Dominic Wilkinson’s Posts

Can we solve the world’s problems by offering a large enough prize?

On the 22nd of October 1707, more than 1400 British sailors died when a British naval fleet sank in stormy weather off the Isles of Scilly. The disaster was later attributed to failings in navigation and sailors’ difficulty in determining their location at sea. This was a perennial problem at the time, and had persisted despite intense scientific research. Seven years later, the UK government passed the Longitude Act, offering 20,000 pounds (more than 2 million pounds in today’s money) to anyone who could develop a method for reliably determining longitude at sea. The longitude prize was eventually won by John Harrison, a self-educated Lincolnshire clockmaker.

Yesterday, 300 years after the original Longitude act, the UK Technology Strategy Board launched a £10 million pound prize competition, a new ‘Longitude prize’. The money will be awarded to a scientist or group of scientists who come up with a solution to one of a set of major global challenges – inadequate food/clean water supply for everyone, antibiotic resistance, spinal cord injury, dementia, the large carbon impact of air-flight.

The new Longitude prize is the latest in a series of innovation inducement competitions over time. These competitions have offered monetary rewards for solving problems as diverse as the development of butter substitutes, the first trans-Atlantic air flight, reusable aircraft for space flight, or an alternative fertilizer to bird poo. One novel feature of the 2014 Longitude prize is that it is seeking public input into the specific challenge to be targeted. Public voting will decide which of the six global challenges above are to be the focus of the prize.

But are innovation prizes an effective or appropriate way to solve major global scientific challenges? Continue reading

Murder or mercy?

The newspapers today are full of the horrifying story of three children who were found dead in their family home in South London on Tuesday.  The children had all apparently been diagnosed with a severe genetic disorder (spinal muscular atrophy), that was likely to lead to death in early childhood. Their mother has today been charged with their murder.

There are relatively few details available at this stage, and doubtless more will emerge over coming days and months. It would be premature to comment on the specific circumstances of the case (and the family has asked the public and media to refrain from speculation). However, it is likely that as those details do emerge that commentary on the case will take up one of two themes. Some commentators will point to the enormous strain of caring for severely disabled and terminally ill children, and perhaps bemoan the lack of available supportive services. Others (perhaps with disability or with personal experience of caring for the disabled) will react with horror at the idea of a parent killing their child, and reject any attempt to use child disability as a form of excuse for the crime. Continue reading

Cultural relativism and female genital mutilation

The Guardian newspaper has today launched a campaign to end female genital mutilation (FGM). This coincides with evidence that, despite being illegal, a significant number of young women from the UK undergo the practice. Globally, more than 125 million living women have had some form of FGM performed.

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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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Should exceptional people receive exceptional medical treatment?

There are approximately 150,000 human deaths each day around the world. Most of those deaths pass without much notice, yet in the last ten days one death has received enormous, perhaps unprecedented, attention. The death and funeral of Nelson Mandela have been accompanied by countless pages of newsprint and hours of radio and television coverage. Much has been made of what was, by any account, an extraordinary life. There has been less attention, though, on Mandela’s last months and days. One uncomfortable question has not been asked. Was it ethical for this exceptional individual to receive treatment that would be denied to almost everyone else? Continue reading

Keeping pace?

If you receive an implanted pacemaker for your heart, does it become your property? When it is no longer any use to you (because you have died), do you have to give it back?

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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.

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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

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