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Julian Savulescu

Discovering Consciousness in the “Permanently Unconscious”: What Should We Do?

Comment on “Bedside detection of awareness in the vegetative state: a cohort study” by Damian Cruse, Srivas Chennu, Camille Chatelle, Tristan A Bekinschtein, Davinia Fernández-Espejo, John D Pickard, Steven Laureys, Adrian M Owen. Published in The Lancet, online Nov 10.

 Cruse and colleagues founds evidence of some kind of consciousness in 3 out of 16 patients diagnosed as being permanently unconscious. They used an EEG machine, capable of being deployed at the bedside. Is this good news?

This important scientific study raises more ethical questions than it answers. People who are deeply unconscious don’t suffer. But are these patients suffering? How bad is their life? Do they want to continue in that state? If they could express a desire, should it be respected?

The imporMan in Prisontant ethical question is not: are they conscious? It is: in what way are they conscious? Ethically, we need answers to that. Life prolonging treatment has been and legally can be withdrawn from patients who are permanently unconsciousness. We need guidelines for when life-prolonging treatment should be withdrawn in these minimally conscious states. Paradoxically, it could be worse for some than being permanently unconscious. And in countries like the Netherlands, we need guidelines on whether and when active euthanasia should be performed. For some of these patients, consciousness could be the experience of a living hell.

Read More »Discovering Consciousness in the “Permanently Unconscious”: What Should We Do?

Wellcome Lecture in Neuroethics: Moral enhancement? Evidence and challenges, Dr Molly Crockett, University of Zürich

Abstract: Can pills change our morals? Neuroscientists are now discovering how hormones and brain chemicals shape social behaviour, opening potential avenues for pharmacological manipulation of ethical values. In this talk, I will present an overview of recent studies showing how altering brain chemistry can change moral judgment and behaviour. These findings raise new questions about the… Read More »Wellcome Lecture in Neuroethics: Moral enhancement? Evidence and challenges, Dr Molly Crockett, University of Zürich

Ban on ES Cell Patents Deeply Immoral

Procedures that involve human embryonic stem cells cannot be patented, the European Court of Justice recently declared. Apparently on the basis that patents “would be contrary to ethics and public policy”

“The decision from the European court of justice is a legal clarification for a court case brought by Greenpeace against a German scientist, Oliver Brüstle, who patented a way to turn stem cells into healthy brain cells. The environmental group argued that Brüstle’s work was “contrary to public order” because embryos were destroyed to gather the stem cells used.

“The judgment effectively supports the Greenpeace view and imposes a ban on patenting work that uses embryonic stem cells on the grounds that it represents an immoral “industrial” use of human embryos.” (http://www.guardian.co.uk/science/2011/oct/18/european-patents-embryonic-stem-cells)

This ruling is deeply immoral. In effect, it shuts down embryonic stem cell research by the back door. This ruling is only supported by a narrow, controversial position on the moral status of the human embryo. It imposes a conservative morality on all Europeans to the detriment of their future health.

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JOB: postdoc in law for the “Enhancing Responsibility” project- TU Delft and University of Oxford

**Deadline: 31 October 2011** Applicants are sought for a law postdoc position of 2.5 year duration to work on the international interdisciplinary research project “Enhancing Responsibility: the effects of cognitive enhancement on moral and legal responsibility” funded by the Netherlands Organisation for Scientific Research (NWO). A brief description of this project’s aims and inter-disciplinary approach… Read More »JOB: postdoc in law for the “Enhancing Responsibility” project- TU Delft and University of Oxford

The Myth of Elite Sport

In an interesting article, “Why we’re the best”, Oliver Poole writing in the Evening Standard yesterday claims: Culture, environment and genes are all cited as reasons for sporting success. But it is practice that really makes perfect. He cites evidence that it not some genetic advantage that makes Kenyan runners so great but the fact… Read More »The Myth of Elite Sport

‘No smoking’ signs trigger urge to light up: Communism, Marriage, Evidence-Based Medicine and the Fate of the World

Before you read the blog, please take:

General Knowledge Ethics Quiz

  1. What is the main cause of climate change?
  2. What is main cause of global poverty?
  3. Why does terrorism exist?
  4. What caused the Fukushima nuclear reactor disaster?

Write your answers on a piece of paper for reference. I will provide my answers presently and we can compare.

THE BLOG

Brian Earp, a master’s student at Oxford University’s Department of Experimental Psychology, has found that ‘no-smoking and anti junk food adverts can be counter-productive by encouraging the behaviour they warn against’. Mr Earp asked 29 smokers to look at 25 images, some of which included ‘no smoking signs’. He found that when they viewed images of the signs they were more motivated to smoke than when they did not see the images.

Read More »‘No smoking’ signs trigger urge to light up: Communism, Marriage, Evidence-Based Medicine and the Fate of the World

How to Stop the Medical Killing Spree

According to a recent study, around 350 patients die in Australian hospitals every two weeks. The figure would be expected to be much higher in the UK.

Prof Jeff Richardson, from Monash University, appropriately said, “The issue of adverse events in the Australian health system should dominate all others. However, it would be closer to the truth to describe it as Australia’s best kept secret.”

I have a personal interest in this issue. My father died as a result of a “preventable hospital error.” He was having a routine imaging procedure of his liver and bile ducts and a major artery was hit. The bleeding was not recognised til too late and he bled to death. (The autopsy report claimed he died of a heart attack! The heart eventuyally does stop when there is not enough blood.)

So what is the answer? Current debate is focussed on improving systems. Mandatory reporting of incidents, immunity from prosecution for those who report, etc.

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Ethical Lessons From Locked-In Syndrome: What Is a Living Hell?

A recent important study by Stephen Laureys and colleagueson what it is like to be to experience severe brain damage has been widely reported. (eg, http://abcnews.go.com/Health/Wellness/locked-patients-life/story?id=12984627). Laureys and colleagues surveyed the views of people with “locked-in” syndrome. This syndrome, which typically occurs after certain kinds of stroke, results in the person unable to move his arms or legs and unable to speak. In some cases, they can move their eyes and communicate through eye movements but in other cases, the eyes are paralysed. They are awake and aware.

Many people would think this is a living hell, imprisoned in one’s own body, with limited if any means of communication. But Laureys et al found differently when they actually asked patients who were in this condition. According to the ABC,

“More than half of patients coping with a form of nearly complete paralysis called locked-in syndrome indicated — through eye blinks in some cases — that they were getting some satisfaction in life, though 8 percent had often thought of suicide.

“Among 65 patients who had developed the syndrome a median of eight years previously, only 18 characterized their lives as “somewhat on the bad side” or worse… Seventeen patients indicated that they felt as well, or almost as well, as in their happiest times before becoming locked-in. Another 21 gave their overall quality of life lesser but still positive marks.”

So what can we learn from this study?Read More »Ethical Lessons From Locked-In Syndrome: What Is a Living Hell?

Moralism and Reproduction: Ten Infringements of Liberty

One of the great success stories of British science in the last 30 years was the introduction of In Vitro Fertilisation by Steptoe and Edwards in 1978. They should have won the Nobel Prize. Around 3% of babies are now born after IVF. Testing of and experimentation on early human embryos offers great prospects for improving not only the health of the next generation but how well their lives go. Today, a wide variety of genes which cause or contribute significantly to disease can be tested. Soon, it will be possible to test for all the genes an embryo has and choose embryos which start life with the least prospects of disease and greatest range of talents, abilities and capacities. And IVF has allowed individuals and couples to have children in new ways, expanding procreative liberty. Experimentation on embryos is yielding important knowledge of human development and contributing to the development of regenerative medicine, or stem cell therapies.

Assisted reproduction, including embryo testing, and research involving the embryo has been controlled by the Human Fertlisation and Embryology Authority (HFEA). I recently wrote an evaluation of the performance of the HFEA. I argued that the HFEA was set up on the wrong premise: the embryo was said to have a special moral status. Regulation should be set up on the basis of preventing real, tangible and direct harm. Destroying some embryos but not others is not an example of preventing harm. Secondly, it has operated to enforce public morality, imposing moralism not preventing harm. This was kind of objectionable moralism that was employed by Lord Devlin to justify a ban on homosexuality. Thankfully, HLA famously disposed of that bad justification, at least in the case of homosexuality. Moralism, however, has been alive and well in the case of reproduction.Read More »Moralism and Reproduction: Ten Infringements of Liberty

Solving the Puzzle of the Moral Status of the Embryo and Fetus

In March 2006, 21 yo Cleveland man Christopher Challancin was driving home from a party with his 17 yo girlfriend, Jessica Karos. She was 4 months pregnant. They began to argue about her ability to care for their child. Challancin, who had been drinking, became angry. He began to weave high speed through traffic and crashed. Karos was left paralysed.  The baby died. Challancin was unhurt. Because he killed the baby, he was charged with homicide and sentenced to five years.

In 2005, Alison Miller and Todd Parrish sued their fertility clinic in Chicago. They had been having IVF treatment back in 2002 and stored 9 embryos. One of these was “mistakenly” discarded. The clinic apologised and offered the couple a free cycle of IVF. They sued for the “wrongful death” of their embryo.

Every year, about 100 000 fetuses are aborted. No one is charged over these deaths. Thousands of embryos are also destroyed. The law on IVF in England and Australia requires their destruction after a period of time, 5 to 10 years.

How can killing a fetus at once be homicide and yet no crime at all? How can the destruction of embryos be required by law and widely practised but also, in some places, the crime of wrongful death? How can one act – killing early human life – be both right and wrong? This is the puzzle of social practice involving early human life.

Read More »Solving the Puzzle of the Moral Status of the Embryo and Fetus