, researchers from the Oxford Martin Programme on Collective Responsibility for Infectious Disease discuss possible responses.

Alberto Giubilini: Yes, “we need to be bold” and take drastic measures to increase vaccination uptake

In response to the dramatic fall in vaccination uptake in the UK, Health Secretary Matt Hancock has said that “we need to be bold” and that he “will not rule out action so that every child is properly protected”. This suggests that the Health Secretary is seriously considering some form of mandatory vaccination program or some form of penalty for non-vaccination, as is already the case in other countries, such as the US, Italy, France, or Australia. It is about time the UK takes action to ensure that individuals fulfil their social responsibility to protect not only their own children, but also other people, from infectious disease, and more generally to make their fair contribution to maintaining a good level of public health. 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.

Continue reading

Cross Post: Ten Ethical Flaws in the Caster Semenya Decision on Intersex in Sport

Written by Julian Savulescu, University of Oxford

File 20190508 183103 1eva5jd.jpg?ixlib=rb 1.1
Caster Semenya is legally female, was from birth raised as female and identifies as a female.
Jon Connell on flickr , CC BY-NC

Middle-distance runner Caster Semenya will need to take hormone-lowering agents, or have surgery, if she wishes to continue her career in her chosen athletic events.

The Court of Arbitration in Sport (CAS) decided last week to uphold a rule requiring athletes with certain forms of what they call “disorders of sex development” (DSD) – more commonly called “intersex” conditions – to lower their testosterone levels in order to still be eligible to compete as women in certain elite races.

The case was brought to CAS by Semenya, as she argued discrimination linked to a 2018 decision preventing some women, including herself, from competing in some female events.

This ruling is flawed. On the basis of science and ethical reasoning, there are ten reasons CAS’s decision does not stand up. Continue reading

Cross Post: Why No-Platforming is Sometimes a Justifiable Position

Written by Professor Neil Levy

Originally published in Aeon Magazine

The discussion over no-platforming is often presented as a debate between proponents of free speech, who think that the only appropriate response to bad speech is more speech, and those who think that speech can be harmful. I think this way of framing the debate is only half-right. Advocates of open speech emphasise evidence, but they overlook the ways in which the provision of a platform itself provides evidence.

No-platforming is when a person is prevented from contributing to a public debate, either through policy or protest, on the grounds that their beliefs are dangerous or unacceptable. Open-speech advocates highlight what we might call first-order evidence: evidence for and against the arguments that the speakers make. But they overlook higher-order evidence. Continue reading

Cross Post: Biased Algorithms: Here’s a More Radical Approach to Creating Fairness

Written by Dr Tom Douglas

File 20190116 163283 1s61b5v.jpg?ixlib=rb 1.1

Our lives are increasingly affected by algorithms. People may be denied loans, jobs, insurance policies, or even parole on the basis of risk scores that they produce.

Yet algorithms are notoriously prone to biases. For example, algorithms used to assess the risk of criminal recidivism often have higher error rates in minority ethic groups. As ProPublica found, the COMPAS algorithm – widely used to predict re-offending in the US criminal justice system – had a higher false positive rate in black than in white people; black people were more likely to be wrongly predicted to re-offend.

Corrupt code.
Vintage Tone/Shutterstock

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