MSt in Practical Ethics
Closed to applications for entry in 2021-22
Applications for courses offered for admission in 2022-23 will open on 1 September 2021
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Applications for the modules as standalone courses are still available for some courses.
This flexible, part -time course consists of six modules and a dissertation. The MSt in Practical Ethics is a part-time course consisting of six taught modules and a dissertation. Modules may also be taken as standalone courses. Continue reading
Urgency, Delayed Decision-making and Ethics in the Court of Protection
By Dominic Wilkinson, 24th June 2021
cross post from the Open Justice Court of Protection Project
On 11th June 2021, I was a public observer (via MS Teams) of a case in the Court of Protection: Case No. 1375980T Re GU (also blogged about by Jenny Kitzinger here).
The case was (though I did not know it beforehand) related closely to issues that I have written about over a number of years (for example here, here, here ). It was an urgent hearing before Mr Justice Hayden concerning clinically-assisted nutrition and hydration (CANH) for a 70 year old man, GU, who has been in a prolonged disorder of consciousness for seven years.
I have read the judgments from many similar cases in the UK, from the first ever case concerning a feeding tube for a vegetative patient heard in (what is now) the Supreme Court in 1992 (the case of Tony Bland, injured in the Hillsborough football stadium disaster), through to the most recent Supreme Court case of Re. Y, at which the court ruled that it is not mandatory to bring cases concerning CANH-withdrawal to court unless there is disagreement about best interests, or the decision is finely balanced (report here). I’m also familiar with the judgments in other jurisdictions (e.g. Schiavo in the USA, Lambert in France) and have been involved in deliberation in clinical ethics committees about cases with similar features.
Yet, this was my first time hearing open deliberations in the Court of Protection. It was a fascinating and thought-provoking experience. Continue reading
Cancelling Books
Written by Neil Levy
One of the latest flare ups in the culture wars concerns book publishing. Recent books by Mike Pence, Woody Allen and by Milo Yiannopoulos have all been met with protests, many of them stemming from staff within the publishing houses. Sometimes, these protests have been successful, at least to the extent that the publisher has decided not to publish the book.
Conflict over these books has pitted younger staff at publishing houses against older. It’s also pitted advocates of (relatively) unconstrained free speech against those who support no-platforming certain speakers. Perhaps showing my age, I find myself on both sides of these debates. These are very different cases, and the case for no-platforming Yiannopoulos seems strong; in the other cases, I am less certain. Elsewhere, I have given an underappreciated reason why we might often want to no-platform (a strong reason; not necessarily a decisive reason). In this post, though, I want to rebut some common arguments against cancelling books. Continue reading
Mandatory Vaccination for Care Workers: Pro and Con
By Dominic Wilkinson and Julian Savulescu
An edited version of this was published in The Conversation
The UK government is set to announce that COVID-19 vaccination will become mandatory for staff in older adult care homes. Staff will be given 16 weeks to undergo vaccination; if they do not, they will face redeployment from frontline services or the loss of their job. The government may also extend the scheme to other healthcare workers.
It is crucial to achieve a high vaccine uptake amongst older adult care home staff due to the high mortality risk faced by residents. ONS Data suggest that there has been a 19.5% increase in excess deaths in care homes since the beginning of the pandemic, with COVID-19 accounting for 24.3% of all care home resident deaths.
According to SAGE, 80% of staff working in care homes with older adult residents (and 90% of the residents themselves) need to be vaccinated in order to confer a minimum level of protection to this vulnerable population. In mid-April, only 53% of older adult care homes in England were meeting these thresholds, whilst, as of the 10th June, 17% of adult care home workers in England have not had a single dose of the COVID-19 vaccine.
Mandating vaccination would increase vaccine uptake in care home workers, but would be a significant intrusion into individual freedom. Is it ethically justifiable?
No jab, no job? Vaccination requirements for care home staff
Written by Lisa Forsberg and Isra Black
Last night the Guardian was first to report that staff working in older adult care homes will be required to get vaccinated against Covid-19. According to BBC News, ‘Care staff are expected to be given 16 weeks to have the jab—or face being redeployed away from frontline care or losing their jobs’. This announcement follows news reports over the last few months that the government have been considering making Covid-19 vaccination mandatory for staff working in older adult care homes in England. As part of this process, an open consultation on vaccination for older adult care home staff was held in April and May of this year, to which we responded.
While we think a vaccination requirement for older adult care home staff may be a necessary and proportionate measure, we nevertheless have concerns about the government’s proposed policy.
Care home staff vaccination – press release
Two (contrasting) perspectives on the news this morning about planned mandatory vaccination of care home workers.
Professor Julian Savulescu
“The proposal to make vaccination mandatory for care home workers is muddle-headed. Vaccination should be mandatory for the residents, not the workers. It is the residents who stand to gain most from being vaccinated. Young care workers have little to gain personally from vaccination and there are now lethal risks, as well as uncertain long term consequences of novel vaccines. They have already risked their own lives during the pandemic. Some will be immune from past infection. Those remaining should be offered incentives, including financial incentives, to be vaccinated, not coerced. Vaccines like hepatitis and influenza may be mandatory, but they have been around for years and have established safety profiles.
“It’s too soon to be talking about mandates. We’re still researching rare but potentially serious side-effects that have been thrown up by national monitoring, for example a possible link between Pfizer and myocarditis. We don’t have the full picture on how well they prevent transmission. Public Health England data about how transmission is only available for the first dose and it is currently at up to 50%. Meanwhile the level of protection afforded to vaccinated individuals themselves is holding up very well in terms of hospitalisation and death even against the new variants. With the level of confidence we have encouragement to vaccinate is warranted, and incentives are warranted. Mandates should only be made on the basis of bulletproof safety and efficacy data, including transmission data.”
Prof Dominic Wilkinson & Dr Jonathan Pugh
“In the earlier phase of the pandemic, some of the most medically vulnerable members of our community, patients in care homes and acutely ill patients in hospitals, ended up catching coronavirus from those caring for them. Some patients and care home residents died from infections that they caught from their caregivers.”
“That is a tragic and distressing situation that we must do everything possible to avoid repeating.
First, we should ensure that all those who are high risk have access to vaccination. There are still approximately 10% of older adult care home residents who have not had a 2nd dose of the vaccine.
Second, those who work in the frontline with vulnerable high risk patients have an ethical obligation to take all reasonable measures to prevent spread of the vaccine to those they are caring for. They must follow guidance about the use of measures like hand washing and PPE. They should take part in lateral flow testing schemes. And they should be vaccinated.
In England, as of 10th June, 17% of adult care home workers have not had the COVID-19 vaccine.
There is a strong ethical case that care home workers (and NHS staff) who have not had the COVID vaccine should be redeployed to areas other than frontline care.
It would be ethical to make COVID vaccination (in the absence of a medical exemption) a condition of employment in the same way that hepatitis B vaccination is currently for some health professionals.If vaccines are made mandatory for health care and care home workers, they should be able to choose from available vaccines. Every effort possible should be made to address any concerns that they have about the vaccines.”
Post-Normal Challenges of Covid
Written by Stephen Rainey
How to manage the inevitable disruptions to life brought about by the emergence of a viral pandemic – a question that for many seemed remote has now had us all preoccupied for well over a year. With our just-published article, entitled The Post-Normal Challenges of COVID-19: Constructing Effective and Legitimate Responses, in the Journal Science and Public Policy, Maru Mormina, Sapfo Lignou, Joseph Nguyen, Paula Larsson and I set out to investigate some of the perplexing difficulties especially relating to effectiveness and legitimacy. We examine these in the light of pandemics as wicked problems and lay out how ‘post-normal science’ can contribute to a sound pandemic response.
In any pandemic response, the measures undertaken by authorities must effective in the sense of actually addressing the viral threats. A strategy that didn’t slow the rate of viral spread, for instance, wouldn’t work and for that reason would be due criticism. The concept of legitimacy is one perhaps less easy to cash out. In any pandemic response, the measures undertaken by authorities must be legitimate in the sense of fairly and justifiably constraining liberties enjoyed prior to the viral outbreak. A strategy that placed undue or disproportionate burdens on societal sub-groups, for instance, wouldn’t be legitimate and for that reason would be due criticism. For effectiveness in a medical crisis particularly, science is an essential element of any response. Continue reading
Guest Post: Frances Kamm- Harms, Wrongs, and Meaning in a Pandemic
Written by F M Kamm
This post originally appeared in The Philosophers’ Magazine
When the number of people who have died of COVID-19 in the U.S. reached 500,000 special notice was taken of this great tragedy. As a way of helping people appreciate how enormous an event this was, some commentators thought it would help to compare it to other events that involved a comparable number of people losing their lives. For example, it was compared to all the U.S lives lost on the battlefield in World Wars 1 and II and the Vietnam War (or World War II, the Korean War, and Vietnam). Such comparisons raise questions, concerning dimensions of comparison, some of which are about degrees of harm, wrong, and meaningfulness which are considered in this essay. (Since the focus in the comparison was on the number of soldiers who died rather the number of other people affected by their deaths, this discussion will also focus on the people who die in a pandemic rather than those affected by their deaths.)
Pfizer Jab Approved for Children, but First Other People need to be Vaccinated
Dominic Wilkinson, University of Oxford; Jonathan Pugh, University of Oxford, and Julian Savulescu, University of Oxford
Moderna and Pfizer have released data suggesting that their vaccines are well tolerated in adolescents and highly effective in preventing COVID-19. Canada, the US and the EU have already authorised the Pfizer vaccine in children as young as 12. And the UK has just approved the use of the Pfizer vaccine in children aged 12 to 15. But there may a case for holding out on an immediate rollout, for several reasons.
Whether a vaccine is beneficial for someone depends on three things: how likely they are to become seriously ill from the infection, how effective the vaccine is, and the risks of vaccination. Continue reading
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