The Family Court in Brisbance this week authorised a hysterectomy for a severely disabled 11 year old girl. Disability groups have branded the decision an abuse of human rights and called for a law prohibiting the sterilisation of disabled children.
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"?”
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).
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.
Read More »Second-hand and second-class organs. Should the patient know?
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.
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.
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?
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
In late 2007 a young woman with a history of depression and several previous suicide attempts presented to an emergency department following an overdose. She gave doctors a copy of her living will, written 3 days previously, in which she made it clear that she wanted no measures to be taken to save her life. Earlier this week Roger Crisp and Julian Savulescu argued separately in this blog that the wishes of competent patients to end their lives should be respected. But if we believe that suicide can be rationally sought, and should sometimes not be resisted, should this include those who have been diagnosed with depression?
Question: When is a crime not a crime? Answer: when it will never be prosecuted.
The release this week by the Director of Public Prosecutions of his interim policy on prosecution of assisted suicide raises a number of questions – as discussed yesterday in this blog by Simon Rippon. The new policy formalises what has been informal for some time, that family members of patients with terminal illnesses (or other serious conditions) who help the patients to travel overseas to access assisted suicide are unlikely to be prosecuted for their actions. But their actions will still be technically criminal. Should there be a class of ambiguous actions that are neither legal, nor illegal?
Read More »T-illegal actions and the case for legal ambiguity
