medical ethics

Cross Post: You Could Lie To A Health Chatbot – But It Might Change How You Perceive Yourself

Dominic Wilkinson, Consultant Neonatologist and Professor of Ethics, University of Oxford

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

Imagine that you are on the waiting list for a non-urgent operation. You were seen in the clinic some months ago, but still don’t have a date for the procedure. It is extremely frustrating, but it seems that you will just have to wait.

However, the hospital surgical team has just got in contact via a chatbot. The chatbot asks some screening questions about whether your symptoms have worsened since you were last seen, and whether they are stopping you from sleeping, working, or doing your everyday activities.

Your symptoms are much the same, but part of you wonders if you should answer yes. After all, perhaps that will get you bumped up the list, or at least able to speak to someone. And anyway, it’s not as if this is a real person. Continue reading

Cross Post: Should A Health Professional Be Disciplined For Reporting An Illegal Abortion?

Written by: Prof Dominic Wilkinson, University of Oxford

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

There have been several high-profile cases in the last year of women in the UK being prosecuted for allegedly obtaining abortions illegally. In 2022, there were 29 cases of suspected unlawful abortions that were reported to police – almost a twofold rise on the number reported four years earlier.

In response to this, the Royal College of Obstetrics and Gynaecologists (RCOG) has issued guidance that seeks to clarify the legal obligations of healthcare professionals. The full guideline has not yet been released, but the RCOG insists that professionals “are under no legal obligation to contact the police following an abortion, pregnancy loss or unattended delivery”. Continue reading

Event Summary: New St Cross Special Ethics Seminar: Should people have indefinite lifespans? Ethical and social considerations in life-extension, Professor João Pedro de Magalhães

Written by: Dr Amna Whiston

 

On Thursday, 16th November 2023, Professor João Pedro de Magalhães, a prominent microbiologist specialising in ageing and longevity research, gave an engaging and personable New St Cross Ethics Seminar entitled: ‘Should people have indefinite lifespans? Ethical and social considerations in life-extension?’

Following a brief introduction to the biology of ageing, de Magalhães explained the potential intervening with the ageing process, in advance of discussing the ethical and social implications of extending life span. De Magalhães humbly noted at the beginning of his talk that the importance of ethical and social considerations of biomedical research is sometimes underappreciated by the scientists working in this area. However, he argued that the scientific effort to counter ageing is ethical since it aims to enable people to have long and healthy lives for as long as possible. Continue reading

Guest Post: Nothing if not family?

Written by Daniela Cutas Lund University

What are genetic relatives to each other if they are not de facto relatives? Is there no relation between a donor-conceived person and their gamete donor? Between the donor-conceived person and the donor´s other offspring or parents or aunts and uncles? Should parents facilitate acquaintance between their children and their children´s gamete donors or donor siblings or other close genetic relatives?

Answers to these questions will differ depending on how one regards the significance of genetic ties. For some, genetic ties equal real relatedness between people: blood is thicker than water, and your genetic relatives ultimately are your family. Anything else is at best a proxy, and at worst a lie. For others, the focus on genes and genetic relatedness is irrational and potentially harmful. It reinforces prejudice and reduces people to their biological components and the relationships between them to combinations of genes. Both these and other attitudes are simultaneously represented in many cultures and legislatures in the Western world. Sometimes, parents of donor-conceived children, who see themselves without a doubt as their children´s rightful parents, may fear that their children may choose to see the gamete donors as their parents instead. Other parents and children may be blissfully in sync with each other but find themselves in extended families and communities in which others see things differently and behave accordingly. Continue reading

Video Interview: Introducing Academic Visitor Dr María de Jesús Medina Arellano

An interview with academic visitor Dr María de Jesús Medina Arellano, Professor and Researcher at the Institute of Legal Research at the National Autonomous University (UNAM), on her research focusing on the ethics and regulation of biotechnologies in developing countries, such as stem cell science, human genome editing and reproductive technologies.

Cross Post: Dutch Government to Expand Euthanasia Law to Include Children Aged One to 12 – An Ethicist’s View

Written by Dominic Wilkinson, University of Oxford

Ernst Kuipers, the Dutch health minister, recently announced that regulations were being modified to allow doctors to actively end the lives of children aged one to 12 years who were terminally ill and suffering unbearably.

Previously, assisted dying was an option in the Netherlands in rare cases in younger children (under one year) and in some older teenagers who requested voluntary euthanasia. Until now, Belgium was the only country in the world to allow assisted dying in children under 12.

Under the proposal, it will remain against the law for doctors in the Netherlands to actively end the life of a child under the age of 12. However, a force majeure clause gives prosecutors the discretion not to prosecute in exceptional circumstances.

In 2005, Dutch doctors and legal experts published guidelines (the so-called “Groningen protocol”) elaborating when these exceptional circumstances would apply for infants under the age of one year. That included certainty about diagnosis and prognosis, “hopeless and unbearable suffering”, the support of both parents and appropriateness confirmed by an independent doctor.

The new regulations would allow the same principles to apply to children between one and 12 years of age. Continue reading

Cross Post: Halving Subsidised Psychology Appoints is a Grave Mistake—Young Australians Will Bear a Significant Burden 

Written by Dr Daniel D’Hotman, DPhil student studying mental health and ethics at the Oxford Uehiro Centre

The original version of this article was published in the Sydney Morning Herald

Unprecedented times called for unprecedented measures. COVID-19 was the most significant health crisis many of us had ever faced. While the physical effects were much discussed, the mental health burden was arguably just as devastating. In response, the previous Government doubled subsidised mental health appointments under the Better Access Program, allowing Australians suffering from mental illnesses like anxiety, PTSD and depression to claim an extra 10 appointments per year.

Now we are trying to convince ourselves COVID-19 and its impacts are over. In addition to requiring referrals for some PCR tests, the Australian Government is cutting the number of mental health visits available under Medicare to pre-pandemic levels, arguing this is a necessary step to improve equity. According to a review of the program, extra appointments clogged up waitlists and reduced access for those not engaging with services. Continue reading

Protecting Children or Policing Gender?

Laws on genital mutilation, gender affirmation and cosmetic genital surgery are at odds. The key criteria should be medical necessity and consent.

By Brian D. Earp (@briandavidearp)

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In Ohio, USA, lawmakers are currently considering the Save Adolescents from Experimentation (SAFE) Act that would ban hormones or surgeries for minors who identify as transgender or non-binary. In April this year, Alabama passed similar legislation.

Alleging anti-trans prejudice, opponents of such legislation say these bans will stop trans youth from accessing necessary healthcare, citing guidance from the American Psychiatric Association, the American Medical Association and the American Academy of Pediatrics.

Providers of gender-affirming services point out that puberty-suppressing medications and hormone therapies are considered standard-of-care for trans adolescents who qualify. Neither is administered before puberty, with younger children receiving psychosocial support only. Meanwhile genital surgeries for gender affirmation are rarely performed before age 18.

Nevertheless, proponents of the new laws say they are needed to protect vulnerable minors from understudied medical risks and potentially lifelong bodily harms. Proponents note that irreversible mastectomies are increasingly performed before the age of legal majority.

Republican legislators in several states argue that if a child’s breasts or genitalia are ‘healthy’, there is no medical or ethical justification to use hormones or surgeries to alter those parts of the body.

However, while trans adolescents struggle to access voluntary services and rarely undergo genital surgeries prior to adulthood, non-trans-identifying children in the United States and elsewhere are routinely subjected to medically unnecessary surgeries affecting their healthy sexual anatomy — without opposition from conservative lawmakers.

Continue reading

Event Summary: Hope in Healthcare – a talk by Professor Steve Clarke

In a special lecture on 14 June 2022, Professor Steve Clarke presented work co-authored with Justin Oakley, ‘Hope in Healthcare’.

It is widely supposed that it is important to imbue patients undergoing medical procedures with a sense of hope. But why is hope so important in healthcare, if indeed it is? We examine the answers that are currently on offer and show that none do enough to properly explain the importance that is often attributed to hope in healthcare. We then identify a hitherto unrecognised reason for supposing that it is important to imbue patients undergoing significant medical procedures with hope, which draws on prospect theory, Kahneman and Tversky’s hugely influential descriptive theory about decision making in situations of risk and uncertainty. We also consider some concerns about patient consent and the potential manipulation of patients, that are raised by our account. We then consider some complications for the account raised by religious sources of hope, which are commonly drawn on by patients undergoing major healthcare procedures.

Bio: Steve Clarke is a Professor in the Centre for Applied Philosophy and Public Ethics, Charles Sturt University, and a Senior Research Associate in the Uehiro Centre for Practical Ethics at the University of Oxford.

This lecture was jointly organised between the Wellcome Centre for Ethics and Humanities and Oxford Uehiro Centre for Practical Ethics.

Recordings available at
YouTube https://youtu.be/o5e22qnZeaQ

Oxford Podcasts http://media.podcasts.ox.ac.uk/philfac/uehiro/2022-06-23-uehiro-hope-clarke.mp3

Transcript https://media.podcasts.ox.ac.uk/philfac/uehiro/2022-06-23-uehiro-hope-clarke.srt

Returning To Personhood: On The Ethical Significance Of Paradoxical Lucidity In Late-Stage Dementia

By David M Lyreskog

About Dementia

Dementia is a class of medical conditions which typically impair our cognitive abilities and significantly alter our emotional and personal lives. The absolute majority of dementia cases – approximately 70% – are caused by Alzheimer’s disease. Other causes include cardiovascular conditions, Lewy body disease, and Parkinson’s disease. In the UK alone, it is estimated that over 1 million people are currently living with dementia, and that care costs amount to approximately £38 billion a year. Globally, it is estimated that over 55 million people live with dementia in some form, with an expected 10 million increase per year, and the cost of care exceeds £1 trillion. As such, dementia is widely regarded as one of the main medical challenges of our time, along with cancer, and infectious diseases. As a response to this, large amounts of money have been put towards finding solutions over decades. The UK government alone spends over £75 million per year on the search for improved diagnostics, effective treatments, and cures. Yet, dementia remains a terrible enigma, and continues to elude our grasp.

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