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Bioethics

Is Home Birth Really As Safe As Hospital Birth? “Woman-centred Care” vs “Baby-centred Care”

Imagine that you and your partner are having a baby in hospital. Tragically something goes wrong unexpectedly during birth and the baby is born blue. He urgently needs resuscitation if there is to be a chance of preventing permanent severe brain damage. How long would it be reasonable for doctors to wait before starting resuscitation? 15 minutes? 5 minutes? 1 minute?

What would be a reasonable excuse for delaying the commencement of resuscitation? They wanted to get a cup of coffee? The mother wanted to hold the baby first? The mother had catastrophic bleeding and this needed urgent attention?

If it were my baby, I would not want any delay in starting resuscitation. And there would be no justification for delaying resuscitation except some more serious, more urgent problem for another patient, such as the mother.

Yet when people choose homebirth, delay is precisely what they choose. It is simply not possible to start advanced resuscitation in the home within minutes. And their reason is not typically some relevant competing health concern that necessitates delivery at home.

Choosing home birth is choosing delay if some serious problem arises which requires immediate resuscitation.

Read More »Is Home Birth Really As Safe As Hospital Birth? “Woman-centred Care” vs “Baby-centred Care”

Complicity and Contraception: Rethinking Hobby Lobby’s Claim of ‘Substantial Burden on the Exercise of Religion’

Within the next month, the United States Supreme Court will decide whether for-profit corporations shall receive an exemption from providing certain types of contraceptives that are otherwise mandated for healthcare coverage by federal law to employees on the basis of the religious objections of the corporations’ owners.  The two cases considered in tandem by the Supreme Court, Sebelius v Hobby Lobby Stores, Inc., and Conestoga Wood Specialties Corporation v Sebelius (Hobby Lobby from here on out), feature a Christian-owned arts and crafts chain and a Mennonite Christian-owned furniture manufacturer, the owners of which object to four specific forms of birth control that they claim cause abortions.

In making their argument for an exemption, the claimants rely mainly on the Religious Freedom Restoration Act (RFRA) passed by Congress in 1993. The RFRA states, “Government shall not substantially burden a person’s exercise of religion…” unless “that application of the burden to the person – 1) is furtherance of a compelling governmental interest; and 2) is the least restrictive means of furthering that compelling governmental interest.” This sets up three tests for judging the permissibility of a government act: the substantial burden test, the compelling interest test, and the least restrictive means test. For the claimants in Hobby Lobby to be successful under the RFRA, the Supreme Court would need to decide first that the government’s ‘contraception mandate’ is indeed a ‘substantial burden’ and second that the provision of contraception is both a compelling government interest and that employer based health insurance is the least restrictive method for securing that interest.

Scholars and journalists have taken various approaches in responding to the range of questions related to these three tests. However, I argue here that Hobby Lobby’s exemption claim can be denied without diving into this spectrum by showing that it fails to meet the first test: the government does not place a substantial burden on the exercise of religion by Hobby Lobby and Conestoga Wood in its ‘contraception mandate.’Read More »Complicity and Contraception: Rethinking Hobby Lobby’s Claim of ‘Substantial Burden on the Exercise of Religion’

The advantages and disadvantages of stigmatizing smoking

A new study among students, found that those who smoked cannabis performed better academically than their tobacco smoking, stigmatized peers. The study has been collecting data among students (8,331 in total) in grade 7,9 and 11 for 30 years, and noticed the following trends. While the use of tobacco around the 90ties decreased, the use of cannabis increased. While the use of tobacco became increasingly associated with a slow and painful death due to cancer, the cry for legalization of cannabis for medicinal purposes (for example to treats side effects of cancer treatment) gave cannabis a more positive image. The study emphasizes that performing worse academically has nothing to do with the substance tobacco itself. Although it is well known that cannabis can effect one’s memory, no such effect is known about tobacco. The fact that tobacco users perform worse than cannabis users has all to do with changing social norms and the marginalizing of tobacco smokers. The study seems to suggest that it is a double effect: marginalized students will choose to smoke tobacco rather than cannabis, but this will marginalize them further. Students who use marijuana are more like the general population, so perform better academically than the marginalized group. Instead of zooming in on the effects of marginalization of tobacco smokers, the study chooses to warn again the normalization of cannabis use, which, according to the study, is a very dangerous substance, in many aspects as dangerous as tobacco. Non-users of tobacco or cannabis still perform better than cannabis users. The study wants to make a case against the legalization of cannabis.
Zinberg famously distinguished three aspects that determined the effect of a substance: the properties of the substance itself, the characteristics of the person taking them, and the social setting wherein the substance is taken. This study nicely illustrates the importance of setting, or social norms around substance use. It shows that setting determines more of the negative effects of the substance than the properties of the substance itself, and how hard it is to determine the negative effects of a substance separated from the social context. It shows that the attractiveness of certain substances is more determined by their social status than by their properties. Many studies have also shown that the effect of a substance in a vulnerable population is different than in a general population. The famous veteran study of Robins showed that Vietnam veterans who became dependent on heroin in Vietnam, had no problems giving up their habits once returned to the United States. The general population mostly succeeds better in the recreational or temporarily use of a substance, because they have more incentives to control their use, and less other problems to self-medicate for.Read More »The advantages and disadvantages of stigmatizing smoking

Murder or mercy?

The newspapers today are full of the horrifying story of three children who were found dead in their family home in South London on Tuesday.  The children had all apparently been diagnosed with a severe genetic disorder (spinal muscular atrophy), that was likely to lead to death in early childhood. Their mother has today been charged with their murder.

There are relatively few details available at this stage, and doubtless more will emerge over coming days and months. It would be premature to comment on the specific circumstances of the case (and the family has asked the public and media to refrain from speculation). However, it is likely that as those details do emerge that commentary on the case will take up one of two themes. Some commentators will point to the enormous strain of caring for severely disabled and terminally ill children, and perhaps bemoan the lack of available supportive services. Others (perhaps with disability or with personal experience of caring for the disabled) will react with horror at the idea of a parent killing their child, and reject any attempt to use child disability as a form of excuse for the crime.Read More »Murder or mercy?

“Whoa though, does it ever burn” – Why the consumer market for brain stimulation devices will be a good thing, as long as it is regulated

In many places around the world, there are people connecting electrodes to their heads to electrically stimulate their brains. Their intentions are often to boost various aspect of mental performance for skill development, gaming or just to see what happens. With the emergence of a more accessible market for glossy, well-branded brain stimulation devices it is likely that more and more people will consider trying them out.

Transcranial direct current stimulation (tDCS) is a brain stimulation technique which involves passing a small electrical current between two or more electrodes positioned on the left and right side of the scalp. The current excites the neurons, increasing their spontaneous activity. Although the first whole-unit devices are being marketed primarily for gamers, there is a well-established DIY tDCS community, members of which have been using the principles of tDCS to experiment with home-built devices which they use for purposes ranging from self-treatment of depression to improvement of memory, alertness, motor skills and reaction times.

Until now, non-clinical tDCS has been the preserve of those willing to invest time and nerve into researching which components to buy, how to attach wires to batteries and electrodes to wires, and how best to avoid burnt scalps, headaches, visual disturbances and even passing out. The tDCS Reddit forum currently has 3,763 subscribed readers who swap stories about best techniques, bad experiences and apparent successes. Many seem to be relying on other posters to answer technical questions and to seek reassurance about which side effects are ‘normal’. Worryingly, the answers they receive are often conflicting.Read More »“Whoa though, does it ever burn” – Why the consumer market for brain stimulation devices will be a good thing, as long as it is regulated

Terminal Illness and The Right Not to Know

The parents of a young woman named Vickie Harvey, who tragically died at the age of 24 from acute myeloid leukaemia, have launched a campaign to give patients the right not to know that they are terminally ill.  Eric and Lyn Harvey claim that their daughter lost the will to live when, after her leukaemia returned following a period of remission, doctors told her ‘in graphic detail’ how she would now succumb to her disease. Eric Harvey told the Daily Mail:

After [Vickie was about her prognosis] she changed – and never really got out of bed again. We knew she was dying, but we feel that, if she hadn’t been told that day, she would have lasted longer’.Read More »Terminal Illness and The Right Not to Know

Academia, philosophy, and ‘race’

It was recently brought to public attention that of the UK’s 18,510 university professors, only 85 are of black origin (Black African/Black Caribbean/Black ‘other’), a soberingly disproportionate figure. Some people may want to explain this incongruence by saying that it is proportionate, or makes sense, when you consider the amount of black people entering and remaining within higher education. However, rather than the problem being solved with this explanation, it re-emerges in questions surrounding the reasons as to why this may be the case. If there are a disproportionately low number of black students entering (and remaining in) higher education, this itself needs to be questioned, with discussions had on financial situations, state education, implicit biases, and other social and economic barriers that may be disproportionately affecting certain sections of the population. In this blog post I will explore these factors, as well as suggesting that discussions on ‘intelligence’ genes within bioethics may serve to perpetuate a hostile and exclusionary environment.

The situation for black academics appears to be more acute in academic philosophy. There are only 5 black philosophers employed in UK universities, with just two of these being employed in philosophy departments (both at UCL), and the other 3 in classics, humanities and ‘theology, philosophy and religious studies’ departments. Philosophy is also notorious for its lack of female representation. Statistics show the number of women gradually reducing at each stage of academia – although 46% of philosophy undergraduates are female, this drops to 31% of philosophy PhD students, and is at its lowest with only 24% of full time staff being women.

Read More »Academia, philosophy, and ‘race’

The future of punishment: a clarification

By Rebecca Roache

Follow Rebecca on Twitter here

I’m working on a paper entitled ‘Cyborg justice: punishment in the age of transformative technology’ with my colleagues Anders Sandberg and Hannah Maslen. In it, we consider how punishment practices might change as technology advances, and what ethical issues might arise. The paper grew out of a blog post I wrote last year at Practical Ethics, a version of which was published as an article in Slate. A few months ago, Ross Andersen from the brilliant online magazine Aeon interviewed Anders, Hannah, and me, and the interview was published earlier this month. Versions of the story quickly appeared in various sources, beginning with a predictably inept effort in the Daily Mail, and followed by articles in The Telegraph, Huffington Post, Gawker, Boing Boing, and elsewhere. The interview also sparked debate in the blogosphere, including posts by Daily Nous, Polaris Koi, The Good Men Project, Filip Spagnoli, Brian Leiter, Rogue Priest, Luke Davies, and Ari Kohen, and comments and questions on Twitter and on my website. I’ve also received, by email, many comments, questions, and requests for further interviews and media appearances. These arrived at a time when I was travelling and lacked regular email access, and I’m yet to get around to replying to most of them. Apologies if you’re one of the people waiting for a reply.
I’m very happy to have started a debate on this topic, although less happy to have received a lot of negative attention based on a misunderstanding of my views on punishment and my reasons for being interested in this topic. I respond to the most common questions and concerns below. Feel free to leave a comment if there’s something important that I haven’t covered.Read More »The future of punishment: a clarification

How much transparency?

By Dominic Wilkinson (Twitter: @Neonatalethics)

There are reports in the press this week that the remains of 86 unborn fetuses were kept in a UK hospital mortuary for months or even years longer than they should have been. The majority were fetuses less than 12 weeks gestation. According to the report, this arose because of administrative error and a failure to obtain the necessary permissions for cremation.

The hospital has publicly apologized, and set up an enquiry into the error. They are planning to cremate the remaining fetuses. However, they have decided not to contact all of the families and women whose fetal remains were kept on the basis that this would likely cause a greater amount of distress.

Is this the right approach? Guidelines and teaching in medical schools encourage health-care professionals and institutions to own up to their errors and disclose them to patients. Is it justifiable then to not reveal errors on the grounds that this would be too upsetting? How much transparency is desirable in healthcare?

Read More »How much transparency?