Our special treatment of patients in a vegetative state is a form of cruel and unusual punishment
by Professor Dominic Wilkinson, @Neonatalethics
Professor of Medical Ethics, Consultant Neonatologist
Our society has good reason to provide special treatment to people with severe brain injuries and their families.
But our current “special treatment” for a group of the most severely affected people with brain injuries leads to devastating, agonising, protracted and totally preventable suffering.
Veterinarians and the best interests of animals
By Charles Foster
English law has traditionally, for most purposes, regarded animals as mere chattels. There is now animal welfare legislation which seeks to prevent or limit animal suffering, but provided that legislation is complied with, and that no other relevant laws (eg those related to public health) are broken, you are free to do what you want with your animal.
Veterinary surgeons are in an interesting position. The UK regulatory body for veterinarians, the Royal College of Veterinary Surgeons (‘RCVS’) publishes a Code of Professional Conduct. This provides, inter alia:
‘1.1 Veterinary surgeons must make animal health and welfare their first consideration when attending to animals.’
‘2.2 Veterinary surgeons must provide independent and impartial advice and inform a client of any conflict of interest.’
‘First consideration’ in 1.1 is a rather weasly formulation. Does it mean that it is the overriding consideration, trumping all others, however weighty those others might be? Or the one that veterinarians ought to consider first, before moving on to other criteria which might well prevail? Continue reading
Brexit: lessons from the law
37% of the UK electorate voted to leave the European Community – slightly more than voted to remain. There is evidence that some of them regret their votes. The former editor of the Sun, Kelvin Mackenzie, who voted ‘Leave’, has spoken publicly about his ‘buyer’s remorse’. Others have indicated that they would not vote ‘leave’ again.
There are calls for a second referendum, generally based on assertions that the ‘Leave’ campaign made misrepresentations (for instance about how money saved by leaving the EU would be spent), or on the contention that an issue as constitutionally tectonic should not be decided on such a slender majority, or the observation that an overwhelming number of young voters (who will be affected by the decision for the longest) voted to remain. Continue reading
Private education: in defence of hypocrisy
(Photo: Daily Telegraph)
I am a bitter opponent of private education. All my political hackles rise whenever the subject is mentioned.
Yet of my four currently school-aged children, one (‘A’) is educated privately (at a specialist choir school), and another (‘B’, who is dyslexic) will shortly be in private education (at a hip, Indian-cotton swathed, high-fibre, bongo-drumming, holistic school). The two others (‘C’ and ‘D’) are currently in state primary schools. There are two older children too (‘E’ and ‘F’) They were both educated privately, at a fairly traditional school.
How can I live with myself?
One way would be to avert my eyes from the apparently plain discrepancy between my actions and my political convictions. That’s often been my strategy. But I want to attempt some kind of defence – at least in relation to A and B, and lay the ground for a potential defence in relation to C and D, should we choose to educate them privately. Continue reading
Animal suffering and the pointlessness of moral philosophy
(Above image here) Consider the infamous Chinese dog market. Dogs are rounded up, sometimes beaten while still alive (ostensibly to improve the flavour of their meat), killed, and eaten.
Everyone I know thinks it’s obscene, and that the suffering of the dogs cannot possibly be outweighed by the sensual satisfaction of the diners, the desirability of not interfering, colonially, with practices acceptable in another culture, or by any other consideration. It’s just wrong.
‘It’s just wrong’ is the observation that moral philosophers exist to denounce. They draw their salaries for interrogating this observation, exploding its naivety, and showing that the unexamined observation is the observation not worth making.
But what can the moral philosophers bring to the discussion about the Chinese dogs? Alone, and unaided by science, not much. The philosophy turns out to be either (a) reheated science or (b) a description of our intuitions, together with more or less bare assertions that those intuitions are either good or bad. Continue reading
Mindfulness and morality
Every day, for about thirty-five minutes, I sit cross-legged on a cushion with my eyes shut. I regulate my breath, titrating its speed against numbers in my head; I watch my breath surging and trickling in and out of my chest; I feel the air at the point of entry and exit; I export my mind to a point just beyond my nose and pour the breath into that point. When my mind wanders off, I tug it back.
The practice is systematic and arduous. In some ways it is complex: it involves 16 distinct stages. When I am tired, and the errant mind won’t come quietly back on track, I find it helpful to summarise the injunctions to myself as:
- I am here
- This is it
I alternate the emphases: ‘I am here’: ‘I am here’; ‘I am here’; ‘This is it’; ‘This is it’; ‘This is it.’
I note (although not usually, and not ideally, when I’m in the middle of the practice) that each of these connotations presumes something about the existence of an ‘I’. This is less obvious with the second proposition, but clearly there: ‘This’ is something that requires a subject. Continue reading
Pre-marital cohabitation endangers your marriage
By Charles Foster
Marriage is not well served by its defenders. The loudest and best reported of them are often fundamentalist bigots. It’s a shame, for marriage has a lot going for it.
Even if you think that marriage is an anachronistic/bourgeois/theologically contaminated institution, you’ll probably agree that the breakdown of marriages is best avoided. Of course incurably dysfunctional marriages should be ended, but most people aspire to enduring relationships, and the wrench of marital dislocation is emotionally and financially traumatic. If there are children, marriage breakup is painful for the parents and can be enduringly damaging for the children. There are, in short and quite uncontroversially, some significant harms associated with the breakdown of marriages.
How can marriage breakdown – and hence those harms – be avoided? Continue reading
The reproducibility problem and the status of bioethics
There is a long overdue crisis of confidence in the biological and medical sciences. It would be nice – though perhaps rather ambitious – to think that it could transmute into a culture of humility.
A recent comment in Nature observes that: ‘An unpublished 2015 survey by the American Society for Cell Biology found that more than two-thirds of respondents had on at least one occasion been unable to reproduce published results. Biomedical researchers from drug companies have reported that one-quarter or fewer of high-profile papers are reproducible.’
Reproducibility of results is one of the girders underpinning conventional science. The Nature article acknowledges this: it is accompanied by a cartoon showing the crumbling edifice of ‘Robust Science.’
As the unwarranted confidence of scientists teeters and falls, what will – and what should – happen to bioethics?
Mandatory submission of patient information about FGM: a pointless, damaging, discriminatory mess
Brenda Kelly and Charles Foster
Female Genital Mutilation (‘FGM’) is a term covering various procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons (WHO, 2012). It can be associated with immediate and long-term physical and psychological health problems. FGM is prevalent in Africa, Middle East and South East Asia as well as within diaspora communities from these countries
The Government, keenly aware of the political capital in FGM, has come down hard. The Serious Crime Act 2015 makes it mandatory to report to the police cases of FGM in girls under the age of 18. While we have some issues with that requirement, it is at least concordant with the general law of child protection.
What is of more concern is the requirement, introduced by the cowardly device of a Ministerial Direction and after the most cursory consultation (in which the GMC and the RCOG hardly covered themselves in glory), by which healthcare professionals, from October 2015, are legally obliged to submit patient-identifiable information to the Department of Health (‘DOH’) on every female patient with FGM who presents for whatever reason, through the Enhanced Dataset Collection (EDC). The majority of these women will have undergone FGM in their country of origin prior to coming to the UK. Continue reading
Drinking at Schiphol with the fount of bioethics
A couple of weeks ago, in an airport bar, I met the foundation of modern bioethics.
I was crawling back to London: he was heading to JFK.
‘I usually fly First’, was his opening, as we sat on those vertiginous stools. ‘So I’m usually in the Lounge. But it’s good to be reminded how the other half live.’ I was glad, for about a minute, to be part of his democratic education.
He’d had quite a start on me, and was several G & Ts down when I arrived. That might have loosened his tongue. Or perhaps, and probably, he was as keen when sober to talk obsessively, self-referentially and self-reverentially about himself. Continue reading
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