Ethics

Ethics Goes on Holiday

By Stephen Rainey

Summer time, and the living is ethically perplexing. Hordes of holidaymakers, the shimmering sea, busy beaches, and one sun over it all. How can the eager ethicist assess how to make the most of a fortnight away? We all know how we can generally make the most of things – but how ought we to treat the beach while we’re away? Should we think of our own pleasure, the pleasure of all, or something else? Here, we can explore some options, and get some answers. Continue reading

UK Supreme Court Decision Means Patients No Longer Forced to Live

By Mackenzie Graham

On July 30, The UK’s Supreme Court ruled that there is no requirement to obtain court approval before withdrawing clinically assisted nutrition and hydration (CANH), when there is agreement between physicians and the family that this is in the best interests of the patient.

In the judgement, Lady Black writes:

“If the provisions of the MCA [Mental Capacity Act] 2005 are followed and the relevant guidance observed, and if there is agreement upon what is in the best interests of the patient, the patient may be treated in accordance with that agreement without application to the court.”

Until now, requests to withdraw CANH needed to be heard by the Court of Protection to determine if withdrawing treatment was in the patient’s best interest. In addition to being emotionally difficult for families, this is a time-consuming and expensive process, and often results in the patient dying before a judgement is rendered.

I think this decision has much to be said in its favour. First, it means that when there is agreement that continued treatment is no longer in the best interests of a patient with a prolonged disorder of consciousness, these patients are no longer being ‘forced to live’ until the Court affirms that being allowed to die is in their best interests. In many cases, court decisions take months, meaning that a patient is forced to be kept alive, against their best interests and the wishes of their family. Making the decision to withdraw care from a loved one is highly distressing, and this is likely further compounded by the burden and distraction of court proceedings.

Continue reading

The Dangers Of Deferring To Doctors

By Charles Foster

(Image: tctmd.com)

There is a dizzying circularity in much medical law. Judges make legal decisions based on the judgments of rightly directed clinicians, and rightly directed clinicians make their judgments based on what they think the judges expect of them. This is intellectually unfortunate. It can also be dangerous.

There are two causes: Judges’ reluctance to interfere with the decisions of clinicians, and doctors’ fear of falling foul of the law.

In some ways judicial deference to the judgment of professionals in a discipline very different from their own is appropriate. Judges cannot be doctors. The deference is best illustrated by the famous and ubiquitous Bolam test, which is the touchstone for liability in professional negligence cases.1 A doctor will not be negligent if their action or inaction would be endorsed by a responsible body of professional opinion in the relevant specialty.

In the realm of civil litigation for alleged negligence this deference is justified. The problem arises when the deference is exported to legal arenas where it should have no place. The classic example relates to determinations of the ‘best interests’ of incapacitous patients. Something done in relation to an incapacitous patient will only be lawful if it is in that patient’s best interests. Continue reading

Should Gene Editing Be Compulsory?

Written by Julian Savulescu

Hypothetical Case 1: Enzyme Replacement Therapy for Gaucher’s Disease

Consider a hypothetical version of a real life disease, Gaucher’s Disease. Gaucher’s disease is an inherited disorder caused by a genetic mutation. The mutation means an enzyme–  glucocerebrosidase — is not produced. A a result, glucerebrosides (fats) build up, damaging cells. This can cause bone fractures, liver enlargement, and bleeding but most importantly, brain damage. Once this has occurred it is irreversible.

Enzyme Replacement Therapy (ERT) is now available and for the purposes of this hypothetical case, the treatment offered, if given from the moment of birth, will prevent all damage (in real life current enzyme replacement treatments do prevent most symptoms, but do not affect nervous system involvement).

In our hypothetical case, a child is born to parents known to carry the mutation for Gaucher’s Disease, and prenatal testing has already confirmed that the baby is affected. ERT must be started at birth in order to prevent brain and other damage. However, the parents are Christian Scientists and refuse medical treatment. They believe prayer can cure their child’s condition.

Doctors are concerned the missing enzyme needs to be replaced before the child’s brain is damaged. They take the case to court where judges agree that therapy is in the child’s best interests.

Continue reading

Pain for Ethicists: What is the Affective Dimension of Pain?

This is my first post in a series highlighting current pain science that is relevant to philosophers writing about well-being and ethics.  My work on this topic has been supported by the W. Maurice Young Centre for Applied Ethics, the Oxford Uehiro Centre for Practical Ethics, and the Wellcome Centre for Ethics and Humanities, as well as a generous grant from Effective Altruism Grants

There have been numerous published cases in the scientific literature of patients who, for various reasons, report feeling pain but not finding the pain unpleasant. As Daniel Dennett noted in his seminal paper “Why You Can’t Make A Computer That Feels Pain,” these reports seem to be at odds with some of our most basic intuitions about pain, in particular the conjunction of our intuitions that ‘‘a pain is something we mind’’ and ‘‘we know when we are having a pain.’’ Dennett was discussing the effects of morphine, but similar dissociations have been reported in patients who undergo cingulotomies to treat terminal cancer pain and in extremely rare cases called “pain asymbolia” involving damage to the insula cortex. Continue reading

Treating the Dead Well

Written by Stephen Rainey

What happens after we die? This might be taken as an eschatological question, seeking some explanation or reassurance around the destiny of an immortal soul or some such vital element of our very being. But there is another sense that has at least as much importance. What should we do with dead bodies?

According to a Yougov survey from 2016, a majority of UK residents prefer cremation over burial, with their ashes scattered in some meaningful place. This could be good news, given the apparent dwindling of burial space globally. In the face of this sort of constraint, the re-use of graves becomes necessary, which can cause distress to the families of even the long dead.

Less commonly, dead bodies can be donated to medical science and put to use for purposes of research and medical training. Research suggests the rate is low owing to ‘non-cognitive factors’ such as ‘the desire to maintain bodily integrity, worries that signing a donor card might ‘jinx’ a person, and medical mistrust.’

Maybe we should think again about how we treat dead bodies. There could come a time when cremation and burial might be considered a waste of resources, given the uses to which cadavers can be put. One body can be used to train many surgeons in complex procedures by being pared into relevant sections – individual limbs, organ systems, brains. Nevertheless, whilst a corpse is indeed a valuable object, it was also previously a subject. The nature of bodies as post-persons does seem to deserve some special consideration. If we can account for this, we might be in a position to recommend very generally why we ought to respect the bodies of the dead. Continue reading

Music Streaming, Hateful Conduct and Censorship

Written by Rebecca Brown

Last month, one of the largest music streaming services in the world, Spotify, announced a new ‘hate content and hateful conduct’ policy. In it, they state that “We believe in openness, diversity, tolerance and respect, and we want to promote those values through music and the creative arts.” They condemn hate content that “expressly and principally promotes, advocates, or incites hatred or violence against a group or individual based on characteristics, including, race, religion, gender identity, sex, ethnicity, nationality, sexual orientation, veteran status, or disability.” Content that is found to fulfil these criteria may be removed from the service, or may cease to be promoted, for example, through playlists and advertisements. Spotify further describe how they will approach “hateful conduct” by artists: 

We don’t censor content because of an artist’s or creator’s behavior, but we want our editorial decisions – what we choose to program – to reflect our values. When an artist or creator does something that is especially harmful or hateful (for example, violence against children and sexual violence), it may affect the ways we work with or support that artist or creator.

An immediate consequence of this policy was the removal from featured playlists of R. Kelly and XXXTentacion, two American R&B artists. Whilst the 20 year old XXXTentacion has had moderate success in the US, R. Kelly is one of the biggest R&B artists in the world. As a result, the decision not to playlist R. Kelly attracted significant attention, including accusations of censorship and racism. Subsequently, Spotify backtracked on their decision, rescinding the section of their policy on hateful conduct and announcing regret for the “vague” language of the policy which “left too many elements open to interpretation.” Consequently, XXXTentacion’s music has reappeared on playlists such as Rap Caviar, although R. Kelly has not (yet) been reinstated. The controversy surrounding R. Kelly and Spotify raises questions about the extent to which commercial organisations, such as music streaming services, should make clear moral expressions. 
Continue reading

Addiction, Desire, and The Polluted Environment – Richard Holton’s 2nd Uehiro Lecture

By Jonathan Pugh

 

In the second of his three Uehiro lectures on the theme of ‘illness and the social self’, Richard Holton turned to the moral questions raised by addiction. In the first half of the lecture, he outlined an account of addictive behaviour according to which addictive substances disrupt the link between wanting and liking. In the second half of the lecture, he discusses the implications of this account for the moral significance of preferences, and for how we might structure environments to avoid triggering addictive desires.

 

You can find a recording of the lecture here

 

Continue reading

Coffee with Colleagues: Caffeine is a “Social” Enhancer

By Nadira Faber

The coffee you are having with your colleagues at a business meeting does more than keep you awake. Many of us know that caffeine can help with alertness and working memory – the first systematic study on caffeine and performance, sponsored by Coca-Cola, was published over 100 years ago. But did you know caffeine can also have “social” effects?

Continue reading

Hell, Damnation, The Royal Wedding, And The Thrashing Of Schoolboys

By Charles Foster

Image: Holly Fisher, a Conservative Christian blogger from West Virginia, posing with gun, Bible, and US flag:  from www.nydailynews.com

There was a near universal consensus that Bishop Michael Curry’s sermon at the wedding of Prince Harry and Meghan Markle was magnificent.  ‘Frock Star’, panted the Sun.  The Bishop ‘stole the show…and is the ‘new Pippa Middleton’’ He left for the US, the Sun continued, ‘leaving Britain still raving about his electrifying sermon.’ The Bishop ‘just stole the show’, said Vox.com ‘Prince Harry and Meghan were all but upstaged by the Episcopal priest’s fiery sermon….You might say Curry just made the Anglican communion great again.’

‘The Rev Michael Curry’, tweeted Ed Miliband, ‘could almost make me a believer, ’ and Piers Morgan tweeted: ‘Wow. Still reeling from Rev Curry. What a moment. What a man!’ The BBC commentator Jeremy Vine said that the preacher was ‘doing 50 in a 30 zone, and it’s brilliant.’ Continue reading

Authors

Subscribe Via Email

Affiliations