Guest Post

Response from David S. Oderberg to “Against Conscientious Objection In Health Care: A Counterdeclaration And Reply To Oderberg”

I am grateful to Prof. Savulescu and Dr Giubilini for taking the time and care to respond in detail to my Declaration in Support of Conscientious Objection in Health Care. I also thank Prof. Savulescu for giving me the opportunity to reply to their lengthy analysis. The authors make a series of important criticisms and observations, all of which I will face directly. The topic of freedom of conscience in medicine is both contentious and likely to become increasingly urgent in the future, so it is as well to dispel misunderstandings, clarify assertions and respond to objections as thoroughly as possible. That said, I hope I do not try the reader’s patience by discussing Giubilini and Savulescu’s objections point by point, in the order in which they raise them.

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Fetal Reduction in a Multiple Pregnancy: the Case of Identical Twins

Written by Elizabeth Crisp and Roger Crisp

When a woman aborts a single fetus, that abortion can be a morally troubling experience for her. What about a situation in which a woman is pregnant with more than one fetus, perhaps identical twins, and wishes to abort just one of them – that is, engage in what is sometimes called ‘fetal reduction’ in a ‘multiple pregnancy’? Continue reading

Victoria’s Voluntary Assisted Dying Law isn’t on a Slippery Slope

By David Copolov and Julian Savulescu 

This week the Australian Senate will debate a private members’ bill that will consider whether to overturn the 21-year-old Euthanasia Laws Act that nullified the ability of Australian self-governing territories to pass legislation in relation to euthanasia and assisted suicide.

The deliberation on whether to continue the arbitrary over-riding of the territories’ legislative autonomy in this domain will inevitably also turn a spotlight on the judiciousness of Victoria’s recent voluntary assisted dying legislation that empowers terminally ill people who are residents of our state and who are experiencing unrelievable suffering, to end their lives on their own terms.

Standing firmly and resolutely against such legislation is Professor Margaret Somerville, from the University of Notre Dame, who was interestingly described in an article in the Sydney Morning Herald two days ago as having “spent decades observing euthanasia in Canada”, even though medically assisted dying only became legal in that country in 2016.

One of the concerns she has raised is the “slippery slope” to unethical assistance in dying. Currently, this might well be on people’s minds because of the reports of the deaths of three minors during 2016-2017 as the result of euthanasia in Belgium, out of 4337 deaths during that period. The deaths of the under-18-year-olds occurred as a result of the removal of age limits on access to euthanasia in Belgium that took place as a result of legislation introduced in 2014, 12 years after the introduction of euthanasia for adults.

In contrast to Belgium (which is the only jurisdiction that places no age restrictions on euthanasia or assisted dying), the Victorian Parliament passed the Voluntary Assisted Dying Act in November last year, which limits voluntary assisted dying (VAD) to terminally ill people 18 years and older, who fulfil very strict criteria in relation to experiencing unrelievable suffering and possessing sufficient decision-making capabilities. They must be in the last six months of life, unless they’re suffering from a neurodegenerative disease, in which case they must be in the last 12 months of life.

There are many reasons that both the Victorian Legislative Council’s Inquiry into end of life choices and the Ministerial Advisory Panel on Voluntary Assisted Dying recommended limiting VAD to adults, including the fact that the extensive consultations with the Victorian public led to the firm conclusion that, as stated in the inquiry’s final report: “Victorian values do not support allowing assisted dying to be provided to those who are yet to reach adulthood.”

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Guest Post: Cambridge Analytica: You Can Have My Money but Not My Vote

Emily Feng-Gu, Medical Student, Monash University

When news broke that Facebook data from 50 million American users had been harvested and misused, and that Facebook had kept silent about it for two years, the 17th of March 2018 became a bad day for the mega-corporation. In the week following what became known as the Cambridge Analytica scandal, Facebook’s market value fell by around $80 billion. Facebook CEO Mark Zuckerberg came under intense scrutiny and criticism, the #DeleteFacebook movement was born, and the incident received wide media coverage. Elon Musk, the tech billionare and founder of Tesla, was one high profile deleter. Facebook, however, is only one morally questionable half of the story.

Cambridge Analytica was allegedly involved in influencing the outcomes of several high-profile elections, including the 2016 US election, the 2016 Brexit referendum, and the 2013 and 2017 Kenyan elections. Its methods involve data mining and analysis to more precisely tailor campaign materials to audiences and, as whistle blower Christopher Wylie put it, ‘target their inner demons.’1 The practice, known as ‘micro-targeting’, has become more common in the digital age of politics and aims to influence swing voter behaviour by using data and information to hone in on fears, anxieties, or attitudes which campaigns can use to their advantage. This was one of techniques used in Trump’s campaign, targeting the 50 million unsuspecting Americans whose Facebook data was misused. Further adding to the ethical unease, the company was founded by Republican key players Steve Bannon, later to become Trump’s chief strategist, and billionaire Republican donor Robert Mercer.

There are two broad issues raised by the incident.

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Guest Post: Consequentialism and Ethics? Bridging the Normative Gap.

Written by Simon Beard

University of Cambridge

After years of deliberation, a US moratorium on so-called ‘gain of function’ experiments, involving the production of novel pathogens with a high degree of pandemic potential, has been lifted [https://www.nih.gov/about-nih/who-we-are/nih-director/statements/nih-lifts-funding-pause-gain-function-research]. At the same time, a ground-breaking new set of guidelines about how and when such experiments can be funded has been published [https://thebulletin.org/new-pathogen-research-rules-gain-function-loss-clarity11540] by the National Institutes of Health. This is to be welcomed, and I hope that these guidelines stimulate broader discussions about the ethics and funding of duel use scientific research, both inside and outside of the life sciences. At the very least, it is essential that people learn from this experience and do not engage in the kind of intellectual head banging that has undermined important research, and disrupted the careers of talented researchers.

Yet, there is something in these guidelines that many philosophers may find troubling.

These new guidelines insist, for the first time it seems, that NIH funding will depend not only on the benefits of scientific research outweighing the potential risks, but also on whether or not the research is “ethically justified”. In defining what is ethically justifiable, the NIH make specific reference to standards of beneficence, non-maleficence, justice, scientific freedom, respect for persons and responsible stewardship.

Much has been made of this additional dimension of evaluation and whether or not review committees will be up to assessing it. Whereas before, it is said, they merely had to assess whether research would have good or bad outcomes, they now have to determine whether it is right or wrong as well! Continue reading

Announcement: Medical Ethics Symposium on Health Care Rationing – Oxford June 20th. Registration Now Open

Practical medical ethics: Rationing responsibly in an age of austerity
Date: June 20th 2018, 2-5pm, includes refreshments
Location: Ship Street Centre, Jesus College, Oxford

Health professionals face ever expanding possibilities for medical treatment, increasing patient expectations and at the same time intense pressures to reduce healthcare costs. This leads frequently to conflicts between obligations to current patients, and others who might benefit from treatment.

Is it ethical for doctors and other health professionals to engage in bedside rationing? What ethical principles should guide decisions (for example about which patients to offer intensive care admission or surgery)? Is it discriminatory to take into account disability in allocating resources? If patients are responsible for their illness, should that lead to a lower priority for treatment?

In this seminar philosophers from the Oxford Uehiro Centre for Practical Ethics will explore and shed light on the profound ethical challenges around allocating limited health care resources.

Speakers include Prof Dominic Wilkinson, Professor Julian Savulescu, Dr Rebecca Brown. Guest lecture by Professor Thaddeus Pope (Professor of Law, Mitchell Hamline School of Law, Minnesota) – on the US approach to allocating organs

Topics  include:

  • Allocating intensive care beds and balancing ethical values
  • Moralising medicine – is it ethical to allocate treatment based on responsibility for illness?
  • Cost-equivalence – rethinking treatment allocation.

This seminar is aimed at health professionals/ethicists

There are strictly limited places. Early bird registration £15/10* if register by 29th April and £25/20* subsequently

*Discounted registration for students

Registration includes tea/coffee and Wine/soft drinks/cheese at the end

Online Registration 

*Philosophical case discussion and *prize*

The afternoon will conclude with a live “ethics committee” deliberation on a clinical case.
Attendees at the meeting are encouraged to submit a case for discussion based on their clinical experience.
If chosen for presentation, attendees will have the opportunity to present a short (5 minute) clinical summary.
They will also receive complementary registration at the seminar, and a £40 Blackwell’s voucher.

To submit a case, please send a short (less than 200 word) deidentified case description including the key ethical questions to dominic.wilkinson@philosophy.ox.ac.uk

Guest Post: The Real Problem With Human Head Transplantation

Written by Michael S. Dauber, MA

In 2015, Sergio Canavero announced that he would perform a therapeutic head transplant procedure on a human subject by December 2017. Since then, he has recruited the assistance of surgeon Xiaoping Ren and switched from Valery Spiridonov to an anonymous Chinese patient whose medical condition remains undisclosed. The procedure, which consists of removing the patient’s head and attaching it to a decapitated donor body, is expected to be carried out in China, will cost tens of millions of dollars, and will require dozens of surgeons. The procedure returned to international attention this week when Canavero announced he had successfully performed the procedure on a human cadaver, and said that the announcement of an official procedure date was “immanent.” Continue reading

Guest Post: Track Authorities Are Wrong To Ban Women With Naturally High Testosterone levels

Michael S. Dauber, MA

 According to a story by Catherine Caruso published in STAT News this week, authorities at the International Association of Athletics Federations (IAAF) are getting set to debate whether or not women with hyperandrogenism, or higher-than-expected testosterone levels, should be restricted from competing against women with “normal” or “expected” levels. The debate over the IAAF rules began in 2011, when a rule was first created to prevent women with high testosterone levels competing because of the belief that their hormone levels gave them an unfair advantage. The rule was challenged in 2015, and the IAAF was given two years to provide further justification for its position.

As Caruso writes, the main focus of the current controversy is the legal case of Dutee Chand, an Indian athlete whose testosterone levels exceed “the 10 nanomoles per liter limit, the level deemed to be the lower end of the ‘male range,’” i.e., the amount of testosterone in the blood typically exhibited by male athletes. Testosterone is widely considered a hormone that assists in athletic performance, given that it increases the rate of muscle development and bone mass, among other traits. The idea behind the IAAF’s position is that “unnaturally” high levels of testosterone that exceed levels typical of one’s gender would give such athletes an unfair advantage over other competitiors. Insofar as the IAAF is concerned with creating the fairest competition possible, the presence of elevated testosterone levels in a select group of athletes, like Chand, presents a serious problem.

The problem with the IAAF’s position, however, is that it overlooks one of the central nuances of sporting ethics. It is true that sporting events are supposed to be fair in a wide sense: we would not consider the competition just if one athlete took some action that made it impossible for other athletes to win. This is why athletes are given certain rules to which they must conform. In basketball, for example, one is forbidden from reaching out and grabbing the opposing player’s arm to prevent them from dribbling; in hockey, players are forbidden from tripping each other; and soccer players cannot decide to randomly touch the ball with their hands (unless, of course, they are a goalie).

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Functional neo-Aristotelianism as a way to preserve moral agency: A response to Dr William Casebeer’s lecture: The Neuroscience of Moral Agency

Written by Dr Anibal Monasterio Astobiza

Audio File of Dr Casebeer’s talk is available here: http://media.philosophy.ox.ac.uk/uehiro/HT17_Casebeer.mp3

 

Dr. William Casebeer has an unusual, but nonetheless very interesting, professional career. He retired from active duty as a US Air Force Lieutenant Colonel and intelligence analyst. He obtained his PhD in Cognitive Science and Philosophy from University of California, San Diego, under the guidance and inspiration of Patricia and Paul Churchland, served as a Program Manager at the Defense Advanced Research Projects Agency from 2010-14 in the Defense Sciences Office and helped to established DARPA’s neuroethics program. Nowadays, Dr. William Casebeer is a Research Area Manager in Human Systems and Autonomy for Lockheed Martin’s Advanced Technology Laboratories. As I said, not the conventional path for a well known researcher with very prominent contributions in neuroethics and moral evolution. His book Natural Ethical Facts: Evolution, Connectionism, and Moral Cognition (MIT Press) presented a functional and neo-Aristotelian account of morality with a clever argument trying to solve G. E. Moore´s naturalistic fallacy: according to Casebeer it is possible to reduce what is good, or in other words morality, to natural facts.

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Guest Post: Epigenetics: Barriers to the translation of scientific knowledge into public policies

Written by Charles Dupras and Vardit Ravitsky

Bioethics Programs, School of Public Health, University of Montreal

 

Environmental epigenetics is a rising field of scientific research that has been receiving much attention. It explores how exposure to various physical and social environments (e.g. pollution or social adversity) affects gene expression and, eventually, our health. Environmental epigenetics can sometimes explain why some of us carry increased risks of developing specific diseases. It provides activists a powerful vocabulary to promote environmental awareness and social justice. This new vocabulary, which allows us to discuss the consequences of disparities at the molecular level, has been enthusiastically mobilized as an effective way of stimulating political will for promoting public health preventive strategies. Continue reading

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