Decision Making

Arbitrariness as an Ethical Criticism

Written by Ben Davies

We recently saw a legal challenge to the current UK law that compels fertility clinics to destroy frozen eggs after a decade. According to campaigners, the ten-year limit may have had a rationale when it was instituted, but advances in freezing technology have rendered the limit “arbitrary”. Appeals to arbitrariness often form the basis of moral and political criticisms of policy. Still, we need to be careful in relying on appeals to arbitrariness; it is not clear that arbitrariness is always a moral ‘deal-breaker’.

On the face of it, it seems clear why arbitrary policies are ethically unacceptable. To be arbitrary is to lack basis in good reasons. An appeal against arbitrariness is an appeal to consistency, to the principle that like cases should be treated alike. Arbitrariness may therefore seem to cut against the very root of fairness.

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In Praise Of Dementia

By Charles Foster

Statistically there is a good chance that I will ultimately develop dementia. It is one of the most feared conditions, but bring it on, I say.

It will strip me of some of my precious memories and some of my cognitive function, but it will also strip me of many of the neuroses that make life wretched. It may (but see below) make me anxious because the world takes on an unaccustomed form, but surely there are worse anxieties that are dependent on full function – such as hypochondriacal worries, or the worry that comes from watching the gradual march of a terminal illness. On balance the trade seems a good one. Continue reading

The Re-Greening of Abraham

By Charles Foster

Some odd alliances are being forged in this strange new world,

I well remember, a few years ago, the open hostility shown by dreadlocked, shamanic, eco-warriors towards the Abrahamic monotheisms. They’d spit when they passed a church.

The rhetoric of their distaste was predictable. The very notion of a creed was anathema to a free spirit. ‘No one’s going to tell me what to think’, said one (we’ll call him Jack), the marks on his wrists still visible from where he’d been chained to a road-builder’s bulldozer. And the content of the creeds, and the promulgators-in-chief, didn’t help. ‘I’m certainly taking no lessons’, Jack went on, ‘from some patriarchal sky-god represented by a paedophilic priest.’

But it’s changed. Jack still heaves bricks through bank windows (he says), and still copulates inside stone circles, but now he’s mightily impressed with Jesus, has a Greek Orthodox icon of the resurrection next to his bong, and pictures of Richard Dawkins and Sam Harris on his dartboard. He’s not alone. He’s part of a widespread movement that is reclaiming and recruiting the intrinsic radicalism of Judaism, Christianity, and Islam in the fight against Neo-Liberalism and the destruction of the planet. Continue reading

Harmful Choices and Vaccine Refusal

By Dominic Wilkinson @Neonatalethics

 

Last week, medical specialists in the US reported a case of severe tetanus in an unvaccinated 6 year old child, (who I will call ‘C’). The boy had had a minor cut, but six days later he developed intense painful muscle spasms and was rushed to hospital. (Tetanus used to be called, for obvious reasons, “lockjaw”). C was critically unwell, required a tracheostomy and a prolonged stay in intensive care. Patients with this illness develop excruciating muscle spasms in response to noise or disturbance. C had to be heavily sedated and treated in a darkened room with ear plugs for days. The boy was finally discharged from hospital to a rehabilitation facility after 57 days (and an $811,000 hospital bill).

In a disturbing post-script to the case report, the specialists noted that despite being extensively counselled by the hospital staff that this illness could recur, his parents refused for C to be vaccinated with the tetanus (or any other) vaccine.

C has been seriously harmed by his parents’ decision to decline vaccinations. Should he now be vaccinated against his parents’ wishes? Or could a more radical response be justified?

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Take Back Control? Doctors as Appointed Fiduciaries

Written by Ben Davies

There’s a story that’s often told about the evolution of the doctor-patient relationship. Here’s how it goes: back in the bad old days, doctors were paternalists. They knew what was best, and the job of the patient was simply to do as they were told and hopefully get better. Then, in part because of abuses of power, and in part because of cultural changes, a new model emerged. This model cast patients not as passive recipients of instruction, but as active, autonomous agents, put in charge of their own medical decisions. The doctor-patient relationship was remodelled, from a paternalistic relationship (doctor looks after patient’s health) to a service relationship (doctor does what patient wants, within limits).

That story is almost certainly too simple to be true. But even histories that aren’t wholly accurate can come to influence our culture and expectations. And the dominant assumption between both patients and medical professionals seems to be that our relationship will be cast on what is sometimes called the “informative model” (Emmanuel and Emmanuel, 1992), where the medical role is simply to provide the patient with empirical information, such as information about likely risks and outcomes.

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Separation Anxiety – Should Treatment be Imposed for Conjoined Twins?

by Dominic Wilkinson

@Neonatalethics

On the BBC News website this week, there is a feature on a pair of conjoined twins from Senegal who are currently living in Wales. They have an extremely rare condition – fused at the lower abdomen they have separate brains, hearts and lungs, but shared liver, bladder and digestive system.

The twins travelled to the UK to access medical treatment and surgery for their condition, however, the BBC reports that there is concern that both twins would not survive the surgery. The heart of one twin (Marieme) is weak, and the worry is that if she is separated she will die. Tragically, if the twins remain conjoined there is a fear that Marieme will still die, and her twin Ndeye will also not survive.

What should happen in this case? The twins’ father, Ibrahima, is, according to reports, struggling with the terrible decision that he faces. It isn’t clear at this stage what he will decide.

But what if he refused surgery? What should happen then? Continue reading

Abortion: a Law Unto Itself

By   Charles Foster

Wrongful life cases (typically where a birth has resulted from a failed sterilisation procedure), used to be big business. The parents would sue the negligent steriliser for the costs of bringing up the unwanted child. There was always something distasteful about parents unwishing their child, and this distaste found legal expression in Macfarlane v Tayside Health Board,1  where the House of Lords said that such claims were unlawful. The ratio of Macfarlane was summarised by the Lord Steyn in Rees v Darlington Memorial Hospital NHS Trust:2 Continue reading

Hard Choices, Fredkin’s Paradox and is Ethics a Waste of Time?

Think back to the last time you were faced with a really great menu in a restaurant. Loads of options, all of them appealing. Plus you’re very hungry. Culinary choices, though typically trivial, can also be hard. This is because it can be tricky to make comparisons – and to judge what’s best – across different options, all with particular qualities. The philosopher Ruth Chang describes hard choices as arising when ‘reasons run out.’ Often this is credited to one of three things: ignorance (we lack some of the information needed to choose between options); incommensurability (we can’t find a common currency with which to compare the value/disvalue of different options); incomparability (the options are of such drastically different kinds that we cannot compare across them). But, Chang argues, sometimes we face hard choices in the absence of these factors: we sometimes face hard choices because of parity (the options are on a par). This might be the case when we’re faced with hard food choices (lasagne or risotto), and also much more significant life choices (move to a new country or stay put; prioritise career advancement or start a family). Continue reading

Ethics Goes on Holiday

By Stephen Rainey

Summer time, and the living is ethically perplexing. Hordes of holidaymakers, the shimmering sea, busy beaches, and one sun over it all. How can the eager ethicist assess how to make the most of a fortnight away? We all know how we can generally make the most of things – but how ought we to treat the beach while we’re away? Should we think of our own pleasure, the pleasure of all, or something else? Here, we can explore some options, and get some answers. Continue reading

The Dangers Of Deferring To Doctors

By Charles Foster

(Image: tctmd.com)

There is a dizzying circularity in much medical law. Judges make legal decisions based on the judgments of rightly directed clinicians, and rightly directed clinicians make their judgments based on what they think the judges expect of them. This is intellectually unfortunate. It can also be dangerous.

There are two causes: Judges’ reluctance to interfere with the decisions of clinicians, and doctors’ fear of falling foul of the law.

In some ways judicial deference to the judgment of professionals in a discipline very different from their own is appropriate. Judges cannot be doctors. The deference is best illustrated by the famous and ubiquitous Bolam test, which is the touchstone for liability in professional negligence cases.1 A doctor will not be negligent if their action or inaction would be endorsed by a responsible body of professional opinion in the relevant specialty.

In the realm of civil litigation for alleged negligence this deference is justified. The problem arises when the deference is exported to legal arenas where it should have no place. The classic example relates to determinations of the ‘best interests’ of incapacitous patients. Something done in relation to an incapacitous patient will only be lawful if it is in that patient’s best interests. Continue reading

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