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.
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.Read More »Cross Post: Dutch Government to Expand Euthanasia Law to Include Children Aged One to 12 – An Ethicist’s View
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.Read More »Cross Post: Halving Subsidised Psychology Appoints is a Grave Mistake—Young Australians Will Bear a Significant Burden
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.
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… Read More »Event Summary: Hope in Healthcare – a talk by Professor Steve Clarke
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.
Written by: Anantharaman Muralidharan, G Owen Schaefer, Julian Savulescu
Cross-posted with the Journal of Medical Ethics blog
Consider the following kind of medical AI. It consists of 2 parts. The first part consists of a core deep machine learning algorithm. These blackbox algorithms may be more accurate than human judgment or interpretable algorithms, but are notoriously opaque in terms of telling us on what basis the decision was made. The second part consists of an algorithm that generates a post-hoc medical justification for the core algorithm. Algorithms like this are already available for visual classification. When the primary algorithm identifies a given bird as a Western Grebe, the secondary algorithm provides a justification for this decision: “because the bird has a long white neck, pointy yellow beak and red eyes”. The justification goes beyond just a description of the provided image or a definition of the bird in question, and is able to provide a justification that links the information provided in the image to the features that distinguish the bird. The justification is also sufficiently fine grained as to account for why the bird in the picture is not a similar bird like the Laysan Albatross. It is not hard to imagine that such an algorithm would soon be available for medical decisions if not already so. Let us call this type of AI “justifying AI” to distinguish it from algorithms which try, to some degree or other, to wear their inner workings on their sleeves.
Possibly, it might turn out that the medical justification given by the justifying AI sounds like pure nonsense. Rich Caruana et al present a case whereby asthmatics were deemed less at risk of dying by pneumonia. As a result, it prescribed less aggressive treatments for asthmatics who contracted pneumonia. The key mistake the primary algorithm made was that it failed to account for the fact that asthmatics who contracted pneumonia had better outcomes only because they tended to receive more aggressive treatment in the first place. Even though the algorithm was more accurate on average, it was systematically mistaken about one subgroup. When incidents like these occur, one option here is to disregard the primary AI’s recommendation. The rationale here is that we could hope to do better than by relying on the blackbox alone by intervening in cases where the blackbox gives an implausible recommendation/prediction. The aim of having justifying AI is to make it easier to identify when the primary AI is misfiring. After all, we can expect trained physicians to recognise a good medical justification when they see one and likewise recognise bad justifications. The thought here is that the secondary algorithm generating a bad justification is good evidence that the primary AI has misfired.
The worry here is that our existing medical knowledge is notoriously incomplete in places. It is to be expected that there will be cases where the optimal decision vis a vis patient welfare does not have a plausible medical justification at least based on our current medical knowledge. For instance, Lithium is used as a mood stabilizer but the reason why this works is poorly understood. This means that ignoring the blackbox whenever a plausible justification in terms of our current medical knowledge is unavailable will tend to lead to less optimal decisions. Below are three observations that we might make about this type of justifying AI.
Written by Dominic Wilkinson, Alberto Giubilini, and Julian Savulescu
The UK government recently announced a dramatic U-turn on the COVID vaccine mandate for healthcare workers, originally scheduled to take effect on April 1 2022. Health or social care staff will no longer need to provide proof of vaccination to stay employed. The reason, as health secretary Sajid Javid made clear, is that “it is no longer proportionate”.
There are several reasons why it was the right decision at this point to scrap the mandate. Most notably, omicron causes less severe disease than other coronavirus variants; many healthcare workers have already had the virus (potentially giving them immunity equivalent to the vaccine); vaccines are not as effective at preventing re-infection and transmission of omicron; and less restrictive alternatives are available (such as personal protective equipment and lateral flow testing of staff).Read More »Cross Post: Is This the End of the Road for Vaccine Mandates in Healthcare?
Written by Dominic Wilkinson, Jonathan Pugh and Julian Savulescu
Time is running out for National Health Service staff in England who have not had a COVID vaccine. Doctors and nurses have until Thursday, February 3, to have their first jab. If they don’t, they will not be fully immunised by the beginning of April and could be dismissed.
But there are reports this week that the UK government is debating whether to postpone the COVID vaccine mandate for healthcare staff. Would that be the right thing to do?
Vaccine requirements are controversial and have led to worldwide protests. Those in favour have argued that it is necessary and proportionate to protect vulnerable patients by making vaccination a condition of employment for healthcare staff. But critics have argued that vaccine mandates amount to a violation of human rights.Read More »Cross Post: Vaccine Mandates For Healthcare Workers Should Be Scrapped – Omicron Has Changed The Game
Dominic Wilkinson, University of Oxford
The recent world-first heart transplant from a genetically modified pig to a human generated both headlines and ethical questions.
Many of those questions related to the ethics of xenotransplantation. This is the technical term for organ transplants between species. There has been research into this for more than a century, but recent scientific developments involving genetic modifications of animals to stop the organ being rejected appear to make this much more feasible.
Typical questions about xenotransplantation relate to the risks (for example, of transmitting infection), treatment of the animals, and the ethics of genetic modification of animals for this purpose.Read More »Cross Post: Pig’s Heart Transplant: Was David Bennett the Right Person to Receive Groundbreaking Surgery?
