Dominic Wilkinson’s Posts

Should vegans avoid avocados and almonds?

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Avocadon’t?
Nataliya Arzamasova/Shutterstock

Dominic Wilkinson, University of Oxford

A video recently doing the rounds on Facebook included a segment from the BBC comedy quiz show QI. The video asks which of avocados, almonds, melon, kiwi or butternut squash are suitable for vegans. The answer, at least according to QI, is none of them.

Commercial farming of those vegetables, at least in some parts of the world, often involves migratory beekeeping. In places such as California, there are not enough local bees or other pollinating insects to pollinate the massive almond orchards. Bee hives are transported on the back of large trucks between farms – they might go from almond orchards in one part of the US then on to avocado orchards in another, and later to sunflower fields in time for summer.

Vegans avoid animal products. For strict vegans this means avoiding honey because of the exploitation of bees. That seems to imply that vegans should also avoid vegetables like avocados that involve exploiting bees in their production.

Is that right? Should vegans forego their avocado on toast? Continue reading

Lecture and Book Launch: Ethics, Conflict and Medical Treatment for Children – From Disagreement to Dissensus

Watch the lecture by Professors Dominic Wilkinson and Julian Savulescu at the book launch for ‘Ethics, Conflict and Medical Treatment for Children’, which took place on 4 October at the Oxford Martin School, University of Oxford.

 

Press Release: Alfie Evans Case

by Dominic Wilkinson

@Neonatalethics

In the light of the media attention today, I have gathered together some of the material relating to the ethics of this case Continue reading

Groundhog Day and Legal Appeals. (What if Alfie Were a Texan?)

By Dominic Wilkinson

@Neonatalethics

 

According to media reports, the family of seriously ill infant Alfie Evans have decided to lodge a second appeal to the Supreme Court today. This is the 6th legal appeal mounted since the High Court decision, on the 20th February, that continued medical treatment was not in Alfie’s best interests. There is no prospect that this latest legal appeal will be any more successful than the previous ones – its only effect will be to delay the inevitable decision to withdraw life-prolonging medical treatment.

However, the appeal raises an important question in relation to disputed medical treatment. The UK legal appeal system gives families the opportunity to delay decisions that they do not agree with by mounting a series of appeals. (The Court of Appeal judges yesterday referred to this as akin to a form of legal “Groundhog day” with the judges revisiting the same arguments over and over again.)  While the family of Alfie Evans may not succeed in their aim to take him overseas for medical treatment, they have achieved almost 2 months of additional intensive care for Alfie – two months of treatment that has been legally judged to be not in his interests.

Is there an alternative to the existing legal process? Is there a way to avoid protracted legal appeals in cases of disputed medical treatment?

Continue reading

Harm, Interests and Medical Treatment. Where the Supreme Court Got it Wrong…

By Dominic Wilkinson

@Neonatalethics

 

In the latest case of disputed medical treatment for a child, the family of Liverpool toddler Alfie Evans yesterday lost their last legal appeal. The family had appealed to the European Court of Human Rights to examine whether the UK courts’ decision (to allow doctors to stop life support) was contrary to the European Convention on Human Rights. The European Court (as it had in two other cases in the last 12 months) rejected the appeal. It is expected that the artificial ventilation that is currently keeping Alfie alive will be withdrawn in the coming days.

This decision, difficult as it is for his family to accept, is the right decision for Alfie. Medical treatment can no longer help him. As I wrote a month ago, it is time to stop fighting, time to let him go.

However, one important legal and ethical issue raised in this case, and in the case of Charlie Gard from last year, is about the basis for deciding when parents and doctors disagree. What ethical standard should apply?

Last week, the UK Supreme Court adamantly refused Alfie’s parents’ previous legal appeal, focused on this specific question.  I will argue that the court’s arguments fail and that the current UK legal approach is mistaken. (Though in fact, in the Evans case as in the case of Charlie Gard, it seems likely that the court would have reached the same decision about treatment even if it had applied a different ethical standard).

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Where There is Life, There is Not Always Hope. Ethics, Futility and the Alfie Evans Case

by Dominic Wilkinson

@Neonatalethics

[Updated 22/02/18]

This afternoon, in another case of disputed medical treatment for a seriously ill child, Justice Hayden in the High Court concluded that treatment should be withdrawn from toddler Alfie Evans against the wishes of his parents.

See below for a press release on the Alfie Evans decision. I will add further reports and links to the court transcript when it is available.

See here for ethics commentary and resources on the Charlie Gard case.

See also my recent blog on the Evans and Haastrup cases: Medical treatment disputes and the international second opinion

Details from the court ruling (Liverpool Echo)

Court judgement

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Medical Treatment Disputes and the International Second Opinion

By Dominic Wilkinson

@Neonatalethics

 

Disputes about medical treatment for seriously ill children are in the news again. Last week, the High Court in London decided in favour of withdrawal of life support from a brain damaged 11-month old infant, Isaiah Haastrup, against the wishes of his parents (an appeal is pending later this month). This week, the High court, sitting in Liverpool, is hearing evidence in the case of 20-month-old Alfie Evans, an infant with an undiagnosed degenerative brain condition.

In both of these cases, as in the controversial Charlie Gard case from last year, medical evidence from UK professionals has been overwhelmingly in favour of withdrawing life support and allowing the children to die. However, in each case parents have sought and have obtained evidence from overseas medical specialists who have testified in favour of continued treatment. In the Evans case, as in the earlier Gard case, experts from the Vatican hospital in Rome have apparently offered ongoing treatment.

This suggests several questions. First, why is there a difference between the views of specialists in this country and those overseas? Second, if there are differences in expert opinion about treatment for a child, should courts give any more weight to the views of UK experts than those from overseas? Is there a valid reason to discount the international second opinion?

Continue reading

Webinar – Charlie Gard Case: Questions and Lessons

by Dominic Wilkinson (@Neonatalethics)

Webinar given recently for the Children’s Mercy Centre for bioethics as part of the excellent (and free) Children’s Mercy webinar series (great resource for those interested in paediatric bioethics) Continue reading

Hard lessons: learning from the Charlie Gard case

by Dominic Wilkinson and Julian Savulescu

 

On the 24th July 2017, the long-running, deeply tragic and emotionally fraught case of Charlie Gard reached its sad conclusion (Box 1). Following further medical assessment of the infant, Charlie’s parents and doctors finally reached agreement that continuing medical treatment was not in Charlie’s best interests. It is expected that life support will be withdrawn in the days ahead.

Over the course of multiple hearings at different levels of the court in both London and Strasbourg, the Charlie Gard case has raised a number of vexed ethical questions (Box 2). The important role of practical ethics in cases like this is to help clarify the key concepts, identify central ethical questions, separate them from questions of scientific fact and subject arguments to critical scrutiny. We have disagreed about the right course of action for Charlie Gard,1 2 but we agree on the key ethical principles as well as the role of ethical analysis and the importance of robust and informed debate. Ethics is not about personal opinion – but about argument, reasons, and rational reflection. While the lasting ramifications of the case for medical treatment decisions in children are yet to become apparent, we here outline some of the potential lessons. Continue reading

Press Release – “The Worst Outcome” Prof Dominic Wilkinson

This afternoon the long-running, deeply tragic and emotionally fraught legal dispute over treatment of Charlie Gard reached its sad and sadly inevitable conclusion. Following further medical assessment of Charlie by several international experts, Charlie’s parents and doctors finally reached agreement that continuing life support and experimental treatment could not help him.

This is the worst possible outcome for Charlie’s family. They have had to accept the devastating news that their beloved son cannot recover and that their hopes for an experimental treatment cannot be realised.

There are important lessons to learn from this case. Cases of deep disagreement between parents and doctors about treatment for a child are rare. Where they occur, it is often possible with time, patience, and support to find common ground. Where agreement cannot be reached, there is an important role for the courts in helping to reach a decision. However, court review of cases like this is not ideal. It is adversarial, costly, and lengthy. In this case, Charlie has received months of treatment that doctors and nurses caring for him felt was doing him more harm than good.

We need to find better ways to avoid cases of disagreement from coming to court. There is an important role for mediation to help parents and doctors where they have reached an impasse.

We also need a fair, expedient way of resolving disputes. This would mean that patients can access early experimental treatment if there is a reasonable chance that it would not cause significant harm. It would also mean that futile and harmful treatment is not prolonged by a protracted legal process.

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