Regulation

Three Ethical Ways to Increase Organ Donation in Australia

Authors: William Isdale & Julian Savulescu

An edited version of this post was published by The Conversation

Last week the Federal Government announced that there would be a review of Australia’s tissue and organ transplantation systems. The impetus for the review appears to be continually disappointing donation rates, despite the adoption of a national reform agenda in 2008.

Since 2008 there has been an increase from 12.1 dpmp  (donations per million population) to a peak of 16.9 in 2013 – but the dip last year (to 16.1) indicates that new policies need to be considered if rates are to be substantially increased.

Australia’s donation levels remain considerably below world’s best practice, even after adjusting for rates and types of mortality. At least twenty countries achieve better donation rates than Australia, including comparable countries like Belgium (29.9), USA (25.9), France (25.5) and the UK (20.8).

The review will focus in particular on the role of the national Organ and Tissue Authority,  which helps coordinate donation services. However, many of the key policy settings are in the hands of state and territory governments.

It is time to go beyond improving the mechanisms for implementing existing laws, and to consider more fundamental changes to organ procurement in Australia.

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What to do with Google—nothing, break it up, nationalise it, turn it into a public utility, treat it as a public space, or something else?

Google has become a service that one cannot go without if one wants to be a well-adapted participant in society. For many, Google is the single most important source of information. Yet people do not have any understanding of the way Google individually curates contents for its users. Its algorithms are secret. For the past year, and as a result of the European Court of Justice’s ruling on the right to be forgotten, Google has been deciding which URLs to delist from its search results on the basis of personal information being “inaccurate, inadequate or no longer relevant.” The search engine has reported that it has received over 250,000 individual requests concerning 1 million URLs in the past year, and that it has delisted around 40% of the URLs that it has reviewed. As was made apparent in a recent open letter from 80 academics urging Google for more transparency, the criteria being used to make these decisions are also secret. We have no idea about what sort of information typically gets delisted, and in what countries. The academics signing the letter point out how Google has been charged with the task of balancing privacy and access to information, thereby shaping public discourse, without facing any kind of public scrutiny. Google rules over us but we have no knowledge of what the rules are.

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Strange brew: opiates from yeast

A recent series of papers have constructed a biochemical pathway that allows yeast to produce opiates. It is not quite a sugar-to-heroin home brew yet, but putting together the pieces looks fairly doable in the very near term. I think I called the news almost exactly five years ago on this blog.

People, including the involved researchers, are concerned and think regulation is needed. It is an interesting case of dual-use biotechnology. While making opiates may be somewhat less frightening than making pathogens, it is still a problematic use of biotechnology: millions of people are addicted, and making it easier for them to get access would worsen the problem. Or would it?

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What’s Wrong With Giving Treatments That Don’t Work: A Social Epistemological Argument.

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

A Challenge to Gun Rights

Written By Professor Jeff McMahan

 

On this day in the US, around thirty people will be killed with a gun, not including suicides.  Many more will be wounded.  I can safely predict this number because that is the average number of homicides committed with a gun in the US each day.  Such killings have become so routine that they are barely noticed even in the local news.  Only when a significant number of people are murdered, particularly when they include children or are killed randomly, is the event considered newsworthy.

 

Yet efforts to regulate the possession of guns in the US are consistently defeated. Continue reading

There are things that even lawyers won’t do

Despite all the jokes there are, in fact, a lot of things that lawyers won’t do. Or at least shouldn’t do. In many jurisdictions qualified lawyers are subject to strict ethical codes which are self-policed, usually effectively, and policed too by alert and draconian regulatory bodies.

Is there any point, then, in law firms having their own ethics committees which would decide:

(a)        how the firm should deal with ethical questions arising in the course of work?; and/or

(b)       whether the firm should accept particular types of work, particular clients or particular cases? 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.

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Smoking, Ice-Cream and Logical Progressions: Why We Shouldn’t Ban Smoking in Outdoor Public Places

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

Gambling on Liberty

Fixed Odd Betting Terminals (FOBTs) allow punters to bet up to £100 a time in casino games such as roulette. Bookmakers are allowed four terminals in each shop, and there are now around 35,000 of them in the UK. In the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) gambling disorder is described in the chapter on substance-disorder and related disorders. It was recently reported that industry-funded research showed that levels of ‘problem gambling’ among those using these machines ran at around 23%. Continue reading

Equality and the Clinical Trial Dating Agency

The first advert for the sale of a clinical trial place offers, for $2 million, the chance to participate as a patient in a trial investigating the Farmington virus (FARV) and its potential efficacy in treating certain forms of brain tumours. Meanwhile, Alexander Masters has written convincingly about his idea for a clinical trial dating agency: matching wealthy but sick donors with scientists who have an idea for a cure but no money for a trial (shorter version also available). In Masters’ idea as in the real life case, the proposal is that the wealthy donor will pay not just for himself or herself, but enough for the trial to go ahead with a full complement of those who could not otherwise afford it, recruited on the same basis as any trial.

Predictably, ethical concerns have been raised, perhaps the main one being equality: “In the UK, the principles in participating in clinical trials include open and equal access for those who chose to participate” (Kate Law, director of clinical and population research at Cancer Research UK, quoted in The Telegraph ).

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