Dominic Wilkinson’s Posts

Trolleyology

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

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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.

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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?

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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?

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Incidentally… avoiding the problem of incidental findings

A new study from the Mayo clinic in the United States points to a frequent problem in certain types of medical research. When healthy volunteers or patients with a given condition take part in research studies they may have brain scans, CAT scans, blood tests or genetic tests that they wouldn’t otherwise have had. These tests are not done for the benefit of the individual, they are designed to answer a research question. But sometimes, quite often according to the authors of this new study, researchers may spot something on the scan that shouldn’t be there, and that could indicate a previously undiagnosed health condition. These ‘incidental findings’ generate an ethical dilemma for researchers. Should they tell the research participant about the shadow seen on their scan? Do they have an obligation to reveal to a research participant that they have found them to carry a gene increasing their risk for breast cancer, or Alzheimer’s disease? There is much agonising by ethics committees, ethicists and researchers about the problem of incidental findings, but there is a simple way of avoiding the problem. Anonymise research databases and tests so that there is no possibility of determining which participant has the breast cancer gene, or the lump in their kidney.

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When you prick me do I not cry?

A fascinating study in the Lancet this week has suggested that a very commonly used and simple analgesic in newborn infants may not actually be preventing them from experiencing pain. The study’s authors suggest that this medicine should no longer be used routinely in newborn infants. A headline in the Guardian reads “Newborn babies should not be given sugar as pain relief”. But there are scientific, philosophical and ethical reasons why this conclusion, though possibly correct, is premature.

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A law that should not be

In New York state last week legislators passed an extraordinary bill that, effectively, indicts the practice of New York doctors. That the bill was thought necessary, and, even more so, that it was opposed by the Medical Society of New York is a sad reflection of medical practice in that part of the world.

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Should doctors come clean? Religion makes a difference to end-of-life decisions

In a paper released today in the Journal of Medical Ethics, a large survey of UK doctors found that doctors’ religion influenced their views and practice of end-of-life care. Why does this matter? A number of headlines highlighted that atheist or agnostic doctors were more likely to report having participated in “ethically contentious end-of life actions”: ie taking part in terminal sedation or in actions that they expected or partly intended would hasten the patient’s death. But other headlines emphasised the obvious flip-side: doctors who identified themselves as ‘very religious’ or ‘extremely religious’ were about 35% less likely than non-religious doctors to report having taken this sort of step.

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Demedicalising and decriminalising drugs

Is drug addiction a disease? Substance Dependence appears as a diagnosis in the influential Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-IV). There are medical specialists in the field who use a range of different drug and non-drug treatments for patients who are addicted. There are hospitals and clinics where those who are addicted can seek help. But if it is a disease why is it treated as a crime? After all we do not lock people up because they have cancer, or hepatitis, or heart disease.

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Between Life and Death…

A powerful BBC documentary, “Between Life and Death”, screened this evening on BBC One. The documentary (which can be viewed online for the next week in the UK) examined the life and death decisions made for critically ill patients with severe brain injury. Neuro-intensive care provides a way to interrupt the process of dying for such patients. But it raises difficult questions for medical staff and for families about the wishes of patients, the wishes of family members, and about uncertainty. Should treatment continue at the risk of the patient surviving in a severely impaired state? Or should patients be allowed to die, with the risk that perhaps if treatment had continued they may have recovered?

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