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Care for the Dying and Cost-effectiveness

Yesterday’s news reports the launch of the Government’s End of Life Care Strategy for England. This strategy will dedicate in excess of £250 million allowing patients who are dying to decide, as the Times puts it, “where and how to die.” This is part of a programme to provide better care for the dying. According to the BBC, only one in five deaths takes place at home despite a comfortable majority expressing a preference for such familiar surroundings. This prioritisation raises some interesting ethical issues particularly in the light of cost-effectiveness considerations.

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Unpopular policy and public rationality

The BBC
reports
that the Japanese
town of Kamikatsu
has become the first ‘zero waste’ town. Residents
compost all of their food waste, and must sort the rest of their rubbish into
34 different categories—all of which they must take to public waste centres,
since there are no rubbish collections from people’s homes. It seems that the inhabitants of the town are
generally enthusiastic about the scheme, which offers small financial rewards
for recycling, and has encouraged people to make an effort to reduce the
rubbish they produce.

This is one
of those relatively rare, uplifting stories about a scheme designed to reduce
environmental damage that is not only successful, but supported by the
community. Could something similar work
in the UK? Recently, many UK councils reduced domestic refuse
collections from once-weekly to once-fortnightly, with recyclable waste being
collected in the intervening weeks. Whilst this has boosted the amount of rubbish being recycled,
some news reports
reveal that the new measures are unpopular, and some councils have bowed to
public pressure by re-introducing weekly collections. Given the environmental impact of adding to
landfill waste sites, ought the government to placate the public by relaxing
measures designed to reduce waste, or should unpopular measures be enforced
regardless of public opinion?

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Paying to top up NHS treatment

The BBC has this week published a story on co-payment in the UK’s National Health Service. Sue Matthews, a Buckinghamshire woman with terminal bowel cancer, would like to top up her NHS care by paying for a £30,000 course of cetuximab – a drug which could extend her life, but which is not funded by her NHS trust. However, if she does so, she may also have to pick up the tab for her standard NHS treatment. That’s because the NHS guidelines advise against allowing such co-payments: they require that a given instance of treatment be either fully privately funded, or fully publicly funded.

Should co-payments be banned?

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Activists and acts of mercy

In Germany this week, and in Australia recently, there has been public
concern and significant media attention about the actions of euthanasia
activists. A former government official and lawyer, Roger Kusch, went
public in Germany with a video of an elderly woman who he had helped to
die. In Australia, Phillip Nitschke has been criticised for his
involvement and subsequent comments about the death of Graeme Wylie a
man suffering from Alzheimer’s disease whose partner and close friend
have been found guilty of manslaughter.

Opponents of euthanasia have used these cases to argue against liberalisation of laws on assisted suicide or euthanasia.

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When autonomy trumps sense: the costs of refusal to allow withdrawal of life support.

In Canada this week, an 84 year old man died after 9 months of treatment
in an intensive care unit. He had severe brain damage and multi-organ
failure, but his family sought a legal injunction to prevent doctors in
the intensive care unit from withdrawing life-support. Over the course
of his long intensive care stay, intensive care beds at a major trauma
centre were closed
so that nurses could used instead to support his
care, and three doctors resigned from the hospital in protest at being
required to provide what they felt was ‘unethical’ treatment.

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Lex Orwell: When is a Surveillance Society OK?

The current Swedish debate about a bill to
allow military intelligence to intercept phone and Internet
communications
has produced something most unSwedish: a grassroots
"blogquake" that has upset the staid logic of traditional politics
. Given the threat that the bill may fall because of MPs disobeying their party whips
(normally unheard of in Swedish politics) there is a real chance the bill is even
withdrawn at the last minute. But even if it is, this is
an issue that will return again and again: exactly how much
information should the government be allowed to gather and for what purposes?

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Same species, different needs: could ‘genes for’ improve the way we treat animals?

The New
Scientist recently reviewed a variety of studies showing that many traits often supposed unique to humans are in fact shared by
animals
.
There is evidence that apes, dolphins,
songbirds, elephants, and monkeys share with humans some of the
most important aspects of behaviour associated with speech; killer whales have
distinct cultural groups; great apes and some monkeys have a degree of
understanding of the minds of others, enabling them to deceive; chimpanzees,
gorillas, and crows use tools; and there is suggestive evidence that elephants,
magpies, baboons, whales, and chimpanzees demonstrate emotional behaviour, and
that monkeys and rats are capable of drawing primitive moral distinctions.

Claims that animals have capacities usually thought
unique to humans are controversial, and those who make them are often accused
of anthropomorphising animal behaviour. Plausibly,
there is often more to such accusations than concern for explanatory
parsimony. As humans, we profit from
using animals—for food, research, sport, and so on—in ways that we would not
use other humans, and suggestions that animals are more like humans than we
usually suppose place an unwelcome demand on society to rethink its ethical stance
towards animals. This suggests that a
clear division between humans and other species is important to us in justifying
the discrepancies between what we view as ethical treatment of other humans and
what we view as ethical treatment of non-human animals. Pragmatically speaking, if we
humans wish to retain a privileged moral status, and if our privileged moral
status is at least partly due to our being different to other animals in
certain important (usually biologically-based) respects, then it is in our
interests to resist attempts to draw similarities between humans and other
animals.

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Legal Abortion Time-Limits: Arbitrary Limits Harm Women

By Dr. Lachlan de Crespigny, Department of Obstetrics and Gynaecology, University of Melbourne

The vote by the British parliament to keep the upper legal limit on abortion at 24 weeks was headline news around the world. An article in The Economist (1) considers that the British were spared America’s abortion wars partly because Britain is less religious than America, but also because abortion laws are made in Parliament, where shades of grey can be debated, not in the courts, where black or white usually prevails.

Interestingly much of the debate was about ‘viability’ – the minimum gestational age at which a newborn is said to be capable of surviving with modern intensive care facilities. This is a simple across-the-board week count. But the survival rate of newborns also depends on many other factors, including where they are born (2, 3), fetal health including the presence or absence of an abnormality (which remains lawful where the child will be ‘seriously handicapped’), plus the condition of the newborn. While around half or so of 24 week newborns in Britain may survive, many or most of the abortions at around that gestation are of problem, or unhealthy, pregnancies.

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Brain Boosting and Cheating in Exams: Four Responses

A report by the Academy of Medical Sciences looking at different aspects of drug use and mental health has identified a growing trend for off-label use of drugs intended for the treatment of diseases including narcolepsy, ADHD and Alzheimer’s. The use of such drugs by a healthy individual can improve memory, alertness and concentration. While the report does not condemn the practice, it raises a number of potential concerns over safety, and fairness. Professor Les Iversen, report co-author, highlighted concerns that the use of enhancement in exams would unfairly advantage wealthier students, and suggested that the use of such drugs could be considered cheating. The report recommends that legislation is prepared to tackle the misuse of such drugs, including the potential for urine testing in schools and universities.

Below are responses from Julian Savulescu, Nick Bostrom, Anders Sandberg and Mark Sheehan on the effects of cognitive enhancing drugs, and the issue of cheating

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