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Bioethics

The Ethics of Gently Electrifying Prisoners’ Brains

By Hazem Zohny and Tom Douglas

Scientists who want to study the effects of passing electric currents through prisoners’ brains have a PR problem: it sounds shady. Even if that electric current is so small as to go largely unnoticed by its recipient – as in the case of transcranial direct current stimulation (tDCS) – for some, such experiments evoke historical abuses of neuroscience in criminal justice, not to mention bringing to mind some of the more haunting scenes in films like One Flew Over the Cuckoo’s Nest and A Clockwork Orange.

And so, last week the Spanish Interior Ministry put on hold an impending experiment in two Spanish prisons investigating the impact of brain stimulation on prisoners’ aggression. At the time of writing, it remains unclear what the ministry’s reasoning for the halt is, though the optics of the experiment might be part of the story.

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Reversibility, Colds, and Neurosurgery

By Jonny Pugh

This blog was originally published on the Journal of Medical Ethics Blog

 

Happy new year to readers of the blog!

I always approach the new year with some trepidation. This is not just due to the terrible weather, or even my resolution to take more exercise (unfortunately in the aforementioned terrible weather). Instead, I approach January with a sense of dread because it is always when I seem to come down with the common cold.

In my recent research, I have been interested in the nature and moral significance of reversibility, and the common cold is an interesting case study of this concept. In this blog, I will use this example to very briefly preview a couple of points that I make in a forthcoming open access article about reversibility in the context of psychiatric neurosurgery. You can read the open access paper here.

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In My Own Blood I Have Written The Things Important To Me

Adrien Locatelli, a French teenager claims to have injected DNA strands encoding verses from the Bible and the Quran in his thighs.

“I did this experiment only for the symbol of peace between religions and science … It’s just symbolic.” he told Motherboard. Sri Kosuri, a UCLA biochemist working on DNA for data storage and quoted in the paper was not amused, tweeting “2018 can’t end soon enough”.

Peak 2018, an inspiring science project, or something else? I will argue for the third option.

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Abortion: a Law Unto Itself

By   Charles Foster

Wrongful life cases (typically where a birth has resulted from a failed sterilisation procedure), used to be big business. The parents would sue the negligent steriliser for the costs of bringing up the unwanted child. There was always something distasteful about parents unwishing their child, and this distaste found legal expression in Macfarlane v Tayside Health Board,1  where the House of Lords said that such claims were unlawful. The ratio of Macfarlane was summarised by the Lord Steyn in Rees v Darlington Memorial Hospital NHS Trust:2Read More »Abortion: a Law Unto Itself

Response from David S. Oderberg to “Against Conscientious Objection In Health Care: A Counterdeclaration And Reply To Oderberg”

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I am grateful to Prof. Savulescu and Dr Giubilini for taking the time and care to respond in detail to my Declaration in Support of Conscientious Objection in Health Care. I also thank Prof. Savulescu for giving me the opportunity to reply to their lengthy analysis. The authors make a series of important criticisms and observations, all of which I will face directly. The topic of freedom of conscience in medicine is both contentious and likely to become increasingly urgent in the future, so it is as well to dispel misunderstandings, clarify assertions and respond to objections as thoroughly as possible. That said, I hope I do not try the reader’s patience by discussing Giubilini and Savulescu’s objections point by point, in the order in which they raise them.

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Fetal Reduction in a Multiple Pregnancy: the Case of Identical Twins

Written by Elizabeth Crisp and Roger Crisp

When a woman aborts a single fetus, that abortion can be a morally troubling experience for her. What about a situation in which a woman is pregnant with more than one fetus, perhaps identical twins, and wishes to abort just one of them – that is, engage in what is sometimes called ‘fetal reduction’ in a ‘multiple pregnancy’?Read More »Fetal Reduction in a Multiple Pregnancy: the Case of Identical Twins

UK Supreme Court Decision Means Patients No Longer Forced to Live

By Mackenzie Graham

On July 30, The UK’s Supreme Court ruled that there is no requirement to obtain court approval before withdrawing clinically assisted nutrition and hydration (CANH), when there is agreement between physicians and the family that this is in the best interests of the patient.

In the judgement, Lady Black writes:

“If the provisions of the MCA [Mental Capacity Act] 2005 are followed and the relevant guidance observed, and if there is agreement upon what is in the best interests of the patient, the patient may be treated in accordance with that agreement without application to the court.”

Until now, requests to withdraw CANH needed to be heard by the Court of Protection to determine if withdrawing treatment was in the patient’s best interest. In addition to being emotionally difficult for families, this is a time-consuming and expensive process, and often results in the patient dying before a judgement is rendered.

I think this decision has much to be said in its favour. First, it means that when there is agreement that continued treatment is no longer in the best interests of a patient with a prolonged disorder of consciousness, these patients are no longer being ‘forced to live’ until the Court affirms that being allowed to die is in their best interests. In many cases, court decisions take months, meaning that a patient is forced to be kept alive, against their best interests and the wishes of their family. Making the decision to withdraw care from a loved one is highly distressing, and this is likely further compounded by the burden and distraction of court proceedings.

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The Dangers Of Deferring To Doctors

By Charles Foster

(Image: tctmd.com)

There is a dizzying circularity in much medical law. Judges make legal decisions based on the judgments of rightly directed clinicians, and rightly directed clinicians make their judgments based on what they think the judges expect of them. This is intellectually unfortunate. It can also be dangerous.

There are two causes: Judges’ reluctance to interfere with the decisions of clinicians, and doctors’ fear of falling foul of the law.

In some ways judicial deference to the judgment of professionals in a discipline very different from their own is appropriate. Judges cannot be doctors. The deference is best illustrated by the famous and ubiquitous Bolam test, which is the touchstone for liability in professional negligence cases.1 A doctor will not be negligent if their action or inaction would be endorsed by a responsible body of professional opinion in the relevant specialty.

In the realm of civil litigation for alleged negligence this deference is justified. The problem arises when the deference is exported to legal arenas where it should have no place. The classic example relates to determinations of the ‘best interests’ of incapacitous patients. Something done in relation to an incapacitous patient will only be lawful if it is in that patient’s best interests.Read More »The Dangers Of Deferring To Doctors

Treating the Dead Well

Written by Stephen Rainey

What happens after we die? This might be taken as an eschatological question, seeking some explanation or reassurance around the destiny of an immortal soul or some such vital element of our very being. But there is another sense that has at least as much importance. What should we do with dead bodies?

According to a Yougov survey from 2016, a majority of UK residents prefer cremation over burial, with their ashes scattered in some meaningful place. This could be good news, given the apparent dwindling of burial space globally. In the face of this sort of constraint, the re-use of graves becomes necessary, which can cause distress to the families of even the long dead.

Less commonly, dead bodies can be donated to medical science and put to use for purposes of research and medical training. Research suggests the rate is low owing to ‘non-cognitive factors’ such as ‘the desire to maintain bodily integrity, worries that signing a donor card might ‘jinx’ a person, and medical mistrust.’

Maybe we should think again about how we treat dead bodies. There could come a time when cremation and burial might be considered a waste of resources, given the uses to which cadavers can be put. One body can be used to train many surgeons in complex procedures by being pared into relevant sections – individual limbs, organ systems, brains. Nevertheless, whilst a corpse is indeed a valuable object, it was also previously a subject. The nature of bodies as post-persons does seem to deserve some special consideration. If we can account for this, we might be in a position to recommend very generally why we ought to respect the bodies of the dead.Read More »Treating the Dead Well