The Dangers Of Deferring To Doctors

By Charles Foster

(Image: tctmd.com)

There is a dizzying circularity in much medical law. Judges make legal decisions based on the judgments of rightly directed clinicians, and rightly directed clinicians make their judgments based on what they think the judges expect of them. This is intellectually unfortunate. It can also be dangerous.

There are two causes: Judges’ reluctance to interfere with the decisions of clinicians, and doctors’ fear of falling foul of the law.

In some ways judicial deference to the judgment of professionals in a discipline very different from their own is appropriate. Judges cannot be doctors. The deference is best illustrated by the famous and ubiquitous Bolam test, which is the touchstone for liability in professional negligence cases.1 A doctor will not be negligent if their action or inaction would be endorsed by a responsible body of professional opinion in the relevant specialty.

In the realm of civil litigation for alleged negligence this deference is justified. The problem arises when the deference is exported to legal arenas where it should have no place. The classic example relates to determinations of the ‘best interests’ of incapacitous patients. Something done in relation to an incapacitous patient will only be lawful if it is in that patient’s best interests. Continue reading

Pain for Ethicists #2: Is the Cerebral Cortex Required for Pain? (Video)

Here’s my presentation from the UQAM 2018 Summer School in Animal Cognition organised by Stevan Harnad:

I also highly recommend Jonathan Birch’s talk on Animal Sentience and the Precautionary Principle and Lars Chittka’s amazing presentation about the minds of bees.

Thanks again to EA Grants for supporting this research as well as my home institutions Uehiro & WEH. And thanks to Mélissa Desrochers for the video.

You can find the first Pain for Ethicists post here.

Adam Shriver is a Research Fellow at the Oxford Uehiro Centre for Practical Ethics and the Wellcome Centre for Ethics and Humanities.

Follow him on Twitter.

Illness and Attitude – Richard Holton’s 3rd Uehiro Lecture

By Jonathan Pugh

 

In the final lecture of the 2018 Uehiro lecture series, Richard Holton concluded his reflections on the theme of ‘illness and the social self’ by turning to questions about how attitudes can play a role in the onset of medical disorders, with a particular focus on psycho-somatic disorders.

 

You can find a recording of the lecture here

 

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Coffee with Colleagues: Caffeine is a “Social” Enhancer

By Nadira Faber

The coffee you are having with your colleagues at a business meeting does more than keep you awake. Many of us know that caffeine can help with alertness and working memory – the first systematic study on caffeine and performance, sponsored by Coca-Cola, was published over 100 years ago. But did you know caffeine can also have “social” effects?

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Video Series: Tom Douglas Defends the Chemical Castration of Sex Offenders

The Minister of Justice in the UK wants to dramatically increase the use of chemical castration in sex offenders to reduce their risk of reoffending.Dr Tom Douglas (University of Oxford) argues that offering chemical castration to sex offenders might be a better option than current practices to prevent sex offenders from reoffending (e.g. incarceration), and responds to concerns about coercion and interfering in sex offenders’ mental states (e.g. by changing their desires).

Neuroblame?

Written by Stephen Rainey

Brain-machine interfaces (BMIs), or brain-computer interfaces (BCIs), are technologies controlled directly by the brain. They are increasingly well known in terms of therapeutic contexts. We have probably all seen the remarkable advances in prosthetic limbs that can be controlled directly by the brain. Brain-controlled legs, arms, and hands allow natural-like mobility to be restored where limbs had been lost. Neuroprosthetic devices connected directly to the brain allow communication to be restored in cases where linguistic ability is impaired or missing.

It is often said that such devices are controlled ‘by thoughts’. This isn’t strictly true, as it is the brain that the devices read, not the mind. In a sense, unnatural patterns of neural activity must be realised to trigger and control devices. Producing the patterns is a learned behaviour – the brain is put to use by the device owner in order to operate it. This distinction between thought-reading and brain-reading might have important consequences for some conceivable scenarios. To think these through, we’ll indulge in a little bit of ‘science fiction prototyping’.

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Video Series: Tom Douglas on Using Neurointerventions in Crime Prevention

Should neurointerventions be used to prevent crime? For example, should we use chemical castration as part of efforts to prevent re-offending in sex offenders? What about methadone treatment for heroin-dependent offenders? Would offering such interventions to incarcerated individuals involve coercion? Would it violate their right to freedom from mental interference? Is there such a right? Should psychiatrists involved in treating offenders always do what is in their patients’ best interests or should they sometimes act in the best interests of society? Tom Douglas (Oxford) briefly introduces these issues, which he investigates in depth as part of his Wellcome Trust project ‘Neurointerventions in Crime Prevention’ (http://www.neurocorrectives.com).

Crosspost: Bring back the dead

A version of this post was originally published at The Conversation.

A trial to see if it is possible to regenerate brains in patients that have been declared clinically dead has been approved. Reanima Advanced Biosciences aims at using stem cells, injections of peptides, and nerve stimulation to cause regeneration in brain dead patients. The primary outcome measure is “reversal of brain death as noted in clinical examination or EEG”, which at least scores high on ambition. The study accepts healthy volunteers, but they need to be brain dead due to traumatic brain injury, which might discourage most people.

Is there any problem with this? Continue reading

Whose lifestyle benefits? Regulatory risk-benefit assessment of enhancement devices

Nearly everyone would agree that a device or drug that relieves pain, or alleviates symptoms of depression confers a benefit – plausibly, a substantial benefit – on its user. No matter what your goals are, no matter what you enjoy, you are likely to agree that your life will go better if you are not in pain and not depressed: whether you’re a painter, a footballer, a Sudoku-enthusiast or a musician, you will be better able to pursue your projects and engage in the activities you love. It is unlikely that you will even question whether pain relief or alleviation of depression indeed constitute benefits.

This general consensus with respect to medical benefits makes it relatively straightforward for regulators to conduct risk-benefit assessments of medical products when they decide whether a particular product can be put on the market. A very small risk of a mild rash or gastrointestinal upset, for example, will be considered reasonable in the context of effective pain relief, as long as patients or consumers are informed. Even as the risks get more significant, substantial pain relief will be considered a large enough benefit to out-weigh a range of negative side effects in many cases.

So far, so straightforward. Continue reading

The Allure of Donald Trump

The primary season is now well underway, and the Trump bandwagon continues to gather pace. Like most observers, I thought it would run out of steam well before this stage. Trump delights in the kinds of vicious attacks and stupidities that would derail any other candidate. His lack of shame and indifference to truth give him a kind of imperviousness to criticism. His candidacy no longer seems funny: it now arouses more horror than humor for many observers. Given that Trump is so awful – so bereft of genuine ideas, of intelligence, and obviously of decency – what explains his poll numbers?  Continue reading

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