By Charles Foster and Jonathan Herring
Scene 1: An Intensive Care Unit
Like many patients in ICU, X is incapacitous. He also needs a lot of care. Much of that care involves needles. Late at night, tired and harassed, Nurse Y is trying to give X an intravenous injection. As happens very commonly, she sticks herself with the needle.
Nurse Y is worried sick. Perhaps she will catch HIV, hepatitis, or some other serious blood-borne infection? She goes tearfully to the Consultant in charge.
‘Don’t worry’, he says. ‘We’ll start you on the regular post-exposure prophylaxis. But to be even safer, we’ll test some of X’s blood for the common infections. I doubt he’ll be positive, but if he is, we’ll start you straight away on the necessary treatment. We needn’t take any more blood: there are plenty of samples already available.’
A sample of blood is submitted for analysis. Continue reading
I have just watched someone die. Just one person. But a whole ecosystem has been destroyed. Everyone’s roots wind round everyone else’s. Rip up one person, and everyone else is compromised, whether they know it or not. This is true, too, for everything that is done to anyone. Death just points up, unavoidably, what is always the case.
This is trite. But it finds little place in bioethical or medico-legal talk. There, a human is a discrete bio-economic unit, and there’s a convention that one can speak meaningfully about its elimination without real reference to other units.
In some medico-legal contexts this is perhaps inevitable. There have to be some limits on doctors’ liability. Hence some notion of the doctor-patient relationship is probably inescapable, and the notion requires an artificially atomistic model of a patient.
But ethics can and should do better. Continue reading
The most recent St. Cross Ethics Seminar took place on February 28th, 2013. Kyle Edwards, who is currently a DPhil Candidate at Oxford, led it. Her informative and compelling presentation was entitled “Methods of Legitimation: How Ethics Committees Decide Which Reasons Count.”
(A podcast of the seminar is located here: http://media.philosophy.ox.ac.uk/uehiro/HT13STX_KE.mp3)
By Charles Foster
When you click ‘Like’ on Facebook, you’re giving away a lot more than you might think. Your ‘Likes’ can be assembled by an algorithm into a terrifyingly accurate portrait.
Here are the chances of an accurate prediction: Single v in a relationship: 67%; Parents still together when you were 21: 60%; Cigarette smoking: 73%; Alcohol drinking: 70%; Drug-using: 65%; Caucasian v African American: 95%; Christianity v Islam: 82%; Democrat v Republican: 85%; Male homosexuality: 88%; Female homosexuality: 75%; Gender: 93%. Continue reading
In the light of the unfolding horsemeat scandal, it was only a matter of time before some equine entrails were uncovered in an Ikea meatball. This is a shame on many levels, not least for the poor pigs, cows, and horses whose flesh will now end up as landfill. I personally am quite partial to an Ikea meatball, would not object on the mere grounds that it contained horsemeat (I think I would have been hard pressed to identify the ingredients anyway prior to the scandal), and recently enjoyed an Ikea meatball dinner in Budapest with a colleague from the Uehiro Centre, not a million miles from where the offending meatball was uncloaked. But for those who consider eating Ikea meatballs intrinsically good, but eating horsemeat intrinsically bad, how could they be advised?
Wednesday the 6th of February saw two of the most prominent ethicists of our time engage in a (friendly) debate on two crucial, related philosophical questions: the value of life and the badness of death. (You can listen to the podcast of the debate here.) In a room filled to capacity at the Oxford Philosophy Faculty, Jeff McMahan, Professor of Philosophy at Rutgers University, and John Broome, White’s Professor of Moral Philosophy at the University of Oxford, discussed their respective views on these questions, explaining in turn where they agreed and disagreed with each other and why, using rigorous, sophisticated philosophical arguments.
There is much that is good to be said about Dominic Wilkinson’s new book Death or Disability? The ‘Carmentis Machine’ and decision-making for critically ill children.
My favourite part of the book is how Dominic confronts head on the issue of the best interests of the family in relation to care, and withdrawal of medical treatment, in newborns.
This is one of the most neglected areas of bioethics.
On the one hand, there is a rhetoric that goes we are all social beings, we are socially connected, not atomistic individuals, the community matters, etc etc The usual communitarian mantra.
Then there is the alleged overriding legal and medical ethical principle of the best interests of the patient, which is the newborn infant in the case of neonatal medicine. The sole basis of the provision of medical treatment is meant to be to promote the best interests of the patient, and medicine should never be used to harm the patient, etc etc. The usual medical ethics and law mantra.
And then there is real life. The interests of the parents, siblings, other relatives, friends, society etc can all diverge from the interests of the patient, even a newborn infant. How are these to be weighed? The hard edged reality is that the interests of families and especially parents do play a role in clinical decision making, and even in cases to withdraw life-prolonging medical treatment. (For example, in one survey 90% of American intensivists believed that family interests should be included in decisions for incompetent patients. )
In ‘Death or Disability?’, Dominic reaches several striking conclusions. We should certainly give some weight to the interests of the family for decisions about children. This is most likely to sway our decisions in relatively borderline cases, where the net benefit or harm to the child is small. But he also argues that the amount of weight will vary depending on the age of the child, and on the availability of resources. We should give greater weight to the wishes of parents for newborn infants than for an older child. And we should give greater weight again in societies with few resources, where the burden of caregiving is going to fall heavily on families, and where health resources are seriously limited.
It is time for an honest, open and rational approach to these kinds of dilemmas. Dominic does just that.
Whatever your view of abortion, there are too many abortions, and too many of them are too late. Even abortion’s fiercest advocates don’t pretend that it’s a Good Thing – just the lesser of two evils.
In 2010 there were 189,574 abortions in England and Wales – an 8% increase in a decade. The tightly policed regime envisaged in 1967, when the Act became law, hasn’t existed for ages, if indeed it ever did. There is abortion on demand, whatever the statute book says.
1967 was a long time ago. There have been many medical advances and societal changes since then. It’s time to take stock of the Act.
That’s what a recently announced cross-party commission, to be chaired by Fiona Bruce MP, will do.
It will focus, rightly, on two issues: medical advances and attitudes to discrimination. Continue reading
Would you trust a minister of finance explaining how he just fixed the latest euro-zone deal if he came out of the summit chambers tipsily waving a glass of wine? No? What about if he gave a press conference after an all-night session? Most likely nobody would even notice.
Yet 24 hours without sleep has (roughly) the same effect on decision-making as a 0.1% blood alcohol content (six glasses of wine in an hour). You would not be allowed to drive at this alcohol level, but you are apparently allowed to make major political decisions.
The example is from a blog essay (in Swedish) by Andreas Cervenka, where he asks the sensible question: can we trust sleep-deprived political leaders?
In a story reminiscent of the film ‘Sophie’s Choice’ Taj Mohammed, a refugee in afghanistan, tells the BBC that he chose to sell his six-year-old daughter Naghma to pay off a debt to a distant relative. To keep his family alive, he took out a loan of $2,500. When the relative demanded the money back, Taj’s three-year-old son and uncle had just died from the cold, and he had no means of repaying the debt. That’s when he took advice and offered his young daughter in lieu of the money.