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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?

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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.)

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Special St Cross Seminar summary of Maureen Kelley’s: Fighting Diseases of Poverty Through Research: Deadly dilemmas, moral distress and misplaced responsibilities

Written By Tess Johnson

You can find the video recording of Maureen Kelley’s seminar here, and the podcast here.

Lately, we have heard much in the media about disease transmission in conditions of poverty, given the crisis-point COVID-19 spread and mortality that India is experiencing. Yet, much of the conversation is centred on the ‘proximal’—or more direct—causes of morbidity and mortality, rather than the ‘structural determinants’—or underlying, systemic conditions that lead to disease vulnerability in a population. As a result, much global health research is focussed on infectious disease treatment and prevention, rather than responses to the complex political, economic and social needs that underly disease in vulnerable communities. This can result not only in less efficient and effective research, but also moral distress for researchers, and a disconnect between research goals and the responsibility that researchers feel for addressing a community’s immediate needs.

In her Special St Cross Seminar last week, Maureen Kelley introduced her audience to these problems in global health research. Professor Kelley outlined, first, empirical findings evidencing this problem, a result of research she recently performed with the Ethox Centre’s REACH team, in collaboration with global health research teams around the world. Second, she linked this empirical work to theory on moral distress and researchers’ and institutions’ responsibilities toward participating communities in low and middle-income countries (LMICs). Continue reading

Cross Post: Vaccine passports: why they are good for society

Written by Barbara Jacquelyn Sahakian, University of Cambridge; Christelle Langley, University of Cambridge,

and Julian Savulescu, University of Oxford

 

As more and more people get vaccinated, some governments are relying on “vaccine passports” as a way of reopening society. These passports are essentially certificates that show the holder has been immunised against COVID-19, which restaurants, pubs, bars, sports venues and others can use to grant them entry.

Israel currently operates a “green pass” system, which allows vaccinated people access to theatres, concert halls, indoor restaurants and bars. The UK government, had to roll back plans to trial vaccine passports after some of the venues involved experienced significant backlash against the proposals.

This is perhaps not surprising – vaccine passport schemes are controversial, with some arguing that they will reinforce inequalities. But there is an ethical case for using some form of certification of COVID status, as long as it is designed properly and as long as everyone has access to vaccines.

Let’s look at the ethics of vaccination and certification. Continue reading

Cross Post: End-of-Life Care: People Should Have the Option of General Anaesthesia as They Die

Written by Dominic Wilkinson and Julian Savulescu

Dying patients who are in pain are usually given an analgesic, such as morphine, to ease their final hours and days. And if an analgesic isn’t enough, they can be given a sedative – something to make them more relaxed and less distressed at the end of life. We have recently written about a third approach: using a general anaesthetic to ensure that the dying patient is completely unconscious. This has been described previously, but largely overlooked.

There are two situations when a general anaesthetic might be used in dying patients. The first is when other drugs have not worked and the patient is still distressed or in pain. The second is when a patient has only a short time to live and expresses a clear wish to be unconscious. Some dying patients just want to sleep. Continue reading

Cross Post: COVID: Is it OK to manipulate people into getting vaccinated?

Written by Maximilian Kiener, University of Oxford

Bored Panda, a website that publishes “lightweight and inoffensive topics”, reports an allegedly true case from the US of a woman who refused to have her child vaccinated. The woman, who is described as a “conspiracy theory magnet”, provided 15 reasons why vaccines are more harmful than the disease they protect against.

When the doctor realised that he wouldn’t be able to dissuade her of her beliefs, he decided to present her with another one:

Have you considered the possibility that anti-vaccine propaganda could be an attempt by the Russians or the Chinese to weaken the health of the United States population?

The doctor deliberately deceived the woman and probably reinforced her belief in conspiracy theories by pretending to find them plausible himself. But the tactic worked. The mother consented to have her child vaccinated.

Right now, vaccination is key to overcoming the COVID-19 pandemic and regaining safe individual freedom. Yet a minority of people, like the woman in our example, still refuse vaccination on mistaken beliefs. But how far can we go to change their minds?

Would the doctor be justified in using similar tactics to make the woman consent to her own COVID-19 vaccination? Continue reading

Oxford Uehiro Prize in Practical Ethics: May the Use of Violent Civil Disobedience Be Justified as a Response to Institutional Racism?

This essay was the joint runner up in the graduate category of the 7th Annual Oxford Uehiro Prize in Practical Ethics.

Written by University of Oxford student Oshy Ray 

The summer of 2020 saw people across the world participating in racial justice protests, demanding the end of state violence against Black people, and calling for the eradication of institutional racism. While these protests were largely peaceful, the use of violence by some protestors was criticised. I argue that some forms of violent civil disobedience—henceforth, VCD— may be justified as responses to institutionalised racism. By “justified,” I mean that something can be made morally permissible—that its outcomes are good enough to warrant the “badness” of its means.

First, I argue that some forms of VCD may be justified as a response to institutional racism. Then, I consider the objection that instrumentally, violence is too uncontrollable to guarantee that desired ends (such as successful social change) may be brought about. In response, I distinguish between violence against persons and violence against objects. Acknowledging that violence against persons may rarely be justified, I claim that violence against objects is more easily justifiable. Finally, I conclude that VCD against objects may be justified as a response to institutional racism. I do not argue that violence can always be a justified response to institutional racism. Rather, my claim is more moderate; I claim that certain forms of VCD may be justified as a response to institutional racism.[1] 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

Oxford Uehiro Prize in Practical Ethics: Should Feminists Endorse a Universal Basic Income?

This essay was the joint runner up in the graduate category of the 7th Annual Oxford Uehiro Prize in Practical Ethics.

Written by University of Oxford student Rebecca L Clark

  • 1 Introduction

A UBI is a regularly remitted, non-means-tested cash grant which is given to every individual with no conditions attached.[1] Within these constraints, UBI proposals can differ considerably. Firstly, there is a Question of Scope – namely, who constitutes ‘every individual’? Secondly, there is a Question of Specification, which can be broken down into three interrelated issues:

  1. At what level of income should a UBI be set?
  2. Should a UBI supplement or replace existing welfare structures?
  3. How should a UBI be funded?

I will set aside the complexities raised by the Question of Scope and focus on a UBI given to adult citizens. In response to the Question of Specification, I will consider a UBI set at a liveable wage which supplements existing welfare institutions and is funded through revenues from publicly owned assets.[2] This is for two reasons. Firstly, I take this to be the most appealing version of a UBI; hence a conclusion that feminists should reject this version would suggest that feminists should reject any UBI proposal. Secondly, I am wary of building in hard limits of political or economic feasibility into my analysis since this forecloses utopian theorising, which is valuable precisely because it challenges conventional views about what is possible. Continue reading

Oxford Uehiro Prize in Practical Ethics: Why, If At All, Is It Unethical For Universities To Prioritise Applicants Related To Their Alumni?

This essay was the runner up in the undergraduate category of the 7th Annual Oxford Uehiro Prize in Practical Ethics.

Written by University of Oxford student Tanae Rao

Introduction

Most notably in the United States, some prestigious universities[1] consider whether or not a student is closely related to one or more alumni when evaluating her application. In an increasingly competitive university admissions landscape, having legacy status increases an applicant’s probability of being admitted to such a great extent that over a third of Harvard’s undergraduate class of 2022 is composed of legacy students.[2] This has led the New York Times Editorial Board to describe the practice as “anti-meritocratic” and “an engine of inequity”.[3]

Considering the alma mater of a student’s relatives when evaluating their university application seems to be wrong, or unfair, in some way. But what is the central aspect of the legacy admissions policy justifying this reaction? I consider three possible answers to this question. Firstly, I reject the academic qualification view, whereby universities should only consider if applicants will be able to meet academic requirements when making admissions decisions. This view does not reflect the actual state of university admissions today, where the number of qualified applicants often far exceeds the number of available seats. I then reject the popular view whereby universities should minimise their consideration of factors outside of the applicant’s control. Though this criterion appears to meet many of our intuitions regarding university admissions, I argue that it is too restrictive, preventing reasonable factors from being considered by universities. Finally, I propose a consequentialist view, whereby admissions decisions should be based on their expected consequences to admitted students and society as a whole. This view—I contend—is a plausible explanation of why legacy admissions should be discontinued, contingent on some evaluative questions. Continue reading

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