News outlets have been discussing a call to require health warnings on alcoholic drinks comparable to those placed on cigarette packets. Amongst other recommendations, the All Party Parliamentary Group (APPG) on Alcohol Misuse has called on political parties to include a health warning on all alcohol labels, and to deliver a government-funded national public awareness campaign on alcohol-related health issues.
If this proposal is to be implemented, it is important to note that there is an important disanalogy with placing health warnings on cigarette packaging. Whilst cigarettes always damage health to some degree, a large body of evidence suggests that moderate drinking is not only non-harmful to health but may in fact promote it. Continue reading
Epigenetics and Blaming Pregnant Women: Hasty Conclusions, Control, and Simplified Burden of Responsibility
In a recent (13.8.2014) article in Nature , Sarah S. Richardson and colleagues maintain that careless discussion of epigenetic research on how early life affects health across generations could harm women.
Authors discuss the extensive history of placing the burden of responsibility of a child’s health on the lifestyle of the pregnant mother – and the means for controlling women’s behavior. Authors describe how, for example, evidence of any fetal harm easily lead to zero-tolerance regulatory frameworks and severe informal and formal consequences (e.g. social condemnation for an occasional sip of alcohol despite the ambiguous evidence that very moderate and occasional drinking should harm the fetus), and how the “lack of emotional warmth” of the “refrigerator mothers ” was considered to be the reason to child autism as late as the 1970s. Going even more backwards in the history, various defects were attributed, for example, to the company the mother kept during pregnancy.
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Luke Malone has published an extremely moving, disturbing, and distressing article in Medium, entitled ‘You’re 16. You’re a pedophile. You don’t want to hurt anyone. What do you do now?’ (warning: Malone’s article contains a graphic description of child abuse). The article focuses on ‘Adam’, a young man who, aged 16, was horrified to discover that he was sexually attracted to children. Disturbed by his sexual desires, and desperate to avoid acting on them, he suffered depression and initially used child pornography as an outlet for his feelings. (He subsequently stopped doing this.) Adam describes how he eventually went to see a therapist, who was unsympathetic, inexperienced in this area, and ultimately of little help. It turns out that, despite the fact that paedophilia is recognised as a mental disorder, there are major obstacles to helping people who, like Adam, are desperate to avoid harming children. Malone summarises some of the main problems: Continue reading
When Are Objections ‘Religious’ Objections?: Hobby Lobby, Wheaton College, and Contraceptive Coverage
On June 30th, the Supreme Court of the United States handed down its decision in Burwell vs. Hobby Lobby. The case required the court to consider whether closely held for-profit companies owned by individuals with sincere religious objections to abortion should receive a special exemption from providing healthcare coverage for contraceptives that may act after fertilisation but before implantation of an egg. Coverage of twenty types of contraceptives – including the four specific types that the owners consider to be abortifacients – is otherwise legally required as part of the employer-sponsored health insurance mandated by the Patient Protection and Affordable Care Act 2010 (ACA). For a more in depth overview of the facts of the Hobby Lobby case and the key questions before the court, see my previous post on this blog. Continue reading
It is reported that Jimmy Savile crept at night into the mortuary at Leeds General Infirmary and committed sex acts on corpses.1
Well, for a start, assuming the acts involved penetration, he had committed a serious criminal offence.2
But shouldn’t we grow up? Shouldn’t we let live, and let the live love the dead? Who was hurt? Isn’t this legislation anachronistic? Doesn’t it stem from superannuated and probably, at root, theological ideas about the sanctity of life – irrationally extended to the sanctity of the dead human body?
If the acts gave Savile pleasure, then what’s the problem? Or, if we grant that the outraged relatives might suffer some distress (because they’ve not read enough philosophy), doesn’t the problem lie only in the fact that the relatives heard about what had happened, rather than in the acts themselves? In which case the real villains are the investigators and the media.
We have strong intuitions about many things. So strong, in fact, that they are often immune to the best arguments of the lawyers and philosophers. Continue reading
By Kimberly Schelle & Nadira Faulmüller
Horizon 2020, the European Union’s 2014-2020 largest research programme ever, includes the call to pursue ‘Responsible Research and Innovation’ (RRI). RRI stands for a research and innovation process in which all societal actors (e.g. citizens, policy makers, business and researchers) are working together in the process to align the outcomes with the values, needs, and expectations of the European Society. In a recently published paper on the importance of including the public and patients’ voices in bioethical reasoning, the authors describe, although in other words, the value of the RRI approach in bioethical issues:
“A bioethical position that fails to do this [exchange with the public opinion], and which thus avoids the confrontation with different public arguments, including ones perhaps based in different cultural histories, relations and ontological grounds […], not only runs the risk of missing important aspects, ideas and arguments. It also arouses strong suspicion of being indeed one-sided, biased or ideological—thus illegitimate.”
The Court of Appeal has stated that a statement in a capacitous patient’s medical notes that resuscitation should not be attempted (a ‘Do Not Attempt Resuscitation’ Order – DNAR), should usually only be inserted after consultation with the patient: see R (Tracey) v Cambridge University Hospitals NHS Foundation Trust and others  EWCA Civ 822 (17 June 2014).
The facts have been widely aired in the media: see, for example, here.
Mrs. Tracey had terminal lung cancer. Her clinicians indicated in the notes that no attempts at resuscitation should be made. Her family found out about this, and were outraged, saying that the DNAR order should not have been made without consultation with Mrs. Tracey. Their quarrel was not with the medical appropriateness of the determination that resuscitation would not be in Mrs. Tracey’s best interests, but with the procedure - the failure to consult. This, they said, violated Mrs. Tracey’s rights under Article 8 of the ECHR.
The Resuscitation Council, intervening, said that a requirement to consult with the patient would interfere with clinicians’ ability to deliver individual and compassionate care. A patient might, for instance, be very distressed by a discussion about a possible DNAR order.
The outcome can be briefly stated:
- Mrs. Tracey’s Article 8 rights were engaged by recording the DNAR in the notes. This followed from, inter alia, Pretty v UK (2002) 35 EHRR 1.
- Her Article 8(1) rights were violated by failing to involve her in the process
- Article 8(2) required the policy adopted by a Trust in relation to DNAR orders to be sufficiently clear and accessible: see Purdy v DPP  UKHL 45;  1 AC 345.
- The absence of a mandatory national DNAR policy was not a violation of Article 8. Local policies would, if properly formulated, satisfy the demands of Article 8(2)
- The concerns of the Resuscitation Council were real, but could be met by an important caveat: there should be consultation with the patient unless the clinician ‘thinks that the patient will be distressed by being consulted and that distress might cause the patient harm.’ Continue reading
The use of placebos in medicine raises a large number of serious ethical issues. Do they involve deceiving patients, or violating their autonomy in some way? Are they harmful to certain patients, in research trials where the actual treatment being trialled is thought likely to be successful? Can placebos – if medically warranted – be funded through a health care budget? All these questions require us to be able to say what a placebo is, and that is more tricky than one might think. Continue reading
The National Institute for Health and Care Excellence (NICE) recently recommended that the NHS should learn from commercial weight loss programmes such as Weight Watchers, Rosemary Conley and Slimming World. The NICE guidelines suggested that doctors should take a “respectful” and “non-judgemental” tone when helping patients to lose weight. As well as this, GPs were encouraged to continue to identify overweight patients for referral to state-funded commercial weight loss schemes, run by companies such as Weight Watchers, with obese adults being given priority.
The plan is estimated to cost hundreds of millions of pounds, but is also likely to save the NHS vast amounts in the long run, if successful in reducing obesity. Approximately 1 in 4 adults in the UK are obese, a condition that is linked with other ailments such as diabetes, heart disease and some cancers. The costs to the NHS attributable to people being overweight and obese are projected to reach £9.7 billion by 2050. Figures show that Weight Watchers and similar schemes manage to reduce participant’s body weight by 3 per cent, and NICE believe that even this small amount will help in the long term. Is it right, therefore, that the NHS subsidise the cost of these commercially run weight loss schemes?