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Dominic Wilkinson

The equal air-time solution for controversial research

When are placebos ethical in medical research? One common answer is that it is only appropriate to use placebos in research when there is no proven effective treatment for the condition (1). On this view, if there is a proven treatment placebos would be unethical, and any trial should compare new drugs or treatments with the existing proven one. But what if the question of ‘proof’ is in dispute? For new medical treatments there often comes a point where some researchers and doctors are convinced that the new treatment is effective and safe while others remain unconvinced. When placebo-controlled trials take place in this setting they are often controversial.

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The real scandals in organ donation consent

Headlines in a number of newspapers in the last day or two have claimed scandalous failures in organ donation consent in the UK. According to ‘Sky News’, organs were “taken without consent”, while the Sun claims that “NHS doctors took the wrong organs from the bodies of donors”. But it is important to put these claims in context. There are some bigger and more serious scandals when it comes to organ donation consent.

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The worth of a life and a life worth living

There has been a lot of discussion about health care rationing in the North American media over the last year, much of it hysterical and barely coherent. A number of respected ethicists have tried to make the case for rationing, including Peter Singer in the New York Times last year, and recently John Freeman.

This week Newsweek Science Editor Sharon Begley asked ‘What is a Life Worth?’ drawing on a recent study presented at the American Society for Maternal-Fetal Medicine meeting. Begley noted

“This is the kind of news that unleashes hysteria about "death panels" and "health-care rationing," but here goes: an analysis of genetic screening for an incurable, untreatable disease called spinal muscular atrophy shows that it would cost $4.7 million to catch and avert one case, compared with $260,000 to provide lifetime care for a child born with it. So here's the question: do we say, "Damn the cost; it is worth any price to spare a single child the misery of being unable to crawl, walk, swallow, or move his head and neck"—or do we, as a society, put on the green eyeshades and say, "No, sorry, we can't afford routine screening"?”

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Is the brain half full – or half empty?

There have been dramatic headlines in the media ('Coma Man. I think…I’m alive') following the publication yesterday of a new study using brain scans to detect consciousness in profoundly brain damaged patients. For the first time scientists and doctors have demonstrated that some patients diagnosed with persistent vegetative state may be able to communicate using functional magnetic resonance imaging (fMRI).

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Second-hand and second-class organs. Should the patient know?

In a urology journal this month American
surgeons describe transplanting kidneys that would previously have been
rejected as unsuitable. In each case the donor kidneys had been found to
contain a solitary mass during the transplant work-up that was potentially
cancerous. Rather than cancelling the donation the surgeons removed the kidney,
cut out the tumour, and then transplanted the tumour-free organ. This follows
reports from a couple of weeks ago that surgeons are increasingly using ‘risky’
organs from donors who are elderly or who have other serious illnesses.

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Are some ethicists really really ethical?

In this blog recently Simon Rippon discussed the empirical evidence collected by Eric Schwitzgebel that suggests that perhaps ethicists are no more ethical in their behaviour than non-ethicists. A survey of academics in the US reveals that philosophers do not think that their peers specialising in ethics behave any better than those who do not study ethics. Self-described ethicists condemn meat-eating more than their peers, but their actual eating behaviour appears similar to non-ethicists. And, paradoxically, more ethics textbooks appear to go missing from libraries than non-ethics books.

As Simon noted, there are some reasons to avoid jumping from this evidence to the conclusion that the study of normative ethics is of no help in the living of a virtuous and ethical life. But even if we accept that on average ethicists are no better citizens than anyone else, it seems that at least in some cases deliberation about ethical issues leads individuals to make decisions that are highly laudable.

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Should parents decide? The case of RB

In the Family Court yesterday, a controversial case that has been widely reported in the media came to a premature close. The father of baby RB, a severely physically disabled 13 month-old infant, withdrew his opposition to the plan by RB’s mother and doctors to take him off life support. It is believed that in the near future doctors will stop breathing machines and allow RB to die. The court did not, in the end, make a judgement about this case, though a statement of endorsement by Justice Macfarlane yesterday suggests that it would have reached the same conclusion.

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Science, drugs, policy and Hume

In this blog last week Anders Sandberg discussed the widely criticised sacking of Professor David Nutt from the government’s advisory council on the misuse of drugs. Professor Nutt had openly criticised government policy, in particular the decision by government to change the classification of cannabis and ecstasy against the advice of the government’s scientific experts. The government claimed that it was not his job to enter the political fray.

In defence of the government, some commentators have sought to distinguish the role of scientists and the role of the politicians. Expert scientists are there to synthesise analyse and present evidence. But politicians have to ultimately decide policy on the basis of values and ethical judgements. Ben Goldacre, writing in the Guardian this weekend replies to this argument by presenting further empirical evidence that is open to scientific enquiry – evidence about the effects of different drug policies on drug use, for example. Goldacre’s argument is that policy questions, as well as medical questions can be assessed scientifically. On this basis, then, perhaps the correct drugs policy can be determined by scientists?

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The ventilator lottery: rolling the dice in the face of difficult choices

As the winter approaches there has been a surge in the number of cases of swine flu, as well as a number of recent deaths in the UK. Although there is hope that the new vaccine will reduce the impact of the pandemic a number of countries including Canada the UK and the  United States have had to face the possibility that health services will not be able to accommodate the predicted surge in demand. Officials have been contemplating guidelines for deciding who should be prioritised for receiving life saving mechanical ventilation. The hope is that such guidelines will enable doctors to save the greatest number of lives in a pandemic.

But one concern about these guidelines is that they are unfair. Should scarce medical resources such as ventilators be allocated using a lottery instead?

Read More »The ventilator lottery: rolling the dice in the face of difficult choices