Dominic Wilkinson’s Posts

Article Announcement:Which lives matter most? Thinking about children who are not yet born confronts us with the question of our ethical obligations to future people.

Professor Dominic Wilkinson and Keyur Doolabh have recently published a provocative essay at Aeon online magazine:

Imagine that a 14-year-old girl, Kate, decides that she wants to become pregnant. Kate’s parents are generally broadminded, and are supportive of her long-term relationship with a boy of the same age. They are aware that Kate is sexually active, like 5 per cent of 14-year-old girls in the United States and 9 per cent in the United Kingdom. They have provided her with access to birth control and advice about using it. However, they are horrified by their daughter’s decision to have a child, and they try to persuade her to change her mind. Nevertheless, Kate decides not to use birth control; she becomes pregnant, and gives birth to her child, Annabel.

Many people might think that Kate’s choice was morally wrong. Setting aside views about teenage sexual behaviour, they might argue that this was a bad decision for Kate – it will limit her access to education and employment. But let’s imagine that Kate wasn’t academically inclined, and was going to drop out of school anyway. Beyond those concerns, people might worry about the child Annabel. Surely Kate should have waited until she was older, to give her child a better start to life? Hasn’t she harmed her child by becoming pregnant now?

This issue is more complicated than it first seems. If Kate had delayed her pregnancy until, say, age 20, her child would have been conceived from a different egg and sperm. Because of this, Kate would have a genetically different child, and Annabel would not have existed.

See here for the full article and to join in the conversation.

Agreement and disagreement about experimental treatment. The Charlie Gard Appeal

by Dominic Wilkinson and Julian Savulescu

@Neonatalethics

@juliansavulescu

Tomorrow, the UK Court of Appeal will review the controversial case of a British infant, Charlie Gard. Charlie’s parents are appealing a recent High Court decision that gave doctors permission to withdraw his life support. They have raised money for Charlie to travel to the US for an experimental medical treatment. Continue reading

Debate Reponse: Charlie Gard, Interests and Justice – an alternative view

Dominic Wilkinson

Responding to Julian Savulescu

The sad and difficult case of Charlie Gard, which featured in the media last week, is the latest in a series of High Court and Family court cases when parents and doctors have disagreed about medical treatment for a child. Doctors regard the treatment as “futile” or “potentially inappropriate”. Parents, in contrast, want treatment to continue, perhaps in the hope that the child’s condition will improve. In the Charlie Gard case, the judge, Justice Francis, rejected Charlie’s parents’ request for him to travel to the US for an experimental medical treatment. He ruled that life-sustaining treatment could be withdrawn, and Charlie allowed to die.

Two reasons

As Julian Savulescu argues,there are two different ethical reasons for health professionals to refuse to provide requested medical treatment for a child. The first of these is based on concern for the best interests of the patient. Treatment should not be provided if it would harm the child. The second reason is on the basis of distributive justice. In a public health system with limited resources, providing expensive or scarce treatment would potentially harm other patients since it would mean that those other patients would be denied access to treatment.

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Good Enough Lives – Procreative Satisficence

By Dominic Wilkinson @Neonatalethics

 

Should parents undertake prenatal testing? Is there a moral reason to prevent disability in your future child through embryo selection?

In a special Moral Philosophy Seminar yesterday evening, Professor Tom Shakespeare, from the University of East Anglia, gave a nuanced and multi-faceted argument against the arguments advanced by Julian Savulescu and Jeff McMahan in favour of embryo selection. In particular he attacked Julian’s Principle of Procreative Beneficence (PB)

Procreative Beneficence (shortened version): when considering different possible children, based on relevant available information, couples should select the child who is expected to have the best life*

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Four myths about IVF in older women

Dominic Wilkinson, @Neonatalethics

Reports that a 62-year-old Spanish woman has given birth after IVF treatment have led many to question whether there should be age limits with such treatment. Lina Alvarez, a doctor in north-west Spain, isn’t the oldest person to have had success with IVF. Earlier this year, in India, Daljinder Kaur is said to have given birth at the age of 72, prompting calls from the Indian Medical Council for a ban on fertility treatment in women over the age of 50.

In many countries where there is funding assistance for IVF there is a limit to obtaining treatment over a certain age. In Britain, for example, the bar is set at age 42. But Alvarez received private treatment. So why care about her age? And what business is it of the rest of us whether she has access to IVF?

There are several arguments that typically surface in debates about age and fertility treatment – and they are all deeply flawed. Continue reading

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.

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Video Series: Dominic Wilkinson on Conscientious Objection in Healthcare

Associate Professor and Consultant Neonatologist Dominic Wilkinson (Oxford Uehiro Centre for Practical Ethics) argues that medical doctors should not always listen to their own conscience and that often they should do what the patient requests, even when this conflicts with their own values.

Striking out? Should we ban doctors strikes?

by Dominic Wilkinson @Neonatalethics

Consultant neonatologist, Director of Medical Ethics

 

Next week, junior doctors in England and Wales will be taking part in industrial action for 15 hours over two successive days. This is the latest in a series of stoppages since late last year, and relates to a dispute over proposed changes to junior doctors’ contracts and pay. It is the first strike, (and the first in the UK since the establishment of the NHS), to include all medical care, including emergency treatment. Junior doctors will not be at work in accident and emergency departments, intensive care units, operating theatres and hospital wards between 8 and 5 on both of those days.

There are a series of questions raised by these strikes. There are disputed claims about the impact of contract changes on take home pay, on working conditions for doctors and on patient care. There are different views about the actual impact of next week’s strike on patients, on public opinion, or on negotiations about the new contract. But for the purposes of this article, I am going set those specific questions aside, and focus on a more general question. Should doctor strikes (particularly emergency care strikes) be legal, should they be allowed? Continue reading

Should we prevent Zika microcephaly using birth control?

Dominic Wilkinson, University of Oxford, @Neonatalethics

The World Health Organisation is to hold an emergency meeting after considerable concern about the zika virus in South America. The epidemic has been of considerable concern particularly because it has been linked to microcephaly (unusually small heads) in newborn babies that can lead to potentially devastating brain problems.

There is fear that this virus (if it is the cause) could spread throughout the Americas, including North America. There is no vaccine or treatment for the virus, and no known treatment for children who suffer brain damage in the womb. Officials in Columbia, Ecuador, El Salavador and Jamaica have recommended that women avoid or defer becoming pregnant to prevent their babies being affected. But is it ethical to use birth control to control Zika microcephaly? Continue reading

Not content with temporal parochialism

By Dominic Wilkinson @Neonatal Ethics, Director of medical ethics

Why should we care about what happens to future generations? What reason do we have to sacrifice our own well-being and interests for the sake of people who will exist after we are dead?

Last night Professor Sam Scheffler from NYU gave the first of the 2015 Uehiro lectures on this controversial and challenging topic.  http://media.philosophy.ox.ac.uk/uehiro/HT16_UL_Scheffler1.mp3

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