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Decision Making

Choosing how to live: death row inmates and terminally ill patients

by Shlomit Harrosh

Convicted murderer Ronnie Lee Gardner was killed by gunfire on July 18, 2010. Given the choice between lethal injection and being shot, Gardner opted for the firing squad. This was the first firing squad execution in the state of Utah since 1996.

In the 37 states where the death penalty is in practice, lethal injection is the primary method of execution. Alternative methods are provided in 20 states, contingent upon the prisoner’s choice, the date of execution or sentence and the constitutional standing of the method used. In Virginia, for example, a convicted murderer can elect to be executed either by lethal injection or electrocution, while in Washington prisoners are executed by lethal injection unless they choose death by hanging.
Assuming that it is a good thing for prisoners to have some choice as to their method of execution, what does this tell us about the morality of voluntary euthanasia in terminally ill patients?

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A costly separation between withdrawing and withholding treatment

by Dominic Wilkinson

Television child star Gary Coleman died recently following a severe brain haemorrhage. He was taken to an intensive care unit, but the next day was taken off life support because of the severity of his brain injury.

Decisions like the one made by Gary Coleman’s doctors are common in intensive care. Many deaths follow decisions to stop intensive treatment because it is believed to have no chance of succeeding or because of the burden of illness even if the treatment does work. One question raised about cases like these is about the importance (or risks) of living wills. A separate question (and one that was raised during the critical care grand round earlier today) is about the difference between stopping treatment and failing to start treatment.

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Critical Care ethics grand round

by Dominic Wilkinson

Today I gave a talk at the John Radcliffe Medical Grand Round on Advance Directives and treatment withdrawal decisions in intensive care – based on a case I was involved in last year.

A middle-aged patient presents with acute respiratory failure, and is intubated and transferred to the intensive care unit. After admission he improves, but it transpires that he has a progressive neurodegenerative disorder and has previously expressed a wish not to have intensive life support measures provided.

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The ethics of geoengineering – comments welcome

Should we encourage or avoid large scale environmental manipulation, for example in order to reduce climate change?

Measures such as carbon dioxide capture or ocean iron fertilisation have the potential to mitigate global warming, but what ethical issues are raised by these technologies? How should we take into account the potential risks of such measures, and how should they be weighed against the risks of inaction?

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Mining your past to justify your terminal care: the idea of a ‘retrospective QALY’

There is no end to human suffering. There is a distinct end to the amount of money that governments will spend on reducing it. Someone has to make decisions about healthcare resource allocation. I am very glad it’s not me.

Many tools are used in the decision-making process. Not many emerge well from a viva with a philosopher.

Individual clinicians use intuition, experience, NICE
guidelines, the fear of hospital accountants and, no doubt, prejudice and the
tossed coin. But policy makers do not have the luxury of being able to account
only to their consciences and the local man in a suit. They have to say something in the minutes about the
reason for funding procedure X but not procedure Y. The real reason might be:
‘My grandma, whom I loved very much, had procedure X, and it did her good’, but
they can’t say that.

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Chillin’ with the Texas Board of Education

The Texas Board of Education recently approved changes to the state's high school social studies curriculum. The Board also has responsibility for reviewing and approving textbooks for use in Texas schools according to whether they meet its curriculum standards, so its move will effectively force textbook publishers to revise their presentation of American history. The curriculum revisions are controversial because many observers believe that they are motivated by, and reflect, an extreme conservative view of American history.

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The hammer or the nail – are addicts morally responsible?

In a case that is probably echoed daily across this country and many others, an amphetamine addict Michael Hunter was jailed yesterday for attacking a friend with a hammer. The judge noted that

"amphetamine had clearly affected
Hunter’s mental health, but he highlighted the fact that he had been
responsible for two unprovoked attacks using weapons."

The judge alluded to the question of responsibility and the influence of addiction. Are addicts morally responsible? Should drug addiction excuse or mitigate blame for actions taken under their influence?

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A nick for Nick, but nix to nicks for Nickie?

The American Academy of Pediatrics (AAP) has come under fire for a policy statement that has a more nuanced approach to female circumcision (FC) than its previous absolute opposition. The new policy proposes that the law be changed to allow pediatricians to perform a ritual ‘nick’ as a compromise where families request female circumcision. The AAP document strongly opposes all female circumcision that would lead to physical or psychological harm, but suggest that pricking or incising the skin of the external genitalia in females is less harmful than ear piercing. This has led to outrage from groups who oppose female circumcision in all forms.

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How to Prescribe Smart Drugs to Children Ethically

Ilina Singh and colleagues argue that the use of drugs such as Ritalin among young people is becoming so common that family doctors should be able to prescribe them as study aids to school pupils aged under 18.(1)

While the Guardian article rather cherry-picks from the range of Singh’s arguments in her original article, I have made broadly similar arguments to those in the Guardian article supporting cognitive enhancement myself (see here for a selection on enhancement).

However, one might ask whether the prescription of enhancement for young children who are incapable of consenting for themselves raises unique issues. 

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