The Court of Protection is due to review very soon the case of a teenager with a relapsed brain tumour. The young man had been diagnosed with the tumour as a baby, but it has apparently come back and spread so that according to his neurosurgeon he has been “going in and out of a coma”. In February, the court heard from medical specialists that he was expected to die within two weeks, and authorized doctors to withhold chemotherapy, neurosurgery and other invasive treatments, against the wishes of the boy’s parents.
However, three months after that ruling, the teenager is still alive, and so the court has been asked to review its decision. What should we make of this case? Were doctors and the court wrong?
Let us suppose we have a treatment and we want to find out if it works. Call this treatment drug X. While we have observational data that it works—that is, patients say it works or, that it appears to work given certain tests—observational data can be misleading. As Edzard Ernst writes:
Whenever a patient or a group of patients receive a medical treatment and subsequently experience improvements, we automatically assume that the improvement was caused by the intervention. This logical fallacy can be very misleading […] Of course, it could be the treatment—but there are many other possibilities as well. Continue reading
Practical ethicists have become increasingly interested in the potential applications of neurointerventions—interventions that exert a direct biological effect on the brain. One application of these interventions that has particularly stimulated moral discussion is the potential use of these interventions to prevent recidivism amongst criminal offenders. To a limited extent, we are already on the path to using what can be described as neuro-interventions in this way. For instance, in certain jurisdictions drug-addicted offenders are required to take medications that are intended to attenuate their addictive desires. Furthermore, sex-offenders in certain jurisdictions may receive testosterone-lowering drugs (sometimes referred to as ‘chemical castration’) as a part of their criminal sentence, or as required by their conditions of parole.
On 13-14th April, a workshop (funded by the Wellcome Trust) focussing on the moral questions raised by the potential use of neuro-interventions to prevent criminal recidivism took place at Kellogg College in Oxford. I lack the space here to adequately explore the nuances of all of the talks in this workshop. Rather, in this post, I shall briefly explain some of the main themes and issues that were raised in the fruitful discussions that took place over the course of the workshop, and attempt to give readers at least a flavour of each of the talks given; I apologise in advance for the fact that I must necessarily gloss over a number of interesting details and arguments. Continue reading
Hannah Maslen and Julian Savulescu
In a pioneering new procedure, deep brain stimulation is being trialed as a treatment for the eating disorder anorexia nervosa. Neurosurgeons at the John Radcliffe Hospital in Oxford implanted electrodes into the nucleus accumbens of a woman suffering with anorexia to stimulate the part of the brain involved in finding food rewarding. Whilst reports emphasize that this treatment is ‘highly experimental’ and would ‘only be for those who have failed all other treatments for anorexia’, there appeared to be tentative optimism surrounding the potential efficacy of the procedure: the woman who had undergone the surgery was reportedly ‘doing well’ and had shown ‘a response to the treatment’.
It goes without saying that successful treatments for otherwise intractable conditions are a good thing and are to be welcomed. Indeed, a woman who had undergone similar treatment at a hospital in Canada is quoted as saying ‘it has turned my life around. I am now at a healthy weight.’ However, the invasive nature of the procedure and the complexity of the psychological, biological and social dimensions of anorexia should prompt us to carefully consider the ethical issues involved in offering, encouraging and performing such interventions. We here outline relevant considerations pertaining to obtaining valid consent from patients, and underscore the cautious approach that should be taken when directly modifying food-related desires in a complex disorder involving interrelated social, psychological and biological factors. Continue reading
The discussion that the scientists in Nature and Science called for should remain in realism, not go on to superhumans
Just over a week ago, prominent scientists in Nature and Science called for a ban for DNA modification in human embryos. This is because the scientists presume that now it actually would be possible to alter the genome in a human embryo in order to treat genetic diseases. Consequently, this would result in modified DNA in germ cells that would be inherited to future generations. The scientists wish to have a full ethical, legal, and public discussion before any germ-line modifications will be made. Furthermore, issues of safety are of importance.
The scientists’ statement is of utmost importance and hopefully this ethical, legal, and public discussion will emerge. However, the discussion on germ-line DNA modification is at danger if the debate will be taken to the level of science fictional superhumans, as already has happen. Not only can such discussion cause unnecessary public worry, it also leads the deliberation away from the actual and urgent questions.
By Dominic Wilkinson @NeonatalEthics
The UK supreme court last week awarded a woman £5 million in compensation after her obstetrician failed to warn her of a risk that she would have difficulty delivering her baby. Over on the JME Blog Kirsty Keywood discusses some interesting and important legal elements of this judgment for the practice of informed consent and how this will be evaluated in negligence claims.
However, the case raises one important ethical issue. Several expert witnesses in the Montgomery case testified that informing women of even very low risks of complications of vaginal birth would likely lead to a significant increase in the number of women choosing elective caesarean section.
If that is true, would it be justified for doctors to deliberately not discuss such risks? Continue reading
It’s a beautiful warm sunny day, and you have decided to take your children to join a group of friends for a barbecue at the local public park. The wine is flowing (orange juice for the kids), you have managed not to burn the sausages (vegetarian or otherwise), and there is even an ice-cream van parked a conveniently short walk away.
An idyllic scenario for many of us, I’m sure you will agree; one might even go so far as to suggest that this is exactly the sort of thing that public parks are there for; they represent a carefree environment in which we can enjoy the sunshine and engage in recreational communal activities with others. Continue reading
Oxford Uehiro Prize in Practical Ethics: In light of the value of personal relationships, is immortality desirable? by Fionn O’Donovan
This essay, by Oxford undergraduate student Fionn O’Donovan, is one of the four shortlisted essays in the undergraduate category of the inaugural Oxford Uehiro Prize in Practical Ethics.
In light of the value of personal relationships, is immortality desirable?
In the future it is likely that advances in medicine will grant us the opportunity to prevent the process of ageing. The question of whether eternal life would be a good thing will then be of the utmost practical importance to humanity. In this essay, I claim that it would be, and that Williams’ concerns about immortality can be assuaged with consideration of how life always gives us at least an opportunity to realise something commonly held to be incommensurably valuable, namely good relationships with others. I note here that, for the purposes of this essay, I assume there is no afterlife. I also want to note that the issues of immortality and euthanasia are linked: a similar question about whether death is ever desirable is central to debate on both. Therefore, many of the considerations I present below could also be used to support a more pro-life view on euthanasia. Continue reading
The latest issue of the Journal of Medical Ethics is out, and in it, Professor Nigel Biggar—an Oxford theologian—argues that “religion” should have a place in secular medicine (click here for a link to the article).
Some people will feel a shiver go down their spines—and not only the non-religious. After all, different religions require different things, and sometimes they come to opposite conclusions. So whose religion, exactly, does Professor Biggar have in mind, and what kind of “place” is he trying to make a case for?