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Decision Making

Back from the grave: Should we allow Elective Ventilation?

Mary is 62 years old. She is brought to hospital after she collapsed suddenly at home. Her neighbour found her unconscious, and called the ambulance. When they arrived she was deeply unconscious and at risk of choking on her own secretions. They put a breathing tube in her airway, and transported her urgently to hospital.

When Mary arrives she is found to have suffered a massive stroke. A brain scan shows very severe bleeding inside her brain. In fact the picture on the scan and her clinical state is described by the x-ray specialist as ‘devastating’. She is not clinically brain dead, but there is no hope. The emergency department doctors have contacted the neurosurgical team, but they have decided not to proceed with surgery as her chance of recovery is so poor.

In Mary’s situation, the usual course of events is to contact family members urgently, to explain to them that there is nothing more that can be done, and to remove her breathing tube in the emergency department. She would be likely to die within minutes or hours. She would not be admitted to the intensive care unit – if called, the ICU team would be likely to say that she is not a “candidate” for intensive care. However, new guidance from the National Institute of Clinical Effectiveness, released late last year, and endorsed in a new British Medical Association working paper, has proposed a radical change to this usual course of events.Read More »Back from the grave: Should we allow Elective Ventilation?

Sergei Lavrov’s Deontology

In Syria, Assad has sought to silence protests against his dictatorial regime using violence. Refusing to be cowed, the protests have resisted. The regime has since escalated the violence. As I write, the Syrian army continues to use massive force against a mainly civilian population. There is little doubt that serious crimes are being committed. After months of ignoring the situation, the West is finally beginning to sympathise with the plight of the Syrians. Yet an emasculated Security Council resolution was thwarted this week by the vetoes of Russia and China. Since then, various explanations have been offered to justify this stance. However, one justification in particular struck me.

Read More »Sergei Lavrov’s Deontology

Nothing to lose? Killing is disabling

In a provocative article forthcoming in the Journal of Medical Ethics (one of a new series of feature articles in the journal) philosophers Walter Sinnott Armstrong and Franklin Miller ask ‘what makes killing wrong?’ Their simple and intuitively appealing answer is that killing is wrong because it strips an individual of all of their abilities – acting, moving, communicating, thinking and feeling.

So what, you might ask? If this is right, say Sinnott-Armstrong and Miller, it means that it would be just as bad to commit an act that caused someone to be in a permanent vegetative state, as it would to kill them.Read More »Nothing to lose? Killing is disabling

Practical Ethics Given Moral Uncertainty

Practical ethics aims to offer advice to decision-makers embedded in the real world.  In order to make the advice practical, it typically takes empirical uncertainty into account.  For example, we don’t currently know exactly to what extent the earth’s temperature will rise, if we are to continue to emit CO2 at the rate we have… Read More »Practical Ethics Given Moral Uncertainty

Choosing one’s own (sexual) identity: Shifting the terms of the ‘gay rights’ debate

Choosing one’s own (sexual) identity: Shifting the terms of the ‘gay rights’ debate

By Brian Earp (Follow Brian on Twitter by clicking here.)

UPDATE: See HuffPost Live debate on this topic here.

Can you be gay by choice? Consider the following, from the Huffington Post:

Former “Sex and the City” star Cynthia Nixon says she is gay by “choice” – a statement that has riled many gay rights activitists who insist that people don’t choose their sexual orientation.

Read More »Choosing one’s own (sexual) identity: Shifting the terms of the ‘gay rights’ debate

Skipping intuitively over the is-ought gap

By Charles Foster

I spent a lot of the weekend at a very good conference entitled Moral Evil in Practical Ethics.
There was, I think, a complete or almost complete consensus about many things. Here are two: (1) Evil exists, and is of a different quality from merely sub-optimal moral behaviour. (2) To recognise evil implied a duty to do something to combat it. Everyone in the room seemed to see (2) as a corollary of (1).
This second proposition is a classic ‘ought’ claim. But how did we get there? The audience included many distinguished philosophers. Were we all plunging naively but disastrously into the is-ought gap? Was the conclusion sloppily reached, and untenable?Read More »Skipping intuitively over the is-ought gap

The cost of living and the cost of dying

X, a patient with reliably diagnosed PVS, lies in a hospital bed for years, fed via a nasogastric tube. He has not, and by definition never will have, any capacity for pain, pleasure or any sort of sensation. Devoted family members come each day to sit by his bedside, but he has no idea that they are devoted, or that they exist.
It is expensive to keep him alive. He occupies a bed and consumes a good deal of nursing time.
The NHS Trust responsible for his care has a limited budget. It decides that the money spent on maintaining his merely biological life would be better spent on dialysis machines. It can, and does, justify its decision in purely utilitarian terms. It writes in the minutes of the relevant committee meeting: ‘For the money we spend keeping X alive, we can save the lives of 10 kidney patients, each of whom will have a good quality of life for many years. The QALY arithmetic makes X’s continued existence nonsensical.’Read More »The cost of living and the cost of dying

World funds: implement free mitigations

The future is uncertain and far. That means, not only do we not know what will happen, but we don’t reason about it as if it were real: stories about the far future are morality tales, warnings or aspirations, not plausible theories about something that is going to actually happen.

Some of the best reasoning about the future assumes a specific model, and then goes on to explore the ramifications and consequences of that assumption. Assuming that property rights will be strictly respected in the future can lead to worrying consequences if artificial intelligence (AI) or uploads (AIs modelled on real human brains) are possible. These scenarios lead to stupidly huge economic growth combined with simultaneous obsolescence of humans as workers – unbelievable wealth for (some of) the investing class and penury for the rest.

This may sound implausible, but the interesting thing about it is that there are free mitigation strategies that could be implemented right now. Read More »World funds: implement free mitigations