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?
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 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.
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.
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. Attractive solicitors raise more money for charities. Very attractive individuals are less likely to engage in criminal activities, whereas unattractive ones have higher propensity for crime. Attractive criminals are punished less severely than unattractive ones.
Both children and adults judge attractive people to be more helpful, more intelligent, and more friendly than their unattractive counterparts.
Adults have higher expectations of attractive kids compared to non attractive ones and mothers of attractive infants tend to be more affectionate, playful, and attentive when interacting with their children than mothers of less attractive infants. Teachers expect better performances from attractive students. Transgressions of unattractive children are judged more negatively than transgressions of attractive ones.
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:
- Assist people to find attractive what they currently find unattractive
- Assist people to be more attractive to those who currently find them unattractive
Both of these are reasonable solutions. The second is cosmetic enhancement.
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.
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/.
US scientists are creating novel life forms: “human pig chimeras”. These are a blend of human and pig characteristics. They are like mules who will provide organs to us. A mule is the offspring of a male donkey (jack) and a female horse (mare). Horses and donkeys are different species, with different numbers of chromosomes but they can breed together.
In this case, they take a skin cell from a person and turn it back in time to make stem cells capable of producing any cell or tissue in the body, “induced pluripotent stem cells.” They then inject this into a pig embryo. This makes a pig human chimera.
However they do a modification to the pig embryo first. They use gene editing, or CRISPR, to knock out the pig’s genes which produce an organ, say the pancreas. The human stem cells for the pancreas then make an almost entirely human pancreas in the pig human chimera. It functions like an organ mule. (The blood vessels are still porcine.)
In this way, your skin cell could grow a new liver, heart, pancreas, or lung.
This is a technique with wider possibilities: other US teams are working on a chimera –based treatment, this time for Parkinson’s disease which will use chimeras to create human neurones.
CRISPR is also credited with enhancing the safety of this technique, with the BBC reporting that a Harvard team were able to use the new and revolutionary technique to remove copies of a pig retrovirus.
Safety is always a major concern when science crosses new boundaries. But even if a sufficient guarantee of safety could be reached, are there ethical problems?
You are on holiday with your partner of several years. Your relationship is going pretty well, but you wonder if it could be better. It’s Valentine’s Day and you find a bottle on the beach. You rub it. A love genie appears. He (or she) will grant you three special Valentine wishes. Here are some of your choices:
- to have more or less sexual desire (lust);
- to remain always as “in love” as you were when you first fell in love (romantic attraction);
- to be more or less bonded to your partner emotionally (attachment);
- to be (happily) monogamous or polygamous.
What would you choose? What should you choose? What would your partner choose? Would you choose together, if you could? What would you choose for your partner?
Cross Post: Ideas for Australia: Rethinking funding and priorities in IVF – should the state pay for people to have babies?
Written by Professor Julian Savulescu and Professor Kelton Tremellen
This is a cross posting of an article which was originally published at The Conversation
How much should the state spend on helping people to have children? At present, government support for infertility treatment is approximately A$240 million a year. The success of fertility treatments such as IVF is good if you are under 35 years of age, but once a woman hits 40 it plummets, falling to an almost futile one-in-80 chance of producing a baby for women 45 years and older. This raises the question – is IVF a cost-effective use of taxpayers’ money? And what about for older women?
Decisions about funding are usually made on grounds of cost-effectiveness. In Australia, the cost-effectiveness threshold is about A$40,000 per “QALY”. A QALY is a quality adjusted life year. Thus the government will spend, for example, A$40,000 to add a year of full health, or improve the quality of life by 10% for 10 years.
Is IVF cost-effective? It depends on how we measure it. Continue reading