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Bioethics

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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Anti Addict Mummy Money

A US group that pays drug addicts to undergo sterilisation visits the UK this week, having recently paid its first British client for undergoing a vasectomy. “Project Prevention” claims that its goal is to make addicts and alcoholics use long-term birth control until they can care for the children they conceive. Founder Barbara Harris has said: “We don’t allow dogs to breed. We spay them. We neuter them. We try to keep them from having unwanted puppies, and yet these women are literally having litters of children.”

The visit has provoked strong responses. Some have compared the group to eugenicists, while supporters point to the cost to the children and society of conception by addicted parents. Dominic Wilkinson has controversially suggested on this blog that a version of the programme could be offered on the National Health Service.

This ethical debate is on the level that Mackie (1977) identifies as first order. However, the issue also highlights second order moral issues about the nature of morality. What are we doing when we express a moral view and how do we know that our views are reliable? One approach to answering these sorts of questions is to understand human morality as an adaptation that contributed to our ancestors’ evolutionary fitness. Without addressing the strengths and weaknesses of such an approach here, if correct, it has the potential to illuminate second, and by implication first, order questions.

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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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Incidentally… avoiding the problem of incidental findings

A new study from the Mayo clinic in the United States points to a frequent problem in certain types of medical research. When healthy volunteers or patients with a given condition take part in research studies they may have brain scans, CAT scans, blood tests or genetic tests that they wouldn’t otherwise have had. These tests are not done for the benefit of the individual, they are designed to answer a research question. But sometimes, quite often according to the authors of this new study, researchers may spot something on the scan that shouldn’t be there, and that could indicate a previously undiagnosed health condition. These ‘incidental findings’ generate an ethical dilemma for researchers. Should they tell the research participant about the shadow seen on their scan? Do they have an obligation to reveal to a research participant that they have found them to carry a gene increasing their risk for breast cancer, or Alzheimer’s disease? There is much agonising by ethics committees, ethicists and researchers about the problem of incidental findings, but there is a simple way of avoiding the problem. Anonymise research databases and tests so that there is no possibility of determining which participant has the breast cancer gene, or the lump in their kidney.

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Should we rid the world of carnivores if we could?

by Alexandre Erler

In a provocative piece for the New York Times, Jeff McMahan remarks that cruelty pervades the natural world: he stresses the vast amount of suffering and the violent deaths inflicted by predators on their innocent victims. He then invites us to consider a daring way of preventing such suffering and deaths: “Suppose that we could arrange the gradual extinction of carnivorous species, replacing them with new herbivorous ones.  Or suppose that we could intervene genetically, so that currently carnivorous species would gradually evolve into herbivorous ones, thereby fulfilling Isaiah’s prophecy.  If we could bring about the end of predation by one or the other of these means at little cost to ourselves, ought we to do it?” McMahan’s conclusion, which he describes himself as “heretical”, is that we do have a moral reason to desire the extinction of carnivorous species, and that it would be good to bring about their extinction if this could be done “without ecological upheaval involving more harm than would be prevented by the end of predation”.

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Is the UK’s HPV vaccination programme unethical and/or unlawful?

A colleague recently emailed me. Her daughter, just turned
12, had come back from school bearing an information leaflet about HPV vaccination
with the Glaxo Cervarix vaccine, and a consent form for the parent to sign.

The consent form nodded inelegantly to Gillick, asserting that ‘[t]he decision to consent or refuse is
legally [the girl’s], as long as she understands the issues in giving consent.’
There was no indication given, in the consent form or the accompanying
literature, as to whether and if so how that understanding would be tested. The
reality is that it won’t be tested at all.

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When you prick me do I not cry?

A fascinating study in the Lancet this week has suggested that a very commonly used and simple analgesic in newborn infants may not actually be preventing them from experiencing pain. The study’s authors suggest that this medicine should no longer be used routinely in newborn infants. A headline in the Guardian reads “Newborn babies should not be given sugar as pain relief”. But there are scientific, philosophical and ethical reasons why this conclusion, though possibly correct, is premature.

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Enhancement – Keep the Game, Change the Basis

Paradoxically, elite sports is largely about seeking for inequality, but simultaneously trying to level the playing field in order to equalize the opponents. So, how is it possible to cultivate inequality through equality? Anti-doping activists argue that enhancing substances falsify the individual and naturally given capability to perform in a competition. As a result, there might be a lack of equal opportunities. In contrast, enhancement advocates underline that doping might be able to level the playing field by removing the effects of genetic inequality, and therefore provides equality.[1] In fact, both arguments imply the noble aspiration of equality. So then, equality must be the ultimate aim.

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