Written by Angeliki Kerasidou & Ruth Horn, The Ethox Centre, Nuffield Department of Population Health, University of Oxford
Recently, a number of media reports and personal testimonies have drawn attention to the intense physical and emotional stress to which doctors and nurses working in the NHS are exposed on a daily basis. Medical professionals are increasingly reporting feelings of exhaustion, depression, and even suicidal thoughts. Long working hours, decreasing numbers of staff, budget cuts and the lack of time to address patients’ needs are mentioned as some of the contributing factors (Campbell, 2015; The Guardian, 2016). Such factors have been linked with loss of empathy towards patients and, in some cases, with gross failures in their care (Francis, 2013). Continue reading
Professor Walter Sinnott-Armstrong (Duke University and Oxford Martin School Visiting Fellow) proposes to use the market forces to solve problems of conscientious objection in healthcare in the US. (He also has a suggestion for how to deal with conscientious objection in a public healthcare system + gives a controversial answer to my question regarding discriminatory treatment of patients.)
Dr Steve Clarke (Charles Sturt University) argues that we should use military tribunals for conscientious objectors in the military as a model for dealing with conscientious objection in healthcare.
In an interview with Dr Katrien Devolder, Professor Julian Savulescu (Oxford) argues that doctors should not impose their religious or non-religious values on patients if this conflicts with the delivery of basic public healthcare.
In the second of a series of interviews by Dr Katrien Devolder which the Practical Ethics in the News blog is currently hosting Alberto Giubilini argues against conscientious objection in healthcare.
See the interview here: https://www.youtube.com/watch?v=hY2XY7uXUfA
Please see here to read further on this issue, and to see information on the recent conference on conscience and conscientious objection in healthcare organised by Alberto Giubilini.
Guest Post by Bill Gardner @Bill_Gardner
Many researchers and physicians assert that randomized clinical trials (RCTs) are the “gold standard” for evidence about what works in medicine. But many others have pointed to both strengths and limitations in RCTs (see, for example, Austin Frakt’s comments on Angus Deaton here). Nancy Cartwright is a major philosopher of science. In this Lancet paper she provides insights into why RCTs are so highly valued and also why they are by themselves insufficient to answer the most important questions in medicine.
X, a patient with reliably diagnosed PVS, lies in a hospital bed for years, fed via a nasogastric tube. He has not, and by definition never will have, any capacity for pain, pleasure or any sort of sensation. Devoted family members come each day to sit by his bedside, but he has no idea that they are devoted, or that they exist.
It is expensive to keep him alive. He occupies a bed and consumes a good deal of nursing time.
The NHS Trust responsible for his care has a limited budget. It decides that the money spent on maintaining his merely biological life would be better spent on dialysis machines. It can, and does, justify its decision in purely utilitarian terms. It writes in the minutes of the relevant committee meeting: ‘For the money we spend keeping X alive, we can save the lives of 10 kidney patients, each of whom will have a good quality of life for many years. The QALY arithmetic makes X’s continued existence nonsensical.’ Continue reading