Dominic Wilkinson’s Posts

Watch your words! The challenges of law around the end of life

by Dominic Wilkinson

Here in South Australia last week, a bill has been proposed to clarify the legal status of advance directives. One very small part of that bill involves a modification to an older palliative care act. The modification corrects an ambiguity in wording in the earlier act. The ambiguity is subtle. However, that choice of words has had major consequences for seriously ill children and adults in South Australia and for health practitioners. It is a salutary reminder of how hard it is to enact good laws in the area of end of life, and how easily such laws can make things worse rather than better.

Continue reading

Obligatory Ventilation: why Elective Ventilation should not be elective

On the BBC’s Moral Maze this evening, the question of elective ventilation was discussed at some length. (For those who missed it, the program is still available here). There were several striking features of that discussion, but one argument that stood out was the argument against elective ventilation based on the importance of respecting the autonomy of patients, and the absence of consent, This has been the basis of previous ethical concerns about Elective Ventilation.

But actually, it seems to me that the consent/autonomy argument is completely upside down.* Patient autonomy provides one of the strongest arguments in favour of elective ventilation. So strong, in fact, that the proposed form of Elective Ventilation should arguably not be ‘elective’. It is morally obligatory that we embrace Elective Ventilation. Continue reading

Back from the grave: Should we allow Elective Ventilation?

Mary is 62 years old. She is brought to hospital after she collapsed suddenly at home. Her neighbour found her unconscious, and called the ambulance. When they arrived she was deeply unconscious and at risk of choking on her own secretions. They put a breathing tube in her airway, and transported her urgently to hospital.

When Mary arrives she is found to have suffered a massive stroke. A brain scan shows very severe bleeding inside her brain. In fact the picture on the scan and her clinical state is described by the x-ray specialist as ‘devastating’. She is not clinically brain dead, but there is no hope. The emergency department doctors have contacted the neurosurgical team, but they have decided not to proceed with surgery as her chance of recovery is so poor.

In Mary’s situation, the usual course of events is to contact family members urgently, to explain to them that there is nothing more that can be done, and to remove her breathing tube in the emergency department. She would be likely to die within minutes or hours. She would not be admitted to the intensive care unit – if called, the ICU team would be likely to say that she is not a “candidate” for intensive care. However, new guidance from the National Institute of Clinical Effectiveness, released late last year, and endorsed in a new British Medical Association working paper, has proposed a radical change to this usual course of events. Continue reading

Nothing to lose? Killing is disabling

In a provocative article forthcoming in the Journal of Medical Ethics (one of a new series of feature articles in the journal) philosophers Walter Sinnott Armstrong and Franklin Miller ask ‘what makes killing wrong?’ Their simple and intuitively appealing answer is that killing is wrong because it strips an individual of all of their abilities – acting, moving, communicating, thinking and feeling.

So what, you might ask? If this is right, say Sinnott-Armstrong and Miller, it means that it would be just as bad to commit an act that caused someone to be in a permanent vegetative state, as it would to kill them. Continue reading

The moral case for elective caesarean section

Should a father dive into a flowing stream to aid his daughter, struggling to keep her head above water? Should a mother donate a kidney to her child with renal failure? Is it ethical for a parent to work two or three jobs so that they can pay private health insurance or school fees for their children? In all of these situations most of us would think that it is commendable for a parent to take these actions. We applaud and approve of a parent who decides to take on some personal risk, who sacrifices his or her own wellbeing and health in order to prevent a risk of serious harm to their child. It is one of the duties of a parent to do whatever they reasonably can to avoid risks  and secure benefits to their children. How morally important it is for parents to make these sacrifices depends on the balance between the risks to the child and those to the parent. But it is appropriate for a parent to give greater weight to the risks to their child than to themselves. Indeed we might well be critical of a parent who failed to do so.

What then, of a mother who decides to undergo abdominal surgery in order to reduce the risk of her child suffering brain injury, or being admitted to intensive care? Shouldn’t we also applaud this decision? Continue reading

The patient vanishes

by Dominic Wilkinson

If a patient’s family refuse to allow withdrawal of breathing machines should doctors provide long-term support in an intensive care unit for a patient who is clinically brain dead? Should doctors provide heart-lung bypass (ECMO) for a child with anencephaly? Should doctors perform a tracheostomy and provide a long-term breathing machine for a patient in a documented persistent vegetative state? Continue reading

Trolleyology

In the October edition of Prospect magazine, Practical ethics blogger David Edmonds provides an accessible and thoughtful insight into "Trolley problems"

Continue reading

Is professional integrity a futile argument?

by Dominic Wilkinson

In an earlier post this week I argued that there are only two substantive reasons for doctors not to provide treatment that they judge futile – either on the basis of a judgement that treatment would harm the patient (a form of paternalism), or on the basis that providing treatment would harm others (on the basis of distributive justice). I rejected the idea that professional integrity provided an additional reason to withhold or withdraw treatment.

Continue reading

Break my bones, but don’t let me die! Should doctors provide ‘futile’ CPR?

by Dominic Wilkinson

Two recent cases in a Toronto hospital illustrate a dilemma that hospital doctors face all too frequently. What should they do if patients or their representatives insist on treatment that the doctor believes would be futile? Should they just go along with the patient despite their misgivings? Alternatively, should they unilaterally withhold treatment if they feel it would be inappropriate to provide it?

Continue reading

Is it legitimate to ask opponents of embryonic stem cell therapy whether they support IVF?

by Dominic Wilkinson

In the news this week is the first US officially-sanctioned human trial of embryonic stem cells. A patient with spinal cord injury has received an injection of embryo-derived stem cells.

Predictably, the news has not been received positively by those who are opposed to research with embryonic stem cells.

The development, however, was criticized by those with moral objections to research using the cells because days-old embryos are destroyed to obtain them.

"Geron is helping their stock price, not science and especially not patients," said David Prentice, senior fellow for life sciences at the Family Research Council.

The arguments in favour and against embryonic stem cells have been reviewed and rehearsed ad nauseam. I will not repeat them here.

 

But is it reasonable to ask or demand that those who are opposed to ES cells answer 'the question'. What are your views on IVF?

Continue reading

Authors

Affiliations