Practical Ethics

Is professional integrity a futile argument?

by Dominic Wilkinson

In an earlier post this week I argued that there are only two substantive reasons for doctors not to provide treatment that they judge futile – either on the basis of a judgement that treatment would harm the patient (a form of paternalism), or on the basis that providing treatment would harm others (on the basis of distributive justice). I rejected the idea that professional integrity provided an additional reason to withhold or withdraw treatment.

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Break my bones, but don’t let me die! Should doctors provide ‘futile’ CPR?

by Dominic Wilkinson

Two recent cases in a Toronto hospital illustrate a dilemma that hospital doctors face all too frequently. What should they do if patients or their representatives insist on treatment that the doctor believes would be futile? Should they just go along with the patient despite their misgivings? Alternatively, should they unilaterally withhold treatment if they feel it would be inappropriate to provide it?

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Is Low Libido a Brain Disorder?

by Julian Savulescu

Update: The same misunderstandings are still in evidence, 2 years on (May 2012), for example:  ‘Brain circuitry different for women with anorexia, obesity’

Having started to work in the field of neuroethics a couple of years ago, I have become staggered by the misunderstanding of what neuroscience can tell us. The best example is a recent BBC story which goes by the wonderful title “Libido problems: ‘brain not mind‘” .

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Is it legitimate to ask opponents of embryonic stem cell therapy whether they support IVF?

by Dominic Wilkinson

In the news this week is the first US officially-sanctioned human trial of embryonic stem cells. A patient with spinal cord injury has received an injection of embryo-derived stem cells.

Predictably, the news has not been received positively by those who are opposed to research with embryonic stem cells.

The development, however, was criticized by those with moral objections to research using the cells because days-old embryos are destroyed to obtain them.

"Geron is helping their stock price, not science and especially not patients," said David Prentice, senior fellow for life sciences at the Family Research Council.

The arguments in favour and against embryonic stem cells have been reviewed and rehearsed ad nauseam. I will not repeat them here.


But is it reasonable to ask or demand that those who are opposed to ES cells answer 'the question'. What are your views on IVF?

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Between Life and Death…

A powerful BBC documentary, “Between Life and Death”, screened this evening on BBC One. The documentary (which can be viewed online for the next week in the UK) examined the life and death decisions made for critically ill patients with severe brain injury. Neuro-intensive care provides a way to interrupt the process of dying for such patients. But it raises difficult questions for medical staff and for families about the wishes of patients, the wishes of family members, and about uncertainty. Should treatment continue at the risk of the patient surviving in a severely impaired state? Or should patients be allowed to die, with the risk that perhaps if treatment had continued they may have recovered?

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The Age of the Genome – on BBC radio tomorrow night

Genetic tests at birth, designer babies, synthetic life and resurrected mammoths. In the final part of this series, Richard Dawkins talks to Craig Venter and other leading scientists about the potential powers of genome science in the future.

The program also includes an interview with Julian Savulescu and others about the ethical implications of these developments

You can listen to the program at 2100 tomorrow 14th July on radio 4 in the UK, or listen online on the BBC website after that time.

Special Guest Blog – The problem of militarism

by Tony Coady

Israel’s decision to institute an inquiry into the military misadventure with the flotilla attempting to break its blockade of Gaza and its subsequent partial relaxation of restrictions on aid to Gaza represent grudging concessions to international outrage about the flotilla episode. Any recognition by Israel that its military policies are offensive to so many in the outside world is surely welcome. But the flotilla episode will be misunderstood if it is seen only as a failure in public relations or an instance of military mismanagement. Certainly it constitutes both of these since it has badly damaged Israel’s image throughout the world and alienated its few friends in the region as well as called into question the competence of its much-vaunted armed forces. But there is a deeper lesson to this tragic fiasco and that concerns the influence and failings of the spirit of militarism.

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Critical Care ethics series – the ethics of maxiple pregnancies

by Dominic Wilkinson

Quads, Quins, Sexts, Septs, even Octs!

High order multiple pregnancies such as the Suleman octuplets in California generate enormous media attention. However, they also raise some unique ethical questions. In the second of a series of seminars on critical care ethics, the neonatal grand round today looked at ethical questions arising from 'maxiple' pregnancies. These include questions about the normativity of conception decisions, the moral status of fetuses, selective feticide and lifeboat-type dilemmas. Around the time of delivery these pregnancies generate enormous practical and ethical questions for neonatal intensive care relating to their impact on capacity and the potential need to balance claims on intensive care beds between different infants and families.

Here is a copy of today's 
presentation (pdf 4.6MB).

Further reading…

The Suleman Octuplet Case: An Analysis of Multiple Ethical Issues. Women's Health Issues (2010) vol. 20 pp. 260-5

Evans et al. Update on selective reduction. Prenat Diagn (2005) vol. 25 (9) pp. 807-13

Daar. Selective reduction of multiple pregnancy: lifeboat ethics in the womb. Univ Calif Davis Law Rev (1992) vol. 25 (4) pp. 773-843

Pector. Ethical Issues of High-order Multiple Births. Newborn and Infant Nursing Reviews (2005) pp. 8

Robolove – Robot Machines as Companions

Robot companions are being used in Japan and the the US for elderly patients in nursing homes. They take advantage of our innate tendency to develop affection for things that are cute and appear to respond positively to us.

Paro is a robot modeled after a baby harp seal. It trills and paddles when petted, blinks when the lights go up, opens its eyes at loud noises and yelps when handled roughly or held upside down. Two microprocessors under its artificial white fur adjust its behavior based on information from dozens of hidden sensors that monitor sound, light, temperature and touch. It perks up at the sound of its name, praise and, over time, the words it hears frequently.

But this raises questions about whether it is a form of deception. Should we be using robot companions, or real ones? What do you think?


Don’t forget to vote in the Drugs in Sport debate

Would relaxing the ban on doping lead to a fairer, safer sporting field with a better spectacle for audiences? Or would it distort and undermine the very nature of sporting endeavour and run contrary to the virtues that are the essence of sport?

What have the debaters got right and where have they gone wrong? Have they addressed the most important questions for you? Would you go to watch an 'enhanced' Olympics/Tour de France, or would you prefer a drug-free version? Which would be better for athletes, for spectators and for society?

The Oxford Debates website will be open for comments and for voting
until the end of this week (9th July). Make sure that you have your say, and cast your vote!

You can find all of the debaters' arguments in our Debate Special Edition, along with a number of related papers, blogs and resources

(Image Alan Cleaver)

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