medical ethics

Medical Nihilism: When A Dose Of Scepticism Can Be Healthy

In his 2018 book, the philosopher of science, Jacob Stegenga defends the view “that we should have little confidence in the effectiveness of medical interventions.” (Stegenga 2018) On the face of it, he acknowledges, this position seems unreasonable: most of us can think of myriad ways in which modern medicine has improved – perhaps saved – our own lives and the lives of those close to us. The asthma attack I had as a baby, effectively treated at the time and subsequently managed through the use of seemingly magical medications which relax the muscles around the airways, opening them up and allowing air to pass freely again. Or the schoolfriend whose ruptured appendix could have resulted in a fatal infection, but for emergency surgery and the administration of antibiotics. Or the countless lives made less painful by the availability of cheap and safe painkillers. 

Medical sceptics tend to get a bad rep – anti-vaxxers who risk the lives of children by regurgitating debunked myths about the links between vaccines and autism, leading to dips in herd immunity and disease outbreaks; credulous folk who believe in the mystical powers of homeopathy and eschew conventional therapies in favour of potions that contain little more than water. This is not the sort of company one wishes to associate with. Continue reading

Human In Vitro Gametogenesis and the Same-Sex Marriage Debate

Written by César Palacios-González

It seems that in the not-so-distant future, scientists will be able to create functional human gametes (i.e. eggs and sperm) in a laboratory setting. In other words, they will be able to create human gametes outside of the human body. And just as there is in vitro fertilization (IVF), there will be in vitro gametogenesis (IVG). This means that our already long list of human reproductive acronyms –IVF, PGD, ICSI, PNT, PBT1, PBT2, MST, UTx, CT, etc.–  will get a bit longer. At present, some of the best biology labs from around the world are actively working on how to achieve such goal, and non-human animal models have shown some amazing results.

For starters, scientists have successfully derived in a laboratory setting mouse oocyte-like cells and sperm-like cells from induced pluripotent stem cells and embryonic stem cells. And, most surprisingly, they have been able to create what has been called “cross-sex gametes”. This means that they have been able to create sperm-like cells from female mice, and oocyte-like cells from male mice (I use the terms ‘sperm-like’ and ‘oocyte-like’ because these cells are not identical to naturally occurring gametes). Some of such cross-sex gametes have, in turn, been capable of producing live offspring. Continue reading

Cross Post: Fresh Urgency in Mapping Out Ethics of Brain Organoid Research

File 20181120 161641 npf87x.jpg?ixlib=rb 1.1

Written by Julian Koplin, University of Melbourne and

Julian Savulescu, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

 

Researchers have grown groups of brain cells in the lab –
known as ‘organoids’ – that produce brain waves resembling
those found in premature infants.
from www.shutterstock.com

 

Scientists have become increasingly adept at creating brain organoids – which are essentially miniature human brains grown in the laboratory from stem cells.

Although brain organoid research might seem outlandish, it serves an important moral purpose. Among other benefits, it promises to help us understand early brain development and neurodevelopmental disorders such as microcephaly, autism and schizophrenia.

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Lecture and Book Launch: Ethics, Conflict and Medical Treatment for Children – From Disagreement to Dissensus

Watch the lecture by Professors Dominic Wilkinson and Julian Savulescu at the book launch for ‘Ethics, Conflict and Medical Treatment for Children’, which took place on 4 October at the Oxford Martin School, University of Oxford.

 

UK Supreme Court Decision Means Patients No Longer Forced to Live

By Mackenzie Graham

On July 30, The UK’s Supreme Court ruled that there is no requirement to obtain court approval before withdrawing clinically assisted nutrition and hydration (CANH), when there is agreement between physicians and the family that this is in the best interests of the patient.

In the judgement, Lady Black writes:

“If the provisions of the MCA [Mental Capacity Act] 2005 are followed and the relevant guidance observed, and if there is agreement upon what is in the best interests of the patient, the patient may be treated in accordance with that agreement without application to the court.”

Until now, requests to withdraw CANH needed to be heard by the Court of Protection to determine if withdrawing treatment was in the patient’s best interest. In addition to being emotionally difficult for families, this is a time-consuming and expensive process, and often results in the patient dying before a judgement is rendered.

I think this decision has much to be said in its favour. First, it means that when there is agreement that continued treatment is no longer in the best interests of a patient with a prolonged disorder of consciousness, these patients are no longer being ‘forced to live’ until the Court affirms that being allowed to die is in their best interests. In many cases, court decisions take months, meaning that a patient is forced to be kept alive, against their best interests and the wishes of their family. Making the decision to withdraw care from a loved one is highly distressing, and this is likely further compounded by the burden and distraction of court proceedings.

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Dementia and the Social Scaffold of Memory

By Jonathan Pugh

 

The number of individuals suffering with dementia is steadily increasing; as such, the moral issues raised by the neurodegenerative diseases that bring about the symptoms typifying dementia are of pressing practical concern. In this context, Richard Holton’s topic for the first of his three 2018 Uehiro lectures (on the theme “Illness and the Social Self”) is a timely one: What are the ethical implications of the progressive and pervasive loss of memory that is a central feature of dementia?

I shall be blogging a synopsis of each lecture in the series on the Practical Ethics blog – You can find a recording of the lecture here

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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).

Harmless Kidney Markets

Written by Adam Shriver

@adamjshriver

Kidney transplants result in improved quality of life and increased longevity compared to dialysis for patients with end-stage renal disease (Evans et al. 1985, Schnuelle et al. 1998, Wolfe et al 1999).  In 2014, the national transplant list in the United States passed a milestone of 100,000 people waiting for kidneys.  However, the current rate of kidney donations, both from living and deceased donors, is not high enough to keep up with demand (Becker & Elias 2007). As a result, many people die each year and the quality of life of many more people is significantly diminished.

In response to this problem, various authors have proposed the creation of a regulated market for kidneys whereupon individuals may sell one of their kidneys in exchange for money and possibly other benefits (Matas et al. 2008, Gaston et al. 2006, Radcliffe-Richards et al. 1998, Radcliffe-Richards 2012, Veatch 2003).  Kidney sellers could be paid relatively large amounts of money (~$95,000) while maintaining a cost-effective system due to the savings obtained from moving people off dialysis (Matas 2008).  If implemented, a regulated kidney market could result in important increases in quality of life and in survival rates.

I admit I find the arguments from authors such as Matas and Radcliffe-Richards largely persuasive.  Nevertheless, their proposals have been subject to a number of criticisms from ethicists that pull on strong moral intuitions.  In what follows, I present an alternative model for a kidney market that I believe avoids the most serious objections to kidney markets.  In contrast to previous arguments that suggest that the benefits of regulated kidney markets would outweigh the harms, I will propose a model that is harmless, on the best way of understanding a harmful practice.  If, as I argue, we can design a kidney market where the decision to give up a kidney does not harm the seller, this suggests that we can reap the benefits of a kidney market without the ethical costs that have raised concerns. Continue reading

Guest Post: The Real Problem With Human Head Transplantation

Written by Michael S. Dauber, MA

In 2015, Sergio Canavero announced that he would perform a therapeutic head transplant procedure on a human subject by December 2017. Since then, he has recruited the assistance of surgeon Xiaoping Ren and switched from Valery Spiridonov to an anonymous Chinese patient whose medical condition remains undisclosed. The procedure, which consists of removing the patient’s head and attaching it to a decapitated donor body, is expected to be carried out in China, will cost tens of millions of dollars, and will require dozens of surgeons. The procedure returned to international attention this week when Canavero announced he had successfully performed the procedure on a human cadaver, and said that the announcement of an official procedure date was “immanent.” Continue reading

Video Series: John Harris Defends Gene-Editing in Human Embryos

Novel gene editing technologies, such as CRISPR/Cas9, allow scientists to make very precise changes in the genome of human embryos. This could prevent serious genetic diseases in future children. But the use of gene editing in human embryos also raises questions: Is it safe? Should prospective parents be free to choose the genetic characteristics of their children? What if they want to use gene editing to have a deaf child, or a child with fair skin and blue eyes? Should gene editing be regulated globally, or should each country have their own legislation? In this interview with Katrien Devolder, John Harris (Professor Emeritus, University of Manchester &  Visiting Professor in Bioethics, King’s College London) answers these and other questions, and defends the view that we have the strongest moral obligation to gene-edit human embryos, not only to prevent disease but also for the purpose of enhancement.

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