Dominic Wilkinson’s Posts

Crosspost: Learning to live with COVID – the tough choices ahead

By Jonathan Pugh, Dominic Wilkinson and Julian Savulescu

This work was supported by the UKRI/ AHRC funded UK Ethics Accelerator project, grant number AH/V013947/1. The UK Ethics Accelerator project can be found at https://ukpandemicethics.org/

 

As mass vaccination continues to be rolled out, the UK is beginning to see encouraging signs that the number of COVID deaths is reducing, and that the vaccines may be reducing the transmission of coronavirus.

While this is very welcome news, a mass vaccination programme is unlikely to be enough to eliminate the virus, so we need to turn our thoughts towards the ethics of the long-term management of COVID-19.

One strategy would be to aim for the elimination of the virus within the UK. New Zealand successfully implemented an elimination strategy earlier in the pandemic and is now in a post-elimination stage.

An elimination strategy in the UK would require combining the mass vaccination programme with severe restrictions on international travel to stop new cases and variants of the virus being imported. However, the government has been reluctant to endorse an elimination strategy, given the importance of international trade to the UK economy.

One of the main alternatives to the elimination strategy is to treat coronavirus as endemic to the UK and to aim for long-term suppression of the virus to acceptable levels. But adopting a suppression strategy for the long term will require us to make a societal decision about the harms we are and are not willing to accept.

 

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Press Release: New Tavistock Legal Ruling on Puberty Blockers

The legal decision this morning, in the Family division of the High Court, provides important clarification. It is likely to be a relief to young people with gender dysphoria and their families.
In December, the High Court found that young people under 16 with gender dysphoria were highly unlikely to be able to understand the complexities and uncertainties of puberty blocking treatment. That meant that they could not consent (on their own) to treatment. The court recommended that doctors and families go to court to seek permission to start treatment.
That decision has caused great uncertainty for a large number of vulnerable teenagers with gender dysphoria who had previously been started on treatment or were awaiting treatment. It wasn’t clear whether they would be able to receive puberty blockers.
The decision today clarifies that parents of young people with gender dysphoria can consent to puberty blocking treatment on behalf of the young person. Where the parents, doctors and young person are all in agreement about this, there is no need to go to court.
 
This court decision reinforces a long established ethical approach to medical treatment in children and young people. The views of the child or young person should be sought. If the young person is sufficiently mature they may be able to consent on their own to the treatment in some cases. But where that isn’t the case, parents are able to consent to treatment that would be in the young person’s best interests (ie would be best overall for them). That ethical approach has long been adopted, in this country and others, for young people needing surgery or chemotherapy or other medical treatment. It applies to extremely important life and death decisions (for example about stopping life support). It also applies to puberty blockers.
Debate about the role of puberty blockers in young people and children is likely to continue. But this decision means that where doctors believe that it would be best for the young person to have this treatment, the young person wants the treatment and parents consent, the treatment can legally be provided.”
Professor Dominic Wilkinson
Professor of Medical Ethics, University of Oxford
Consultant Neonatologist

No conflicts of interest

Cross Post: There’s no Need to Pause Vaccine Rollouts When There’s a Safety Scare. Give the Public the Facts and Let Them Decide

Written By: Julian Savulescu, University of Oxford; Dominic Wilkinson, University of Oxford;

Jonathan Pugh, University of Oxford, and Margie Danchin, Murdoch Children’s Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

 

When someone gets sick after receiving a vaccine, this might be a complication or coincidence. As the recent rollout out of the AstraZeneca vaccine in Europe shows, it can be very difficult to know how to respond.

For instance, reports of blood clots associated with the AstraZeneca vaccine led to several European countries suspending their vaccination programs recently, only to resume them once these clots were judged to be a coincidence. However, authorities couldn’t rule out increased rates of a rare brain blood clot associated with low levels of blood platelets.

There are also problems with the Pfizer and Moderna vaccines. By early February 2021, among the over 20 million people vaccinated in the United States, there have been 20 reported cases of immune thrombocytopenia, a blood disorder featuring a reduced number of platelets in the blood. Experts suspect this is probably a rare vaccine side-effect but argue vaccination should continue.

So what happens with the next safety scare, for these or other vaccines? We argue it’s best to give people the facts so they have the autonomy to make their own decisions. When governments pause vaccine rollouts while investigating apparent safety issues, this is paternalism, and can do more harm than good. Continue reading

Suspending The Astra-Zeneca Vaccine and The Ethics of Precaution

By Jonathan Pugh, Dominic Wilkinson, and Julian Savulescu

The authors are working on the UK Pandemic Ethics Accelerator project – @PandemicEthics_. This project was funded by the Arts and Humanities Research Council (AHRC) as part of UKRI’s Covid-19 funding.  All authors are affiliated to the University of Oxford.

 

Summary Points

  • Preliminary Reviews suggest that the number of thrombotic events in individuals who have received the Astra Zeneca vaccine is not greater than the number we would normally expect in this population.

 

  • It is crucial that we closely monitor these adverse events. The regulation of new medical interventions always requires us to manage uncertainty.

 

  • A precautionary approach to managing this uncertainty may be important for ensuring continued confidence in vaccination.

 

  • Regulators must weigh the potential risk suggested by these reports of adverse events following vaccination against the harm that suspension of the vaccine could have.
  • The harm of suspending the use of the Astra Zeneca vaccine depends on how many preventable deaths we can expect by suspending its use.

 

  • Amongst other things, this will depend on (i) how many people will be delayed in receiving a vaccine as a result (ii) the mortality risk of the people who would be prevented from receiving a vaccine, (iii) the prevalence of the virus at the time of the suspension, and (iv) the number of people who have received one dose of the Astra Zeneca vaccine, but not a second.

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Cross Post: COVID vaccines: is it wrong to jump the queue?

Written by Dominic Wilkinson and Jonathan Pugh

This article is republished from The Conversation under a Creative Commons license. Read the original article.

 

Sabrina Bracher/Shutterstock

In the UK, an Oxford city councillor has been suspended after mentioning on social media that she had received a COVID vaccination from a private doctor. Meanwhile, media reports suggest that two Spanish princesses, who did not yet qualify for vaccination in Spain were vaccinated while visiting their father in the United Arab Emirates. They are among a number of ultra-wealthy people getting vaccinated in that country.

There have also been reports of people accessing vaccines early in the UK, despite not being in any of the groups prioritised for vaccination at the time.

So how concerned should we be about these cases? Continue reading

Is it Irrational Not to Have a Plan? Should There Have Been National Guidance on Rationing in the NHS?

By Dominic Wilkinson and Jonathan Pugh.

This is a crosspost from the Journal of Medical Ethics Blog.

This is an output of the UKRI Pandemic Ethics Accelerator project.

Last April, in the first wave of the COVID-19 pandemic, a number of academics, lawyers, doctors and ethicists wrote publicly about the need for national ethical guidance relating to resource allocation (e.g., see here, here, here). At the time there was concern that there would be insufficient intensive care beds to meet the needs of critically ill patients, and many thought that there needed to be clear guidance to doctors to tell them what to do if that occurred.

While a number of professional groups produced guidelines (for example, the British Medical Association, Royal College of Physicians, Intensive Care Society), no national guidance was ever produced. (A draft guideline was developed but rejected in early April 2020).

Almost 12 months and two pandemic waves later, in a legal ruling last week, Justice Swift refused the application of a number of COVID-affected families who had sought a judicial review on the absence of national guidelines. The ruling is not yet publicly available, but it appears that there were three legal arguments: that there was a statutory obligation to have contingency plans in case demand exceeded capacity, that rationing in the absence of national guidance would violate Article 8 of the Human Rights Act, and that it was “irrational” not to have a national guideline. Swift J apparently rejected all three of these claims.

We will focus here on the third of these – the most ethical of the arguments.

“iii) Rationality – it is irrational not to have a national guideline.”

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Cross-Post: Self-experimentation with vaccines

By Jonathan Pugh, Dominic Wilkinson and Julian Savulescu.

This is a crosspost from the Journal of Medical Ethics Blog.

This is an output of the UKRI Pandemic Ethics Accelerator project.

 

A group of citizen scientists has launched a non-profit, non-commercial organisation named ‘RaDVaC’, which aims to rapidly develop, produce, and self-administer an intranasally delivered COVID-19 vaccine. As an open source project, a white paper detailing RaDVaC’s vaccine rationale, design, materials, protocols, and testing is freely available online. This information can be used by others to manufacture and self-administer their own vaccines, using commercially available materials and equipment.

Self-experimentation in science is not new; indeed, the initial development of some vaccines depended on self-experimentation. Historically, self-experimentation has led to valuable discoveries. Barry Marshall famously shared the Nobel Prize in 2005 for his work on the role of the bacterium Helicobacter pylori, and its role in gastritis –this research involved a self-experiment in 1984 that involved Marshall drinking a prepared mixture containing the bacteria, causing him to develop acute gastritis. This research, which shocked his colleagues at the time, eventually led to a fundamental change in the understanding of gastric ulcers, and they are now routinely treated with antibiotics. Today, self-experimentation is having something of a renaissance in the so-called bio-hacking community. But is self-experimentation to develop and test vaccinations ethical in the present pandemic? In this post we outline two arguments that might be invoked to defend such self-experimentation, and suggest that they are each subject to significant limitations. Continue reading

An Ethical Review of Hotel Quarantine Policies For International Arrivals

Written by:

Jonathan Pugh

Dominic Wilkinson

Julian Savulescu

 

This is an output of the UKRI Pandemic Ethics Accelerator project – it develops an earlier assessment of the English hotel quarantine policy, published by The Conversation)

 

The UK has announced that from 15th Feb, British and Irish nationals and others with residency rights travelling to England from ‘red list’ countries will have to quarantine in a government-sanctioned hotel for 10 days, at a personal cost of £1,750. Accommodation must be booked in advance, and individuals will be required to undergo two tests over the course of the quarantine period.

Failure to comply will carry strict penalties. Failing to quarantine in a designated hotel carries a fine of up to £10,000, and those who lie about visiting a red list country are liable to a 10-year prison sentence.

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Crosspost: Is It Ethical To Quarantine People In Hotel Rooms?

Written by

Dominic Wilkinson and Jonathan Pugh,

 

The UK government announced that from February 15, British and Irish residents travelling to England from “red list” countries will have to quarantine in a government-sanctioned hotel for ten days, at a personal cost of £1,750. Accommodation must be booked in advance, and people will need to have two COVID tests during the quarantine period.

Failing to quarantine in a designated hotel carries a fine of up to £10,000, and those who lie about visiting a red list country could face a ten-year prison sentence.

Other countries have already implemented mandatory hotel quarantines for travellers, including Australia, New Zealand, China and India. When are such quarantines ethical? And who should pay for them if they are?

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DNACPR Orders in a Pandemic: Misgivings and Misconceptions.

by Dominic Wilkinson @Neonatalethics

This week, the Care Quality Commission (CQC) published an interim report into resuscitation decisions during the COVID-19 pandemic. According to a number of media outlets, the report found that in the first wave of the crisis inappropriate and possibly unlawful ‘do not resuscitate’ orders were used “without the consent of patients and families” (see eg Telegraph, Sky).

There are real concerns and important questions to answer about policies and care for patients in care homes and in the community during the pandemic. However, the media stories, and the CQC report itself appear to illustrate two ethical misconceptions.

 

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