medical ethics

Mandating COVID-19 Vaccination for Children

Written by Lisa Forsberg and Anthony Skelton

In many countries vaccine rollouts are now well underway. Vaccine programmes in Israel, the United Kingdom, Chile, United Arab Emirates, Bahrain and the United States have been particularly successful. Mass vaccination is vital to ending the pandemic. However, at present, vaccines are typically not approved for children under the age of 16. Full protection from COVID-19 at a population level will not be achieved until most children and adolescents are inoculated against the deadly disease. A number of pharmaceutical companies have started or will soon start clinical trials to test the safety and efficacy of COVID-19 vaccinations in children and adolescents. Initial results of clinical trials seem promising (see also here and here).

There are strong reasons to inoculate children. COVID-19 may harm or kill them. It disproportionately affects already disadvantaged populations. For example, a CDC study published in August 2020 found the hospitalisation rate to be five times higher for Black children and eight times higher for Latino children than it is for white children. In addition, inoculating children is necessary for establishing herd immunity and (perhaps more importantly), as Jeremy Samuel Faust and Angela L. Rasmussen explained in the New York Times, preventing the virus from spreading and mutating ‘into more dangerous variants, including ones that could harm both children and adults’. Continue reading

Cross Post: There’s no Need to Pause Vaccine Rollouts When There’s a Safety Scare. Give the Public the Facts and Let Them Decide

Written By: Julian Savulescu, University of Oxford; Dominic Wilkinson, University of Oxford;

Jonathan Pugh, University of Oxford, and Margie Danchin, Murdoch Children’s Research Institute

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

 

When someone gets sick after receiving a vaccine, this might be a complication or coincidence. As the recent rollout out of the AstraZeneca vaccine in Europe shows, it can be very difficult to know how to respond.

For instance, reports of blood clots associated with the AstraZeneca vaccine led to several European countries suspending their vaccination programs recently, only to resume them once these clots were judged to be a coincidence. However, authorities couldn’t rule out increased rates of a rare brain blood clot associated with low levels of blood platelets.

There are also problems with the Pfizer and Moderna vaccines. By early February 2021, among the over 20 million people vaccinated in the United States, there have been 20 reported cases of immune thrombocytopenia, a blood disorder featuring a reduced number of platelets in the blood. Experts suspect this is probably a rare vaccine side-effect but argue vaccination should continue.

So what happens with the next safety scare, for these or other vaccines? We argue it’s best to give people the facts so they have the autonomy to make their own decisions. When governments pause vaccine rollouts while investigating apparent safety issues, this is paternalism, and can do more harm than good. Continue reading

Ethics, iBlastoids, and Brain Organoids: Time to Revise Antiquated Laws and Processes

Written by Julian Savulescu
Oxford Uehiro Centre for Practical Ethics and Wellcome Centre for Ethics, University of Oxford
Biomedical Ethics Research Group, Murdoch Children’s Research Institute

Jose Polo and his team at Monash University have successfully reprogrammed human adult cells (fibroblasts – skin cells) to form “iBlastoids”. These are structures which are like early human embryos. Normally when a sperm enters an egg, it produces a new cell, which divides, and these cells divide until a blastocyst is formed in the first week, consisting of 200-300 cells. In normal embryonic development, this would implant in the uterus. However, iBlastoids can’t do this as they lack the normal membrane that surrounds the blastocyst. They cannot by themselves form a fetus or baby.

They will be useful to study early human development and why so many embryos die soon after formation. They can be used to study mutations or the effect of toxins, perhaps developing treatments for infertility. So far, they have only been allowed to develop to the equivalent of a Day 11 Blastocyst. It is not clear whether they can produce the precursors to brain development:

“the developmental potential of iBlastoids as a model for primitive streak formation and gastrulation remains to be determined, and will require an international conversation on the applicability of the 14-day rule to iBlastoids.” (Excerpt from the team’s Nature article)

Continue reading

Cross Post: COVID vaccines: is it wrong to jump the queue?

Written by Dominic Wilkinson and Jonathan Pugh

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

 

Sabrina Bracher/Shutterstock

In the UK, an Oxford city councillor has been suspended after mentioning on social media that she had received a COVID vaccination from a private doctor. Meanwhile, media reports suggest that two Spanish princesses, who did not yet qualify for vaccination in Spain were vaccinated while visiting their father in the United Arab Emirates. They are among a number of ultra-wealthy people getting vaccinated in that country.

There have also been reports of people accessing vaccines early in the UK, despite not being in any of the groups prioritised for vaccination at the time.

So how concerned should we be about these cases? Continue reading

Cross Post: Vaccine Passports: Four Ethical Objections, and Replies

Written By Tom Douglas

This is a (slightly modified) cross-post from The Brussels Times.

Should we all be required to produce a ‘vaccine passport’—proving that we have been vaccinated against Covid-19—before being allowed to enter a cafe, travel abroad, or work in a high-risk job?

Some governments are taking tentative steps in this direction. Belgium may require that its soldiers be vaccinated before travelling abroad on peace-keeping missions. In other countries, companies are introducing requirements of their own. Air New Zealand will begin trialling vaccine passports in April.

Many governments have been reluctant to go down this route. Yet the case for vaccine passports is clear: they could allow us to end some lockdown and distancing measures for vaccinated individuals sooner than it would be safe to end them for everyone. This would be a large benefit, since these measures involve severe interference with freedom of movement, and we know that they have serious economic and psychological costs. Continue reading

Consent Without Alternatives

Written by Ben Davies and Joshua Parker

“COVID-19: Do not resuscitate orders might have been put in place without consent, watchdog says”. This recent headline followed an investigation by the Care Quality Commission into Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions early in the pandemic. In a recent post, Dominic Wilkinson highlights two misconceptions in the coverage of this report, one of which is the ‘consent misconception’.

Dominic’s view is that “there is no ethical requirement…to seek the agreement of patients not to offer or provide a treatment” which a medical professional judges inappropriate. Of course, his position is not that consultation and discussion around CPR is inappropriate, only that consent is not necessary. This is the standard view on consent in this context and, due in part to the Tracey judgment, reflects doctors’ practice. Thus, an important distinction emerges between consenting to the withholding of some treatment, and discussion of that decision. Doctors may be ethically required to discuss a decision without also having an obligation to seek the patient’s consent. The absence of consent, then, does not signal that the DNACPR was unethical, whereas a failure to consult probably will.

Continue reading

Video Series: Covid-19 Who Should Be Vaccinated First?

After healthcare and some other essential workers, it might seem the most obvious candidates for a Covid-19 vaccine (if we have one) are the elderly and other groups that are more vulnerable to the virus. But Alberto Giubilini argues that prioritising children may be a better option as this could maximise the benefits of indirect immunity for elderly and other vulnerable groups.

Pandemic Ethics: Why Lock Down of the Elderly is Not Ageist and Why Levelling Down Equality is Wrong

By Julian Savulescu and James Cameron

Cross-posted with the Journal of Medical Ethics Blog

 

Countries all around the world struggle to develop policies on how to exit the COVID-19 lockdown to restore liberty and prevent economic collapse, while also protecting public health from a resurgence of the pandemic. Hopefully, an effective vaccine or treatment will emerge, but in the meantime the strategy involves continued containment and management of limited resources.

One strategy is a staged relaxation of lockdown. This post explores whether a selective continuation of lockdown on certain groups, in this case the aged, represents unjust discrimination. The arguments extend to any group (co-morbidities, immunosuppressed, etc.) who have significantly increased risk of death.

Continue reading

National Ethics Framework For Use in Acute Paediatric Settings During COVID-19 Pandemic

This ethical framework is a modification of guidance developed for treatment decisions relating to adults. The principles relating to decisions for children in the setting of the pandemic are the same as those for adults. The framework emphasises that decisions should be ethically consistent and apply to patients both with COVID-related and non-COVID related illness.
The focus of the ethical framework provides guidance for a situation where there is extremely high demand and limited critical care capacity. However, it is important to note that at the time of writing (14 April 2020) there is enough paediatric critical care capacity across the UK. At the present time decisions about children in need of critical care should reflect the same fundamental ethical considerations as apply in normal times. Those decisions should be focused on the best interests of the child, and actively involve parents in decision-making.
The framework is available to read in full on the  Royal College of Paediatric and Child Health website.

Oxford Uehiro Prize in Practical Ethics: If Doctors Could Administer a Treatment That Would Move a Patient From a Vegetative State to a Minimally Conscious One, Should They Do So?

This essay was the runner up in the graduate category of the 6th Annual Oxford Uehiro Prize in Practical Ethics.

Written by University of Oxford student Matthew Minehan.

INTRODUCTION
Sally is a healthy young woman who suffers catastrophic brain trauma. Over many months, her doctors subject her to functional Magnetic Resonance Imagining (fMRI) scans and other assessments that leave them in no doubt that she is in a vegetative state. While she shows sleeping and waking activity patterns, her body is operating on ‘automatic’ and she has no consciousness. She is “incognizant, incapacitated and insensate” (Fenwick 1998, p.86).

Sally’s doctors are aware of a new treatment that, if administered, would move her from the vegetative state to a minimally conscious one. This new state would involve fractured consciousness, a lack of awareness of her condition, an inability to direct her own life and an incapacity for complex thought. Because Sally has no known next of kin and issued no advance directive, the decision on her treatment is left to her medical team.

Should the doctors in this hypothetical scenario administer the treatment to Sally? Continue reading

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