by Dominic Wilkinson
If a patient’s family refuse to allow withdrawal of breathing machines should doctors provide long-term support in an intensive care unit for a patient who is clinically brain dead? Should doctors provide heart-lung bypass (ECMO) for a child with anencephaly? Should doctors perform a tracheostomy and provide a long-term breathing machine for a patient in a documented persistent vegetative state?Read More »The patient vanishes
A new study from the Mayo clinic in the United States points to a frequent problem in certain types of medical research. When healthy volunteers or patients with a given condition take part in research studies they may have brain scans, CAT scans, blood tests or genetic tests that they wouldn’t otherwise have had. These tests are not done for the benefit of the individual, they are designed to answer a research question. But sometimes, quite often according to the authors of this new study, researchers may spot something on the scan that shouldn’t be there, and that could indicate a previously undiagnosed health condition. These ‘incidental findings’ generate an ethical dilemma for researchers. Should they tell the research participant about the shadow seen on their scan? Do they have an obligation to reveal to a research participant that they have found them to carry a gene increasing their risk for breast cancer, or Alzheimer’s disease? There is much agonising by ethics committees, ethicists and researchers about the problem of incidental findings, but there is a simple way of avoiding the problem. Anonymise research databases and tests so that there is no possibility of determining which participant has the breast cancer gene, or the lump in their kidney.
Read More »Incidentally… avoiding the problem of incidental findings
A fascinating study in the Lancet this week has suggested that a very commonly used and simple analgesic in newborn infants may not actually be preventing them from experiencing pain. The study’s authors suggest that this medicine should no longer be used routinely in newborn infants. A headline in the Guardian reads “Newborn babies should not be given sugar as pain relief”. But there are scientific, philosophical and ethical reasons why this conclusion, though possibly correct, is premature.
In New York state last week legislators passed an extraordinary bill that, effectively, indicts the practice of New York doctors. That the bill was thought necessary, and, even more so, that it was opposed by the Medical Society of New York is a sad reflection of medical practice in that part of the world.
In a paper released today in the Journal of Medical Ethics, a large survey of UK doctors found that doctors’ religion influenced their views and practice of end-of-life care. Why does this matter? A number of headlines highlighted that atheist or agnostic doctors were more likely to report having participated in “ethically contentious end-of life actions”: ie taking part in terminal sedation or in actions that they expected or partly intended would hasten the patient’s death. But other headlines emphasised the obvious flip-side: doctors who identified themselves as ‘very religious’ or ‘extremely religious’ were about 35% less likely than non-religious doctors to report having taken this sort of step.
Read More »Should doctors come clean? Religion makes a difference to end-of-life decisions
Is drug addiction a disease? Substance Dependence appears as a diagnosis in the influential Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-IV). There are medical specialists in the field who use a range of different drug and non-drug treatments for patients who are addicted. There are hospitals and clinics where those who are addicted can seek help. But if it is a disease why is it treated as a crime? After all we do not lock people up because they have cancer, or hepatitis, or heart disease.
One issue emerging from the recent media circus over Craig Venter’s apparent creation of a synthetic life form is the potential danger … of ethics commentary itself.
In a case that is probably echoed daily across this country and many others, an amphetamine addict Michael Hunter was jailed yesterday for attacking a friend with a hammer. The judge noted that
"amphetamine had clearly affected
Hunter’s mental health, but he highlighted the fact that he had been
responsible for two unprovoked attacks using weapons."
The judge alluded to the question of responsibility and the influence of addiction. Are addicts morally responsible? Should drug addiction excuse or mitigate blame for actions taken under their influence?
Read More »The hammer or the nail – are addicts morally responsible?
The American Academy of Pediatrics (AAP) has come under fire for a policy statement that has a more nuanced approach to female circumcision (FC) than its previous absolute opposition. The new policy proposes that the law be changed to allow pediatricians to perform a ritual ‘nick’ as a compromise where families request female circumcision. The AAP document strongly opposes all female circumcision that would lead to physical or psychological harm, but suggest that pricking or incising the skin of the external genitalia in females is less harmful than ear piercing. This has led to outrage from groups who oppose female circumcision in all forms.
by Dominic Wilkinson and Julian Savulescu
There are 8000 patients on transplant waiting lists in the UK. Every year 400 patients die while waiting for an organ to come available.
We are all far more likely to be in need of an organ transplant than to be a donor. Most of us expect that if we needed a transplant that someone would donate one. On the basis of the ethical golden rule – do unto others as you would want them to do for you, we should all think seriously about whether and how we could donate our organs if we no longer need them.
