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T-illegal actions and the case for legal ambiguity

Question: When is a crime not a crime? Answer: when it will never be prosecuted.

The release this week by the Director of Public Prosecutions of his interim policy on prosecution of assisted suicide raises a number of questions – as discussed yesterday in this blog by Simon Rippon. The new policy formalises what has been informal for some time, that family members of patients with terminal illnesses (or other serious conditions) who help the patients to travel overseas to access assisted suicide are unlikely to be prosecuted for their actions. But their actions will still be technically criminal. Should there be a class of ambiguous actions that are neither legal, nor illegal?

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Justice and Mercy

The moral debate about whether Abdelbaset al-Megrahi, the man convicted for the Lockerbie bombing,  should have been released has now morphed into a political debate about who wanted what and who said what to whom: http://www.guardian.co.uk/politics/blog/2009/sep/07/ed-balls-abdelbaset-al-megrahi . But the moral debate itself remains unresolved.

Let’s assume, for the sake of argument, that (a) Megrahi was guilty as charged, (b) his trial was procedurally just, (c) he deserved his sentence, and (d) he is very close to death. Those who opposed freeing Megrahi tended to concentrate on (a)-(c), especially (a) and (c), as if that settled the matter. But of course those who supported freeing him believe that there was a case, based on compassion or mercy in response to (d), for releasing him before he had finished his sentence. What is going on here?

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The party line and the flu-line

It has emerged over the weekend that the UK government ignored the advice of a key panel of scientific advisors in the formulation of its pandemic response. The panel advised against the mass prescription of antivirals (Tamiflu) because of the fear that this would accelerate resistance of the virus (see also this previous post in the pandemic ethics series). An expert in influenza, Hugh Pennington, has even called for the national flu hotline to be shut down. It appears that the government may have been influenced in its pandemic response by political sensitivities.

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Should we forget about organic food?

A recent
report by the Food Standards Agency argues that organic food doesn’t bring any
substantial nutritional benefits compared to conventionally produced food.
This contradicts the conclusions of previous studies suggesting organic food to
be nutritionally superior. As one might have expected, supporters of organic
farming have been critical of the report, yet it is unfortunate that the media
coverage on this issue often gives the impression that organic food has been
shown to be a sham (some consumer groups thus expect shoppers to now “think
twice before buying organic”)
and that its advocates are now reduced to using any bad argument they can think
of to prove the contrary. This impression is understandable but misleading.

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A change of heart

Earlier this week fourteen-year old Hannah Jones received a heart transplant. This is eight months after Hannah hit the news for her refusal to have the surgery. There was much debate in the media (including this blog) at the time about whether or not teenagers should be allowed to refuse life-saving treatment, though overall there was a lot of support for Hannah’s decision.

But in the last week Hannah has apparently changed her mind, and elected to have the surgical procedure. What is the significance of this for the decision to go along with her earlier choice? Hannah might well have died in the last 8 months, in which case she would never have had a chance to rethink her position on transplants. Does the fact that she has now changed her mind give us more reason, in future, to overrule similar patients who are declining live-saving treatment?

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What’s special about selling gametes?

Dominic Wilkinson posted yesterday on the issue of whether payment for egg and sperm donation should be legalised. This question attracted significant media attention yesterday after Lisa Jardine, of the HFEA, called for debate on the existing UK ban on payment for donors. Today's Guardian contains a piece highlighting several ways in which people can already sell their bodily parts or products, ranging from livers to breast milk, and from blood to hair. Sale of many of these bodily parts/products is regarded is ethically problematic, and is, in many cases, illegal. But not in all cases. For example, few would have a problem with the sale of hair for use in wigs.

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Pandemic ethics: Mild flu and Tamiflu – the patient’s dilemma

In recent days there have been reports of a jump in the number of cases of H1N1 influenza (swine flu) in the UK. There have been 29 deaths associated with pandemic influenza in the UK, and there are 652 people in hospital in England with the flu. Faced with the prospect of primary health care services becoming overwhelmed, the government has set up a telephone hotline to allow those affected by the flu to access antiviral drugs (for example oseltamivir or Tamiflu) without needing to see a doctor. But there are also suggestions that not all patients with flu-like symptoms should be treated. Patients with mild or vague symptoms of the flu, without other medical conditions that put them at particular risk, may not be given medication.

This sets up a problem for patients who develop mild flu-like symptoms. Although there is only a small chance of them becoming seriously ill or dying from the flu it is possible that early treatment with anti-virals would reduce that risk. (Antivirals were only effective in trials if given in the first 48 hours of illness) Should they demand treatment from their doctor in the hope of avoiding a serious complication of influenza? Should they exaggerate their symptoms? If the doctor refuses, should the patient self-treat with medications that they have obtained privately (for example over the internet)? There is a form of the classic prisoner’s dilemma involved in such questions.

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Pandemic Vaccination: Who to Vaccinate?

Fears of the spread of pandemic influenza in the UK continue to grow. Three apparently previously healthy patients have died here. There are now plans for widespread immunisation later in the year – though initially this is likely to be restricted to those at highest risk, and those in 'vital' professions.

Who should be vaccinated? This is a question of distributive justice.

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Refusing Cochlear Implants: Is It Child Neglect?

Australian Graeme Clark developed the cochlear implant, or bionic ear, in the 1970s. It does not amplify sound but directly stimulates any functioning auditory nerves in the inner ear. The Australian Government has promised a screening program of all babies for deafness from 2011. At present, only 70 percent children who might benefit are picked up early. The earlier deafness is detected, the more effective treatment can be.

Lobby group Deaf Australia says the implant "implies that deaf people are ill or incomplete individuals, are lonely and unhappy, cannot communicate effectively with others and are all desperately searching for a cure for their condition. [This] demeans deaf people, belittles their culture and language and makes no acknowledgment of the diversity of lives deaf people lead, or their many achievements."
Some deaf parents have denied their children cochlear implants. Is this right?

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