Disability, Chronic Conditions and Rehabilitation

The Texan flautist and the fetus

Imagine that when you woke up this morning, you found yourself lying next to an unconscious stranger. The stranger has a rare life-threatening illness, and unbeknownst to you he was plugged in to your organs during the night. You are now stuck to the stranger. If you disconnect the life support he will die. If, though, you remain connected to him for most of the next year his illness will have recovered, and he can safely ben unplugged. What should you do? Are you obliged to stay attached to the stranger? It might be generous of you to give up your body, and good if you choose to do so, but should we require you to remain connected?

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If you’re female, your face is worth 48-67% more than mine

If you’re a young woman, your face is worth between 48-67% more than that of a young man.

That’s the gist of the Judicial College’s Guidelines for the Assessment of General Damages in Personal Injury Cases, 12th Edition (2013) – one of the canonical texts used by lawyers.

For ‘Very Severe Scarring’ ‘in relatively young women (typically teens to early 30s), where the cosmetic effect is very disfiguring and the psychological reaction severe’, the suggested range of damages for pain, suffering and loss of amenity (what lawyers call ‘general damages’) is £39,160 – £78,650. The corresponding figures for males (‘especially in males under 30’) are £24,090 – £53,075.

The editors of the Guidelines are embarrassed by the discrepancy. They point out that it arises from ‘cases that stretch back into the mists of time’, but that  it is ‘nonetheless open to serious doubt that gender itself can be a proper or indeed lawful factor in determining the level of general damages.’ The embarrassment is appropriate. Gender in itself should not be relevant. The Guidelines list the relevant factors: they include ‘the subjective impact of the disfigurement upon the claimant and the extent to which it adversely affects the claimant’s social, domestic and work lives’.

Should the Guidelines declare that, as a matter of policy, the law should refuse to distinguish between facial scarring in males and in females? That, one might think, is an appropriate way for the law to declare its gender-blindness: it might help to nudge society (which the law leads, as well as reflects) in the right direction. But that would be wrong: the fact is that, whether we like it or not, facial scarring matters more to women. We should do our best to change the attitudes that make this the case, but it is the case, and in compensating claimants, judges should not pretend that we live in a liberal utopia in which people are not judged (by themselves and others) on the basis of the shape or colour of their face. Similarly, when assessing damages for loss of earnings, the law should not pretend that the legislation which prohibits discrimination on grounds of disability actually works.

Thorpe Park’s ‘Asylum’ maze is unrealistic. Does this make it more or less inappropriate?

There has been much discussion this week about whether Thorpe Park’s ‘Asylum’ maze perpetuates the stigma that sometimes surrounds mental illness. The live action horror maze is an attraction that has opened for Halloween for the last eight years. Replete with special effects, its interior is set up to look like the intermittently-lit corridors of a dilapidated hospital. As the maze-goers try to find their way through the corridors, actors dressed as ‘patients’ jump out, scare and chase them until they find the exit. You can get a sense of the maze here.

Polls have been set up to gauge the public response to the maze and petitions started in an attempt to get Thorpe Park to close it down. Having set up a poll on Twitter, Paul Jenkins, the chief executive officer of the charity Rethink Mental Illness has been quoted as saying ‘While of course there’s nothing wrong with a bit of Halloween fun, explicit references to ‘patients’ crosses a line and reinforces damaging stereotypes about mental illness.’ Continue reading

Is unwanted pregnancy a medical disorder?

by Rebecca Roache

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Abortion is often in the news. Yesterday, The Atlantic Wire reported a poll of Americans’ moral views, which found just under half of Americans believe abortion is morally wrong. Today, The Sun is running an article on the devastating effects on women of having abortions. And, a couple of weeks ago, the law in Ireland was changed to allow abortion under certain circumstances.

Whether (and under what circumstances) abortion is ethical, and whether (and under what circumstances) it should be permitted by law, are two of the most well known and fiercely debated issues of our age. I do not wish to engage with them here. Instead, I will argue as follows:

  1. Abortions cause suffering, and neither permitting them nor banning them is likely to reduce this suffering to an acceptable level.
  2. The best way of reducing the suffering caused by abortion is to reduce unwanted pregnancies.
  3. Current attempts to reduce unwanted pregnancies in the UK do not work well enough.
  4. Viewing unwanted pregnancy as more like a medical disorder and less like a social problem is likely to enable more effective measures to address it.

I then propose such a measure, and defend it against some possible objections.

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In the genetic supermarket, should parents be allowed to buy?

Imagine a world in which genetic interventions (for hair/eye colour, health, strength, happiness, morality…) were tested, safe, effective and accepted. In this genetic supermarket, who should be allowed to buy – to decide how children should be modified? Parents seem the obvious choice – but on reflection, there seem few reasons to allow this.

Why is it good for people to make their own choices? Firstly, out of liberty: everyone should have the right to do what they want with themselves. Secondly, because people know their own preferences much better than anyone else (one of the reasons that the communist command economies failed). And thirdly because people can experience the consequences of their choices, and become more skilled consumers, driving poor products out of business.

None of these applies to parents choosing their children’s genes. Here they are making the choice for other people, whose preferences they don’t know (because they don’t even exist yet!). And unless parents plan to have ten or twenty children, they have no relevant personal experience to draw on for comparing genetic interventions. And the main effects of these interventions are very long term, making the parents even less suited to making the choice in an informed way. Continue reading

How do you want to die?

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

Are cyborgs the future of humanity?

Yesterday’s Observer features two pieces about human enhancement in the prospect of the FutureFest festival in London in September (see here and here). The articles mention Bertolt Meyer, a Swiss man born without a left hand who was recently fitted with a state-of-the-art bionic one (which he controls from his iPhone), and include quotes from well-know authors associated with the topic of human enhancement, such as Nick Bostrom and Andy Miah.

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Non-consensual testing after needlestick injury: A legal and ethical drama

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

Forced Physical Exercise as an Intervention for Mental Disorders?

Studies have shown that regular physical activity has benefits for mental health: exercise can help people to recover from depression and anxiety disorders. However, not all people like exercise, and a mental disorder like depression can additionally decrease motivation for physical activity. So the disorder itself might inhibit behaviour that helps to overcome it.

We would assume that pressurising people is no solution here: several studies have shown that restricting freedom of choice or control increases stress in both humans and animals. However, new research tentatively indicates that controllability might play a smaller role than expected when it comes to exercise, and that even forced exercise might protect against depression and anxiety symptoms:

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Global Positioning Systems and Dementia: An Ethical Analysis

Sussex police have announced a scheme to fit people suffering from dementia with GPS tracking systems. These small devices will allow police to locate the wearer, and also allow the wearer to reach a 24 hour helpline by pressing a small button on the device. It has been claimed that these devices will save police time and resources, as well as reducing both the potential risk to dementia patients who go missing, and the anxiety that relatives of the missing person will feel when their loved one goes missing.

However, some parties have decried the introduction of this scheme as barbaric and inhumane. For example, Neil Duncan-Jordan, the national officer of the National Pensioners’ Convention, claimed that the scheme serves to stigmatise sufferers of dementia by equating them with people who have committed a criminal act. Continue reading

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