Julian Savulescu’s Posts

Agreement and disagreement about experimental treatment. The Charlie Gard Appeal

by Dominic Wilkinson and Julian Savulescu

@Neonatalethics

@juliansavulescu

Tomorrow, the UK Court of Appeal will review the controversial case of a British infant, Charlie Gard. Charlie’s parents are appealing a recent High Court decision that gave doctors permission to withdraw his life support. They have raised money for Charlie to travel to the US for an experimental medical treatment. Continue reading

Cross Post: Five ways the meat on your plate is killing the planet

Cross-posted from The Conversation

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Francis Vergunst, Université de Montréal and Julian Savulescu, University of Oxford

When we hear about the horrors of industrial livestock farming – the pollution, the waste, the miserable lives of billions of animals – it is hard not to feel a twinge of guilt and conclude that we should eat less meat. The Conversation

Yet most of us probably won’t. Instead, we will mumble something about meat being tasty, that “everyone” eats it, and that we only buy “grass fed” beef.

Over the next year, more than 50 billion land animals will be raised and slaughtered for food around the world. Most of them will be reared in conditions that cause them to suffer unnecessarily while also harming people and the environment in significant ways.

This raises serious ethical problems. We’ve compiled a list of arguments against eating meat to help you decide for yourself what to put on your plate.

Continue reading

Debate: The Fiction of an Interest in Death? Justice for Charlie Gard

Julian Savulescu

Dominic Wilkinson’s Response

A judge ruled last week that baby Charlie Gard will have his treatment withdrawn, against the wishes of his parents. His doctors argued that the rare mitochondrial disease (MDDS) he was born with was causing him unbearable suffering.

His parents had raised funds to take him to the US for experimental treatment and they wanted the chance to try the treatment. His doctors argued that such treatment could only prolong his suffering. It was their belief that it was in his best interests for treatment to be withdrawn, and for his life to end, a belief which the trial judge endorsed.

“It is with the heaviest of hearts, but with complete conviction for Charlie’s best interests, that I find it is in Charlie’s best interests that I accede to these applications and rule that GOSH may lawfully withdraw all treatment save for palliative care to permit Charlie to die with dignity.”

This is a profoundly difficult decision, and one in which all parties are acting out of care and compassion for the child. My comments are of course limited as I do not have access to all the relevant facts. However, it does raise an important question about the current basis of such decisions.

Ethics of Limitation of Life Prolonging Medical Treatment

In general, medicine has a presumption in favour of saving life, or prolonging life. There are three justifications for departing from this default. That is, there are 3 justifications for withholding or withdrawing life prolonging medical treatment:

  1. the patient autonomously refuses it. (autonomy)
  2. continued life is no longer in the patient’s interests (best interests)
  3. the probability of the treatment prolonging life, or the quality of life, or the length of time the patient can surVive are too low to justify the cost of the attempt (distributive justice)

Sometimes treatment is withheld or withdrawn because it is “futile.” Dominic Wilkinson and I have argued that although futility is often said to refer to “best interests”, it is more appropriately interpreted as a justice justification for limitation, that is, criterion 3. The reason we have argued this is that the best interests justification (2), requires that doctors establish that life is no longer worth living. That is, that the person would be better off dead. This is a very difficult standard to establish, even if the concept of a life not worth living is coherent. Justice does not require that we establish where the line of of a life worth living is. It only requires a comparative judgement – that compared to other uses of a limited medical resource, this use is not justified. The NHS has thresholds for cost-effectiveness that it routinely employs. A justice justification for limiting life prolonging medical treatment only requires an extension of this every day approach. For example, a treatment which has a 1/10,000 of prolonging a person’s life is a lower priority than a treatment which has a 50% chance of extending life. We need not say that the first treatment is “futile” or confers no benefit to the patient. We need only say that it is very poor value for money.

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The Tale of the Ethical Neonatologist – And Why There Shouldn’t Be a Legal Right of Conscientious Objection

Doctors have values. These are sometimes described as their conscience. Those values can conflict with what has evolved to be medical practice. Where that practice is consistent with principles, concept and norms of medical ethics, their values should not compromise patient care. The place for doctors to express their values and seek to revise the practice of medicine is at the level of policy and law, not at the bedside. Because conscientious objection can compromise patient care, there should be no legal right to conscientious objection to medical practice that is consistent with medical ethics. Personal values (“conscience”) can be accommodated by employers under standard labour law as occurs in Sweden and Finland, or candidates selected for medical specialties who have values consistent with ethical medicine, or new professions developed to provide those services.

Doctors may have very defensible values. But just because their values are reasonable does not imply they should be accommodated by medicine. Consider the Conscientious Neonatologist.

The Conscientious Neonatologist

Peter is a thoughtful, reflective specialist caring for premature babies in intensive care. He is a vegetarian for 20 years. He became deeply concerned about the welfare of animals during his university years. He believes in “animal liberation”. Neither he nor his family consume meat or use animal products for clothing.

In his job, he must prescribe “surfactant” – a substance to help the lungs of premature babies function better. The standard, and most effective form is derived from the lungs of pigs. However there is a new artificial form. He considers this a more “ethical” product and considers using it in his medical practice. However, it is not currently used in the newborn intensive care unit because it is more expensive than standard treatment, and there is not clear evidence about its effectiveness.

Peter conscientiously objects to the use of animals in medicine and medical research. How should his personal values influence his professional practice?

Continue reading

Cross Post: We have a moral obligation to allow drug analysis at music festivals

This article was originally published in The Conversation

Written by Julian Savulescu Sir Louis Matheson Distinguishing Visiting Professor at Monash University,

Uehiro Professor of Practical Ethics, University of Oxford

Connor Rochford Medical Student, Monash University

Daniel D’Hotman Medical Student, Monash University


Drug analysis would be a safe, ethical and cost-effective way to reduce harm to young people. Shutterstock

At the Stereosonic festival last year, Sylvia Choi died after consuming a contaminated ecstasy tablet. Unfortunately Sylvia’s narrative is all too familiar – a bright future extinguished at a music festival that will be remembered for all the wrong reasons.

This summer, many young people will also choose to consume various illegal substances in pursuit of a good time. Regardless of their personal choice to break the law, most would agree that they should not have to die for it. Continue reading

Abortion Should Be Decriminalised

Abortion remains a crime in Queensland and NSW in Australia. Queensland Parliament has just decided against decriminalising abortion. However, laws are obsolete and unclear, dating back over 100 years. Around 100,000 abortions are performed around Australia every year. In practice, early abortion is available on demand.

Abortion should be decriminalised. Early abortion should be freely and easily available on request. Late abortion should be freely and easily available at least for those who have a valid justification: significant fetal abnormality, threat to woman’s health or serious social reason, for example child pregnancy or rape. Family planning, including safe, free and open abortion services, is an essential part of a civilized society.

Failure to regulate abortion properly results in women being denied safe, effective abortion services, affecting their mental health and social welfare, as well as those of their family and society. It is stigmatising to women and health professionals to allow abortion to occur, while retaining it as a criminal offence. It is also moral hypocrisy.

Continue reading

Should Russian athletes really be banned from competing in the Rio Olympics?

Julian Savulescu

Originally posted in The Conversation 

The audience vote is a resounding yes, all Russian track and field athletes should be banned from competing. But is the International Olympic Committee (IOC) justified in giving individual sports federations the right to decide whether athletes can participate in Rio 2016?

In the run-up to the IOC’s decision, anti-doping leaders from 14 countries signed an open letter demanding the Russians’ exclusion. A petition calling for the whole team to be banned was closing in on its aim of 10,000 signatures, while another arguing against a blanket ban had just managed eight.

The IOC decided to face the mob and take a more nuanced approach; it will allow each sporting federation to decide whether the evidence is sufficient to ban athletes in their discipline. Tennis players, who are regularly tested around the world, are in the clear, for instance, with cyclists set to follow.

But athletes in track and field are banned as a group, although individuals may compete as neutral athletes. Is this kind of “collective responsibility” – or “collective punishment” as Mikhail Gorbachev described it – fair?

Standards of evidence

There’s a genuine dilemma here and the situation is not nearly as clear everyone appears to think – and as the World Anti-Doping Agency (WADA) pretends.

Continue reading

The Unfairness of Unattractiveness

In the job market being attractive is advantageous. According to economist Daniel Hamermesh, an attractive man can earn, over a life time, $230,000 more than an unattractive one[1]. Attractive solicitors raise more money for charities[2].  Very attractive individuals are less likely to engage in criminal activities, whereas unattractive ones have higher propensity for crime[3]. Attractive criminals are punished less severely than unattractive ones[4].

Both children and adults judge attractive people to be more helpful, more intelligent, and more friendly than their unattractive counterparts[5].

Cute infants elicit stronger motivation for care-taking than less cute ones[6]. Moreover, cute infants are rated as most adoptable[7].

Adults have higher expectations of attractive kids compared to non attractive ones[8] and mothers of attractive infants tend to be more affectionate, playful, and attentive when interacting with their children than mothers of less attractive infants[9]. Teachers expect better performances from attractive students[10]. Transgressions of unattractive children are judged more negatively than transgressions of attractive ones[11].

Being attractive is also an advantage in romantic relationships[12] as there is a positive correlation  between physical attractiveness and dating [13][14].

One response to unfairness is to get people to stop discriminating unfairly. This might work for some domains, such as employment where interviews could be conducted blind. But it won’t be possible to counteract all the potential downsides.

We can’t require people to like or fall in love with people they find unattractive. There are at least two possible responses:

  1. Assist people to find attractive what they currently find unattractive
  2. Assist people to be more attractive to those who currently find them unattractive

Both of these are reasonable solutions. The second is cosmetic enhancement.

Continue reading

Video: Professor Julian Savulescu speaks in the DNA Manipulation Debate at The Oxford Union

The Oxford Union.

The Motion: This House Believes the Manipulation of Human DNA is an Ethical Necessity.

The Speakers: Julian Savulescu closed the case for the Proposition, as the fifth speaker of six in the debate.

Article Announcement: Should a human-pig chimera be treated as a person?

Professor Julian Savulescu has recently published an article on the treatment of Human-Pig Chimera in the online Aeon Magazine.  To read the full article and join in the conversation please follow this link: http://bit.ly/29NUj1c   Professor Savulescu has written on this topic in the Practical Ethics in the News blog previously: http://blog.practicalethics.ox.ac.uk/2016/06/organ-mules/.

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