‘Precarious (Bio)ethics: Research on Poisoning Patients in Sri Lanka’
On 9 May 2013, Salla Sariola, from ETHOX, gave a fascinating talk at the St Cross Ethics Seminar, based on work done collaboratively with Bob Simpson (Durham). The presentation focused on the large number of self-poisonings which have been taking place in Sri Lanka, often using lethal agricultural pesticides and herbicides unavailable in many developed countries. This presentation is now available as a podcast at the bottom right of the Oxford Uehiro Centre main webpage. Continue reading
Non-consensual testing after needlestick injury: A legal and ethical drama
By Charles Foster and Jonathan Herring
Scene 1: An Intensive Care Unit
Like many patients in ICU, X is incapacitous. He also needs a lot of care. Much of that care involves needles. Late at night, tired and harassed, Nurse Y is trying to give X an intravenous injection. As happens very commonly, she sticks herself with the needle.
Nurse Y is worried sick. Perhaps she will catch HIV, hepatitis, or some other serious blood-borne infection? She goes tearfully to the Consultant in charge.
‘Don’t worry’, he says. ‘We’ll start you on the regular post-exposure prophylaxis. But to be even safer, we’ll test some of X’s blood for the common infections. I doubt he’ll be positive, but if he is, we’ll start you straight away on the necessary treatment. We needn’t take any more blood: there are plenty of samples already available.’
A sample of blood is submitted for analysis. Continue reading
Forced Physical Exercise as an Intervention for Mental Disorders?
Studies have shown that regular physical activity has benefits for mental health: exercise can help people to recover from depression and anxiety disorders. However, not all people like exercise, and a mental disorder like depression can additionally decrease motivation for physical activity. So the disorder itself might inhibit behaviour that helps to overcome it.
We would assume that pressurising people is no solution here: several studies have shown that restricting freedom of choice or control increases stress in both humans and animals. However, new research tentatively indicates that controllability might play a smaller role than expected when it comes to exercise, and that even forced exercise might protect against depression and anxiety symptoms:
What happens when you die
I have just watched someone die. Just one person. But a whole ecosystem has been destroyed. Everyone’s roots wind round everyone else’s. Rip up one person, and everyone else is compromised, whether they know it or not. This is true, too, for everything that is done to anyone. Death just points up, unavoidably, what is always the case.
This is trite. But it finds little place in bioethical or medico-legal talk. There, a human is a discrete bio-economic unit, and there’s a convention that one can speak meaningfully about its elimination without real reference to other units.
In some medico-legal contexts this is perhaps inevitable. There have to be some limits on doctors’ liability. Hence some notion of the doctor-patient relationship is probably inescapable, and the notion requires an artificially atomistic model of a patient.
But ethics can and should do better. Continue reading
“The Best Interests of the Family”: Parents v Baby?
There is much that is good to be said about Dominic Wilkinson’s new book Death or Disability? The ‘Carmentis Machine’ and decision-making for critically ill children.
My favourite part of the book is how Dominic confronts head on the issue of the best interests of the family in relation to care, and withdrawal of medical treatment, in newborns.
This is one of the most neglected areas of bioethics.
On the one hand, there is a rhetoric that goes we are all social beings, we are socially connected, not atomistic individuals, the community matters, etc etc The usual communitarian mantra.
Then there is the alleged overriding legal and medical ethical principle of the best interests of the patient, which is the newborn infant in the case of neonatal medicine. The sole basis of the provision of medical treatment is meant to be to promote the best interests of the patient, and medicine should never be used to harm the patient, etc etc. The usual medical ethics and law mantra.
And then there is real life. The interests of the parents, siblings, other relatives, friends, society etc can all diverge from the interests of the patient, even a newborn infant. How are these to be weighed? The hard edged reality is that the interests of families and especially parents do play a role in clinical decision making, and even in cases to withdraw life-prolonging medical treatment. (For example, in one survey 90% of American intensivists believed that family interests should be included in decisions for incompetent patients. )
In ‘Death or Disability?’, Dominic reaches several striking conclusions. We should certainly give some weight to the interests of the family for decisions about children. This is most likely to sway our decisions in relatively borderline cases, where the net benefit or harm to the child is small. But he also argues that the amount of weight will vary depending on the age of the child, and on the availability of resources. We should give greater weight to the wishes of parents for newborn infants than for an older child. And we should give greater weight again in societies with few resources, where the burden of caregiving is going to fall heavily on families, and where health resources are seriously limited.
It is time for an honest, open and rational approach to these kinds of dilemmas. Dominic does just that.
Too long in gestating: an overdue inquiry into the Abortion Act
Whatever your view of abortion, there are too many abortions, and too many of them are too late. Even abortion’s fiercest advocates don’t pretend that it’s a Good Thing – just the lesser of two evils.
In 2010 there were 189,574 abortions in England and Wales – an 8% increase in a decade. The tightly policed regime envisaged in 1967, when the Act became law, hasn’t existed for ages, if indeed it ever did. There is abortion on demand, whatever the statute book says.
1967 was a long time ago. There have been many medical advances and societal changes since then. It’s time to take stock of the Act.
That’s what a recently announced cross-party commission, to be chaired by Fiona Bruce MP, will do.
It will focus, rightly, on two issues: medical advances and attitudes to discrimination. Continue reading
Flu researchers impartially decide dangerous flu research is safe
Flu researchers have looked deeply at their own field, and decided that everything they were doing is all fine. Where the potentially hideously dangerous H5N1 bird-flu virus is concerned,
They said that the benefits of the research in preventing and dealing with a future flu pandemic outweigh the risks of an accidental leak of the mutant virus from a laboratory or the deliberate attempt to create deadly strains of flu by terrorists or rogue governments.
Outside scientists were instead of the opinion that:
[...] if airborne transmission became possible it would lead to a deadly flu pandemic killing millions of people because most of the individuals who are known to have been infected with H5N1 die from the virus.
and even other virologists claim:
The risks are clear for all to see and the benefits are qualitative, and that’s rather weak. Civil scientists are not here to increase the risk from microbes. We are not here to make the microbial world more dangerous.
It’s quite simple here. The flu researchers are not evil people, and they certainly believe they’re doing the right thing. But it is blatantly clear that people inside their own research community, are unavoidably biased in assessing the risks of their own research.
When you think you’re doing the right thing, but all outsiders are screaming for you to stop, that is the moment to step outside your own self-assessment and stop doing what you’re doing, and think deeply before continuing.
Abortion and the cognitively impaired mother
It will be interesting to watch the reception of a recent Court of Protection case, as yet unreported, in which a woman with profound learning difficulties was found to have capacity to decide not to terminate her pregnancy.
As so often, the case decided nothing new. But it is a timely reminder of the trite but often overlooked principle that capacity is not an all or nothing thing. The question: ‘Does she have capacity?’ is always dangerously incomplete. The correct question is always ‘Does she have capacity to decide X?’
There was no doubt that she did not have capacity to manage many aspects of her affairs. She was in the bottom 1% of the population so far as intellectual function was concerned. Deputies were appropriately appointed. But, so far as the continuation of her pregnancy was concerned, so what?
It was decided as a matter of fact that she had capacity to decide whether or not to continue with, or to terminate, the pregnancy. And that meant that the Court of Protection had no jurisdiction to decide the matter. No best interests determination could lawfully be made. Continue reading
The Best Practical Ethics Books of the Year…
By the editors of the Practical Ethics blog.
What is the best practical ethics book you read this year, and what is so good about it (in 1-3 sentences)?
We asked this question to our colleagues at the Oxford Uehiro Centre for Practical Ethics. To our surprise, not a single title received multiple votes. This perhaps indicates that so many good books in the field appeared in the last couple of years, or perhaps a different explanation is due. Either way, below is the list of the recent titles we found excellent:
The Ends of Harm: The Moral Foundations of Criminal Law by Victor Tadros
‘In this book, Tadros provides a highly engaging non-consequentialist account of the permissible harming of others. It is an important and illuminating work containing a number of original insights’. – David Birks
The Ethics of Transplants: Why Careless Thought Costs Lives by Janet Radcliffe Richards
‘I give this out to people as a paradigm example of how to do good practical philosophy, especially in medical ethics. Janet dismembers bad arguments, like a pathologist dissecting a corpse riddled with metastatic cancer, and reveals the diagnosis, chapter after chapter. It is a fine example in the now neglected method of giving sound arguments, and exposing invalid ones. It is unabashedly pre-postmodernist and, as such, is intelligible and useful to any thoughtful person, specialist or non-specialist.– Julian Savulescu
Moralizing Technology: Understanding and Designing the Morality of Things by Peter-Paul Verbeek
‘A thought-provoking account of human-technology relation that calls for a new understanding of and method for ethics in our technological age. This book will surely give you some food for thought. Perhaps, it will even change the way you understand the technologies around you’. – Pak-Hang Wong
Philosophy and the Environment ed. by Anthony O’Hear
‘Philosophy and the Environment contains several excellent papers, including an outstanding piece by David Wiggins, which is both ethical and practical’. – Roger Crisp
The Prison Officer by Alison Liebling, David Price, and Guy Shefer
‘Most of us never face extreme violence, aggression, corruption and despair, let alone need to make good, daily decisions about how to manage it effectively and with moral decency. Prison officers do. This book explores the psychology of prison officers and their relationships with prisoners, revealing what it is to do this demanding job well and carve morality out of the chaos often found within prisons’. – Hannah Pickard
The Righteous Mind: Why Good People Are Divided by Politics and Religion by Jonathan Haidt
‘The Righteous Mind synthesises Haidt’s influential work on different aspects of moral psychology, to create a unified vision of the field, and it is having significant influence accross a variety of academic disciplines’. – Stephen Clark
Skepticism and Freedom: A Modern Case for Classical Liberalism by Richard A. Epstein
‘An interesting consequentialist defence of classical liberalism, limited government and free markets by an eminent academic lawyer. Philosophers may think some of the philosophical arguments go by rather quickly, but this is to miss the peculiar virtue of the book. His knowlege of the way law has worked in practice and the commonalities of law across culture and history fills out the defence with the kind of important and illuminating facts that philosophers rarely know’. – Nicholas Shackel
‘The Spirit of Compromise skilfully combines normative reasoning with empirical analysis to provide concrete suggestions to correct some of the most serious deficiencies in contemporary democratic politics. It brilliantly shows how the “policy implications” of normative theory can be more than a polite gesture towards funding bodies’. – Kei Hiruta
Thinking, Fast and Slow by Daniel Kahneman
‘A nice summary of the evidence he’s compiled during the course of his brilliant career into the scary levels of human irrationality’. – David Edmonds
Why Some Things Should Not Be for Sale: The Moral Limits of Markets by Debra Satz
‘It draws on philosophy, economics, and anthropology to present a sophisticated and nuanced appraisal of the moral consequences of markets in human organs, sex and other actual or potential commodities. In doing so, it moves the debate about markets beyond the standard trite claims about efficiency, equality, or human dignity’. – Simon Rippon
‘1493 is a beautifully written and deeply insightful exploration of how hard it is (and has always been) to anticipate the human consequences of globalization’. – Regina Rini
Is your favourite recent title listed above, or do you have other suggestions? Please reply below to share with us the practical ethics book you found most interesting this year!
Affiliations
Recent Comments