Bioethics

How we got into this mess, and the way out

By Charles Foster

This week I went to the launch of the latest book by Iain McGilchrist, currently best known for his account of the cultural effects of brain lateralisation, The Master and His Emissary: The Divided Brain and the Making of the Western WorldThe new book, The Matter with Things: Our brains, our delusions, and the unmaking of the world is, whatever, you think of the argument, an extraordinary phenomenon. It is enormously long – over 600,000 words packed into two substantial volumes. To publish such a thing denotes colossal confidence: to write it denotes great ambition.

It was commissioned by mainstream publishers who took fright when they saw its size. There is eloquent irony in the rejection on the ground of its length and depth of a book whose main thesis is that reductionism is killing us. It was picked up by Perspectiva press. That was brave. But I’m predicting that Perspectiva’s nerve will be vindicated. It was suggested at the launch that the book might rival or outshine Kant or Hegel. That sounds hysterical. It is a huge claim, but this is a huge book, and the claim might just be right.

Nobody can doubt that we’re in a terrible mess. The planet is on fire; we’re racked with neuroses and governed by charlatans, and we have no idea what sort of creatures we are. We tend to intuit that we are significant animals, but have no language in which to articulate that significance, and the main output of the Academy is to scoff at the intuition. Continue reading

Philosophical Fiddling While the World Burns

By Charles Foster

An unprecedented editorial has just appeared in many health journals across the world. It relates to climate change.

The authors say that they are ‘united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.’

Climate change, they agree, is the major threat to public health. Here is an excerpt: there will be nothing surprising here:

‘The risks to health of increases above 1.5°C are now well established. Indeed, no temperature rise is “safe.” In the past 20 years, heat related mortality among people aged over 65 has increased by more than 50%.Hi gher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality. Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities, and those with underlying health problems.’ Continue reading

What If Stones Have Souls?

By Charles Foster

Over the 40,000 years or so of the history of behaviourally modern humans, the overwhelming majority of generations have been, so far as we can see, animist. They have, that is, believed that all or most things, human and otherwise, have some sort of soul.

We can argue about the meaning of ‘soul’, and about the relationship of ‘soul’ to consciousness, but most would agree that whatever ‘soul’ and ‘consciousness’ mean, and however they are related, there is some intimate and necessary connection between them – even if they are not identical.

Consciousness is plainly not a characteristic unique to humans. Indeed the better we get at looking for consciousness, the more we find it. The universe seems to be a garden in which consciousness springs up very readily. Continue reading

COVID: Why We Should Stop Testing in Schools

Dominic Wilkinson, University of Oxford; Jonathan Pugh, University of Oxford, and Julian Savulescu, University of Oxford

Education Secretary Gavin Williamson has announced the end of school “bubbles” in England from July 19, following the news that 375,000 children did not attend school for COVID-related reasons in June.

Under the current system, if a schoolchild becomes infected with the coronavirus, pupils who have been in close contact with them have to self-isolate for ten days. In some cases, whole year groups may have to self-isolate.

Such mass self-isolation is hugely disruptive. Yet despite the clamour to switch to other protective measures, such as rapid testing of pupils who have been in close contact with an infected pupil, the public service union Unison has supported self-isolation as “one of the proven ways to keep cases under control”. Continue reading

Compromising On the Right Not to Know?

Written by Ben Davies

Personal autonomy is the guiding light of contemporary clinical and research practice, at least in the UK. Whether someone is a potential participant in a research trial, or a patient being treated by a medical professional, the gold standard, violated only in extremis, is that they should decide for themselves whether to go ahead with a particular intervention, on the basis of as much relevant information as possible.

Roger Crisp recently discussed Professor Gopal Sreenivasan’s New Cross seminar, which argued against a requirement for informational disclosure in consenting to research participation. Sreenivasan’s argument was, at least in its first part, based on a straightforward appeal to autonomy: if autonomy is what matters most, I should have the right to autonomously refuse information.

I have previously outlined a related argument in a clinical context, in which I sought to undermine arguments against a putative ‘Right Not to Know’ that are themselves based in autonomy. In brief, my argument is, firstly, that a decision can itself be autonomous without promoting the agent’s future or overall autonomy and, second, that even if there is an autonomy-based moral duty to hear relevant information (as scholars such as Rosamond Rhodes argue), we can still have a right that people not force us to hear such information.

In a recent paper, Julian Savulescu and I go further into the details of the Right Not to Know, setting out the scope for a degree of compromise between the two central camps.

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‘Waiver or Understanding? A Dilemma for Autonomists about Informed Consent’

by Roger Crisp

At a recent New St Cross Ethics seminar, Gopal Sreenivasan, Crown University Distinguished Professor in Ethics at Duke University and currently visitor at Corpus Christi College and the Oxford Uehiro Centre, gave a fascinating lecture on whether valid informed consent requires that the consenter have understood the relevant information about what they are being asked to consent to. Gopal argued that it doesn’t. Continue reading

Is Life-Sustaining Treatment Being Lawfully Withdrawn From Patients In Prolonged Disorders Of Consciousness? Nobody Seems To Know

By Charles Foster

From the time of the decision of the House of Lords in Airedale NHS Trust v Bland (1993) until the decision of the Supreme Court in An NHS Trust v Y (2018) (which I will refer to here as ‘Y”) it had been understood that the withdrawal of life-sustaining treatment (typically clinically assisted nutrition and hydration – ‘CANH’) from patients in a vegetative state should be endorsed by the court. Over the years, this practice had been extended to cover such withdrawals in Minimally Conscious States too.

In Y, the Supreme Court held that there was no requirement for court review or endorsement. Why? Continue reading

Crosspost: Learning to live with COVID – the tough choices ahead

By Jonathan Pugh, Dominic Wilkinson and Julian Savulescu

This work was supported by the UKRI/ AHRC funded UK Ethics Accelerator project, grant number AH/V013947/1. The UK Ethics Accelerator project can be found at https://ukpandemicethics.org/

 

As mass vaccination continues to be rolled out, the UK is beginning to see encouraging signs that the number of COVID deaths is reducing, and that the vaccines may be reducing the transmission of coronavirus.

While this is very welcome news, a mass vaccination programme is unlikely to be enough to eliminate the virus, so we need to turn our thoughts towards the ethics of the long-term management of COVID-19.

One strategy would be to aim for the elimination of the virus within the UK. New Zealand successfully implemented an elimination strategy earlier in the pandemic and is now in a post-elimination stage.

An elimination strategy in the UK would require combining the mass vaccination programme with severe restrictions on international travel to stop new cases and variants of the virus being imported. However, the government has been reluctant to endorse an elimination strategy, given the importance of international trade to the UK economy.

One of the main alternatives to the elimination strategy is to treat coronavirus as endemic to the UK and to aim for long-term suppression of the virus to acceptable levels. But adopting a suppression strategy for the long term will require us to make a societal decision about the harms we are and are not willing to accept.

 

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Nonconsensual Neurointerventions and Expressed Disrespect: a Dilemma

Written by Gabriel De Marco and Tom Douglas

This essay is based on a co-authored paper recently published in Criminal Law and Philosophy

Neurointerventions—interventions that modify brain states—are sometimes imposed on criminal offenders for the purposes of diminishing the risk that they will re-offend or, more generally, of facilitating their rehabilitation. A commonly discussed example is the use of hormonal agents to reduce the sex drive of certain sexual offenders. Some suggest that in the future, we will have a wider range of such interventions at our disposal, possibly including, for instance, treatments to reduce aggression or impulsivity, or treatment to enhance capacities for empathy or sympathy.

In a recent paper, we consider an objection to the imposition of such neurointerventions without the offender’s prior agreement. Some object to these ‘nonconsensual neurointerventions’ (or ‘NNs’) by claiming that they express disrespect for the offender. This, according to the objection, gives us reason not to implement them. On a strong version of the objection, NNs are invariably wrong because they always express disrespect. Continue reading

Ethics Doesn’t Rule, OK?

By Charles Foster

Ethics and law are different. Or they should be.

Law has the power to coerce. That is a frightening power. There should be as little law as possible. But there should be more ethics than there is.

The boundary between the two domains is not absolute. Clinicians are probably more frightened of being struck off by the General Medical Council (GMC) (after an adjudication on their ethics by the Medical Practitioners’ Tribunal Service) than they are about an order by a civil court that compels their insurers to pay damages for clinical negligence. The exercise of the GMC’s statutory powers can be draconian: the existence of those powers, and the associated sanctions, is certainly coercive.

But although the boundary is sometimes blurred, it is still real. It is the job of the law to keep it from becoming dangerously permeable. In a recent case the law was caught napping. Continue reading

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