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Clinical Ethics

Watch your words! The challenges of law around the end of life

by Dominic Wilkinson

Here in South Australia last week, a bill has been proposed to clarify the legal status of advance directives. One very small part of that bill involves a modification to an older palliative care act. The modification corrects an ambiguity in wording in the earlier act. The ambiguity is subtle. However, that choice of words has had major consequences for seriously ill children and adults in South Australia and for health practitioners. It is a salutary reminder of how hard it is to enact good laws in the area of end of life, and how easily such laws can make things worse rather than better.

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Religious vs. secular ethics and a note about respect

By Brian Earp See Brian’s most recent previous post by clicking here. See all of Brian’s previous posts by clicking here. Follow Brian on Twitter by clicking here. This is a rough draft of a lecture delivered on October 1st, 2012, at the 12th Annual International Symposium on Law, Genital Autonomy, and Children’s Rights (Helsinki, Finland). It… Read More »Religious vs. secular ethics and a note about respect

Physician Assisted Suicide and the Conflict Between Autonomy and Non-Maleficence

In the run-up to the 6th November ballot in Massachussets concerning the prescription of medication to end life, two prominent US physicians, Dr. Ronald Pies and Dr. John Grohol, have been debating the pros and cons of physician assisted suicide (PAS). In his article, Dr Ronald Pies argues against the legalisation of PAS, claiming in the title of his essay that “medical ethics must sometimes trump patient choice”. Although Pies’ acknowledges that respect for autonomy is one of the four cardinal principles in medical ethics, he goes on to claim that “. . . medical ethics must set limits on a patient’s autonomous requests” in the light of another of these cardinal principles, namely the principle of non-maleficence. What are we to make of this claim?Read More »Physician Assisted Suicide and the Conflict Between Autonomy and Non-Maleficence

Banning conversion therapies

The Governor of California, Jerry Brown, has signed a Bill that will ban ‘conversion’ or ‘reparative’ therapies in that State. These are interventions that aim at ‘curing’ homosexuality or at least, controlling homosexual desires. There have been reported cases of exorcisms, shock treatment and aversive therapies not unlike those that were used in Stanley Kubrick and Anthony Burgess’ A Clockwork Orange.Read More »Banning conversion therapies

Dangerous Doctors and Immoral Doctors

In general, if you know someone to be a danger to others you have a duty to do something about it. Exactly what you are obliged to do depends on the person, the situation and you. At the very least you ought to warn others.

In general, and apart from such basic duties as not to interfere with others (more pompously, to respect their autonomy), to keep your promises to them, not to harm them and not to burden them, your strongest duties are those you take on voluntarily, such as those you acquire by taking up a profession.

The professions hold themselves out to us as entitled to special privileges because of their special knowledge. We trust them, we rely on them, we place ourselves in their hands for specific purposes, because when paid for their work they promise to look after our interest before their own. Part of that promise is a special duty to hold members of the profession accountable to professional standards and to exclude persons who fail those standards.

So members of the medical profession have both a very strong duty and a special duty to protect us from dangerous doctors. A book has come out showing that doctors are grossly— indeed, grotesquely —derelict in this duty.Read More »Dangerous Doctors and Immoral Doctors

Refusing Treatment to the Overweight: A Case Analysis

It was recently reported that a doctor in Shrewsbury Massachusetts refused to treat a patient named Ida Davidson because she was overweight. Dr. Helen Carter recently decided to stop admitting patients who weighed over 200 pounds to her practice, justifying her decision by citing three incidents in which her co-workers were injured in the course of caring for obese patients. These incidents led Carter to claim that the office in which she carries out her consultations is “unable to accommodate a certain weight”. She also pointed out that the nearby University of Massachusetts has a dedicated obesity centre which is far better equipped and better staffed to deal with obese patents.Read More »Refusing Treatment to the Overweight: A Case Analysis

The AAP report on circumcision: Bad science + bad ethics = bad medicine

By Brian D. Earp See Brian’s most recent previous post by clicking here. See all of Brian’s previous posts by clicking here. Follow Brian on Twitter by clicking here.   UPDATED as of 27 May, 2013. See the bottom of the post. The AAP report on circumcision: Bad science + bad ethics = bad medicine For… Read More »The AAP report on circumcision: Bad science + bad ethics = bad medicine

How not to save the world

By Charles Foster

Y chromosomes are on the way out, thinks Aarathi Prasad, a geneticist from Imperial College, London: they’re degenerating. If they go, then so do humans – unless an alternative method of reproduction can be devised. It can, says Prasad. In fact the basic technology is already here, and is bound to get better. In 2004 a mouse was conceived using synthetic sperm made by modifying ova. Technological virgin birth (I’ll call it TVB) might be the salvation of the human race.

This is all very interesting. But Prasad isn’t content merely to describe the science. She seems to think that we ought to drop all our taboos against the idea. ‘By all reasonable estimates, in the near future we will conquer the tyranny of the womb. The question remains if we can also conquer the tyranny of human prejudice….’

It’s not clear from this whether she is advising us to conquer our tyrannous prejudice on simply practical grounds –  (because, if we don’t overcome our squeamishness, we won’t develop or embrace the technology, so dooming humanity) or whether she thinks that there is something philosophically wrong with a distaste for TVB. I suspect the latter.

If this suspicion is right, why might she (or anyone else) think that?Read More »How not to save the world

Replying to a critic: My last circumcision post (for a while) – with video debate

By Brian D. Earp

See Brian’s most recent previous post by clicking here.

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VIDEO DEBATE LINKED TO BELOW – ARI KOHEN AND I DISCUSS THE ETHICS OF RELIGIOUSLY-MOTIVATED CIRCUMCISION

Ari Kohen doesn’t like my recent post about circumcision—the one in which I argue that it is unethical to remove healthy tissue from another person’s body without first getting his permission. I then go on to say that religious justifications cannot override this basic principle. Here’s that post again.

Ari is a professor of political theory and human rights at the University of Nebraska at Lincoln. In this blog post, he takes me to task for failing to take seriously the religious commitments of Jews in framing my arguments. And while he gets some things wrong about, for example, the relevance of “sexually-sensitive tissue” to my overall reasoning; and while he misses the point of my bringing up female genital cutting entirely (I’ve since edited my post to clear up any lingering ambiguity) – he is probably right that my approach to debating this issue is unlikely to win me any converts from within the ranks of the religious.

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Parkinson’s medication blamed for sexual offences

Adrian Carter and Wayne Hall, from the Neuroethics group at the University of Queensland Centre for Clinical Research, Australia

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The medication that provides significant relief from debilitating motor disturbances in people with Parkinson’s disease appears to cause a range of psychiatric disturbances that are as distressing and difficult to treat as the motor symptoms they aim to relieve.

Parkinson’s disease is usually treated with dopamine replacement therapy (DRT). This involves daily dosing with either levodopa (a precursor to the neurotransmitter, dopamine) or dopamine agonists (such as pramipexole and ropinirole) that mimic the effects of dopamine in the brain. The aim of DRT is to reduce the effects of the loss of dopaminergic neurons in specific regions of the brain involved in controlling bodily movement. However, dopamine is also a key neurotransmitter in a range of cognitive processes from executive control and memory to motivation and bonding. It is perhaps unsurprising that many Parkinson’s patients experience adverse psychiatric and cognitive side-effects from taking large doses of dopamine every day. 

Parkinson’s patients can experience severe anxiety, depression and mania and have a higher risk of suicide. A significant minority of Parkinson’s patients treated with dopamine replacement therapy will also develop impulsive and compulsive behaviours that appear to be caused by their medication. These include pathological gambling and hypersexuality, and compulsive eating and shopping. In rare cases, patients have committed criminal offences. Read More »Parkinson’s medication blamed for sexual offences