Reporting on a Recent Event: Conscience And Conscientious Objection In Healthcare Conference

The Uehiro Centre for Practical Ethics (University of Oxford) and the Centre for Applied Philosophy and Public Ethics (Charles Sturt University) hosted a conference on conscientious objection in medicine and the role of conscience in healthcare practitioners’ decision making; The Conscience And Conscientious Objection In Healthcare Conference.  It was held at the Oxford Martin School on the 23rd and 24th of November, organised by Julian Savulescu (University of Oxford), Alberto Giubilini (Charles Sturt University) and Steve Clarke (Charles Sturt University)

For the full program please follow this link.

The conference was aimed at analyzing from a philosophical, ethical and legal perspective the meaning and the role of “conscience” in the healthcare profession. Conscientious objection by health professionals has become one of the most pressing problems in healthcare ethics. Health professionals are often required to perform activities that conflict with their own moral or religious beliefs (for example abortion). Their refusal can make it difficult for patients to have access to services they have a right to and, more in general, can create conflicts in the doctor-patient relationship. The widening of the medical options available today or in the near future is likely to sharpen these conflicts. Experts in bioethics, philosophy, law and medicine explored possible solutions.

The conference was supported by the Uehiro Centre for Practical Ethics and an Australian Research Council Discovery Grant (DP 150102068). We are grateful to the Oxford Martin School for providing the venue for the conference.

On the Oxford Uehiro Centre for Practical Ethics website you will find both video and audio files of various commentaries and talks from the conference.

If abolishing China’s one child policy led to more children, would it be so bad?

Written by Simon Beard

This is an unedited version of a paper which was originally published on The Conversation:

please see here to read the original article

After 35 years, the Chinese government recently announced the abolition of its controversial one child policy for one that will allow all Chinese citizens to have up to two children. Whilst this increased respect for personal autonomy is undoubtedly good, it is not clear if the lifting of the ban will actually lead to a marked increase in China’s birth rate – while the birth rate has dramatically reduced since the policy was introduced, so too have those of neighbouring countries without such policies.

Whether or not Chinese parents decide to use their new-found rights to procreate, the move does raise questions. Would it be good or bad if more children were now born in China and the population grew? And what value might there be in any changes to China’s population size and structure? Continue reading

Gene Editing: A CBC Interview of Margaret Somerville and Julian Savulescu

The following is a transcript of an interview conducted by Jim Brown from Canadian Broad Casting Corporation’s program, The 180, on 3 December between Margaret Somerville and Julian Savulescu

Margaret Somerville is the Founding Director of the Centre for Medicine, Ethics and Law, the Samuel Gale Chair in Law and Professor in the Faculty of Medicine at McGill University, Montreal. She’s also the author of the new book ‘Bird on an Ethics Wire: Battles about Values in the Culture Wars’.

Julian Savulescu is Uehiro Chair in Practical Ethics and Director of the Oxford Uehiro Centre for Practical Ethics at the University of Oxford.

JB: Julian Savulescu, if I could begin with you. You argue that there is a moral imperative for us to pursue gene editing research. Briefly, why do you think it’s so important for us to embrace this technology?

JS: Genetic engineering has been around for about 30 years, widely used in medical research, and also in agriculture, but gene editing is a new version of genetic engineering that is highly accurate, specific, and is able to modify genomes without causing side effects or damage. It’s already been used to create malaria-fighting mosquitoes, drought-resistant wheat, and in other areas of agriculture. But what’s currently being proposed is the genetic modification of human embryos, and this has caused widespread resistance. I think there’s a moral obligation to do this kind of research in the following way. This could be used to create human embryos with very precise genetic modifications, to understand how we develop, why development goes wrong, why genetic disorders occur. It could also be used to create embryonic stem cells with precise changes that might make subsequent stem cells, cancer-fighting stem cells, or even stem cells that fight aging. It could also be used to create tissue with say, changes to understand the origins of Parkinson’s disease or Alzheimer’s disease and develop drugs for the treatment of those diseases. This is what I’d call therapeutic gene editing, and because it stands to benefit millions of people who die every year of painful and debilitating conditions, we actually have a moral imperative to do it. What we ought to show more concern for and perhaps ban, is what might be called reproductive gene editing – editing embryos to create live-born babies that are free of genetic disease or perhaps more resistant to common, late-onset diseases or even enhanced in various ways. If we’re concerned about those sorts of changes in society, we can ban reproductive gene editing, yet also engage in the very beneficial research using genetically modified human embryos to study disease.

JB: And Margaret Somerville, what concerns you about this technology? 

MS: Well, I’m interested in the division that Julian makes between the reproductive gene editing and what he calls the therapeutic gene editing. I’m a little surprised that he might not agree with the reproductive gene editing – that is, you would alter the embryo’s germline, so that it wouldn’t be only altered for that embryo, but all the descendants of that embryo would be changed in the same way. And up until – actually, up until this year, there was almost universal agreement, including in some important international documents, that that was wrong, that was ethically wrong, it was a line that we must never step across, that humans have a right to come into existence with their own unique genetic heritage and other humans have no right to alter them, to design them. Julian uses the term genetic engineering – to make them, to manufacture them. Where we would disagree completely is with the setting up of what can be called human embryo manufacturing plants, that is, you would create human embryos in order to use them to make products that would benefit other people, you would use them for experimentation, for research. And Julian’s right, we could do a great deal of good doing that – but there’s a huge danger in looking only at the good that we do. And what we’re doing there is we’re using human life as a product. We’re transmitting human life with the intention of killing it by using it as a product, and I believe that’s wrong. I think that human embryos have moral status that deserves respect, which means they shouldn’t be treated just as products.

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Defaults, status quo, and disagreements about sex

Scott Alexander has a thoughtful piece about who gets to set the default in disagreements about what is reasonable. He describes a couple therapy session where one member is bored with his sex life and goes kinky clubbing, to the anger of his strongly monogamous partner. Yet both want to stay together at least for the sake of the kids. Assuming the answer is an either-or situation where one has to give up on their demand (likely not the ideal response in an actual couple therapy setting), the issue seems to boil down to who has the unreasonable demand.

It resonated with another article I came across in my news flow today: What It’s Like to Be Chemically Castrated. This article is an interview with a man who wanted to be chemically castrated in order to manage his sex addiction and save his 45-year marriage. Is this an unreasonable intervention?

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Video Interview with Professor Jeff McMahon on Increasing Airstrikes in Syria — The Ethics of War

In the first of a series of video interviews by Dr Katrien Devolder hosted by the Practical Ethics in the News blog, Jeff McMahan discusses the war in Syria.

In the aftermath of the Paris terror attacks, the US and France increased the number of airstrikes in Syria.

Is this increase justified?

See the full interview here: https://www.youtube.com/watch?v=Rd3-YrtVMoU

Engineering a Consensus:   Edit Embryos for Research, Not Reproduction

Written by Dr Chris Gyngell, Dr Tom Douglas and Professor Julian Savulescu

A crucial international summit on gene editing continues today in Washington DC. Organised by the US National Academy of Sciences, National Academy of Medicine, the Chinese Academy of Sciences, and the U.K.’s Royal Society, the summit promises to be a pivotal point in the history of the gene editing technologies.

Gene editing (GE) is a truly revolutionary technology, potentially allowing the genetic bases of life to be manipulated at will. It has already been used to create malaria-fighting mosquitoes, drought resistant wheat, hornless cows and cancer killing immune cells. All this despite the fact GE only become widely used in the past few years. The potential applications of GE in a decade are difficult to imagine. It may transform the food we eat, the animals we farm, and the way we battle disease. Continue reading

The Ethics of Genetically Modified Mosquitoes and Gene-Drive Technology

Written by Jonathan Pugh

This is an unedited version of a paper by Dr Pugh which was originally published on The Conversation:

please see here to read the original article

In a startling development in ‘gene-drive’ technology, a team of researchers at the University of California have succeeded in creating hundreds of genetically modified mosquitoes that are incapable of spreading the malaria parasite to humans, and which could potentially spread this trait rapidly throughout mosquito populations in the wild. This success has the potential to be translated into a huge global health benefit. Although global malarial deaths have been in decline over the past decade or so, WHO estimates that malaria has been responsible for over 400’000 deaths this year alone. The Anopheles genus of mosquito acts as the vector for malaria, as infected Anopheles mosquitoes transmit Plasmodium parasites to humans via their bites, and it is these parasites that cause malaria. Continue reading

Podcast: Justifications for Non-Consensual Medical Intervention: From Infectious Disease Control to Criminal Rehabilitation

Dr Jonathan Pugh’s St Cross Special Ethics Seminar on 12 November 2015 is now available at http://media.philosophy.ox.ac.uk/uehiro/MT15_STX_Pugh.mp3

Speaker: Dr Jonathan Pugh

Although a central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to that intervention, there are some circumstances in which it seems that this moral requirement may be trumped. For instance, in some circumstances, it might be claimed that it is morally permissible to carry out certain sorts of non-consensual interventions on competent individuals for the purpose of infectious disease control (IDC). In this paper, I shall explain how one might defend this practice, and consider the extent to which similar considerations might be invoked in favour of carrying out non-consensual medical interventions for the purposes of facilitating rehabilitation amongst criminal offenders. Having considered examples of non-consensual interventions in IDC that seem to be morally permissible, I shall describe two different moral frameworks that a defender of this practice might invoke in order to justify such interventions. I shall then identify five desiderata that can be used to guide the assessments of the moral permissibility of non-consensual IDC interventions on either kind of fundamental justification. Following this analysis, I shall consider how the justification of non-consensual interventions for the purpose of IDC compares to the justification of non-consensual interventions for the purpose of facilitating criminal rehabilitation, according to these five desiderata. I shall argue that the analysis I provide suggests that a plausible case can be made in favour of carrying out certain sorts of non-consensual interventions for the purpose facilitating rehabilitation amongst criminal offenders.

How much would you pay to live an extra year?

Dominic Wilkinson, University of Oxford

@Neonatalethics

Medical science continues to push at the boundaries of life and death with new drugs and technologies that can extend life or improve health. But these advances come at a cost. And that inevitably raises difficult questions about whether public health systems should pay for such treatments – and, if so, how much. For example, should the NHS fund the new breast cancer drug Kadycla which comes with a £90,000 price tag per patient?

Some countries make these difficult decisions by looking at the cost-effectiveness of new treatments. How much does the new treatment cost and how effective is it compared with existing treatments? Treatments may help patients live longer, or they may improve a patient’s quality of life (or both). Kadycla appears to extend life by about six months.

One mathematical way of combining these elements uses the concept of a Quality-Adjusted Life Year saved, or QALY. As an example, a treatment that extends life for one year but at a “quality” level of half normal it said to save 0.5 QALY. When treatments are assessed this way, health systems can then use a threshold to work out a maximum cost that is affordable. The National Institute for Health and Care Excellence (NICE) uses a threshold of £20,000-£30,000 for each Quality-Adjusted Life Year saved (QALY). This would mean (assuming full quality of life), that the NHS would be prepared to pay £10,000-15,000 for a course of Kadycla.

Saving time.
Bank by Shutterstock

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Loebel Lecture 3 of 3: What is the upshot?

Lecture 3 Audio [MP3] | YouTube link [MP4] 
Grove Auditorium, Magdalen College, Longwall Street, Oxford
5 November 2015, 6-8pm Continue reading

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