Decision Making

A change of heart

by Dominic Wilkinson
July 30, 2009

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?

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

by Dominic Wilkinson
July 17, 2009

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.

Is it Worth Living Longer?

by Roger Crisp
July 10, 2009

Research recently published in Nature suggests that the drug rapamycin may have the potential to extend human life span by decades: http://news.bbc.co.uk/1/hi/health/8139816.stm

If the life is of ‘positive’ value, it might seem obvious that the drug is worth taking. But not everyone would agree. The Hellenistic philosopher Epicurus famously argued that, since it marks the end of conscious life, ‘death nothing to us’. Fearing death makes as much sense as regretting you weren’t around for all that time before your birth.

Decisions, decisions.

by Practical Ethics
June 9, 2009

I’ve just returned from Malta where I came across a story that I had missed at the time. A decade ago a Catholic woman from the Maltese island of Gozo gave birth to conjoined twins. Doctors said the twins would both die unless they were operated on; but if this operation went ahead only one of the babies would survive.

Overruling parents and allowing infants to die

by Dominic Wilkinson
March 27, 2009

Over the weekend a nine-month old infant, baby ‘OT’, died following a court ruling that allowed doctors to remove life support. As discussed in a post last week, his parents had wanted treatment to continue, but the court ruled that the hospital could withdraw the breathing machine that was keeping OT alive and allow him to die.

Is doodling a form of cheating?

by Rebecca Roache, Royal Holloway University of London
February 27, 2009

The public
often complains about the fluctuating and conflicting attitudes of scientists. So often do things heralded as good for us
one week turn out to be deadly the next (consider, for example, this recent
report about vitamin pills) that there seems little point in
trying to follow the advice of scientists.

Some recent
news stories raise the question of whether the public is inclined to dismiss
the conflicting views of ethicists, too. Ethical
concerns about pharmacological cognitive enhancement have regularly been
reported in the press (see, for example, here,
here,
and here);
whilst at the same time—as Dominic Wilkinson has noted on this blog—the
public has embraced non-pharmacological cognitive enhancement in the form of software designed to improve brain power, and the media
currently abounds with docile, non-panicky reports of how instant messaging,
texting,
taking short naps,
taking long naps,
listening to The Beatles,
and doodling can all enhance cognition in various ways.
So far, there have been no reports of ethical concerns about these
activities: nobody is suggesting that students who doodle during lectures are cheating. It seems that, despite the concerns of some, the public is willing
to embrace cognitive enhancement in a variety of forms.

Transparent brains: detecting preferences with infrared light

by Anders Sandberg
February 11, 2009

Researchers at University of Toronto have demonstrated that they can decode which of two drinks a test subject prefers by scanning their brains with infrared light. (Original paper here.) The intention is to develop better brain-computer interfaces for severely disabled people, but there are obvious other applications for non-invasive methods of detecting what people want. No doubt neuromarketers are drooling over the applications. But the threat to mental privacy might be a smaller problem than the threat of mistaken preferences.

Tattoos and taboos: making end of life preferences known when it matters

by Dominic Wilkinson
December 16, 2008

A 79 year old euthanasia campaigner in New Zealand has attracted local and international publicity after having the words ‘Do Not Resuscitate’ tattooed across her chest. Although this seems unlikely to be widely emulated her action highlights the problem that at the time when it might be most important to make one’s views known, patients are often unconscious or incompetent.

Climate Change, Abortion, and Impersonality

by Roger Crisp
December 15, 2008

We are surrounded by many ethical issues, and their complexity makes it tempting to treat each in isolation. But we need to remember that to justify any position requires reference to universal principles, and these principles may well have implications in other areas we find uncomfortable. It’s also the case that thinking about one topic… Read More »Climate Change, Abortion, and Impersonality

The root cause

by Janet Radcliffe Richards
December 3, 2008

On April 16 2007 a solitary gunman, Cho Seung-Hui, killed 32 of his fellow students at Virginia Tech, and injured many more http://www.cnn.com/2007/US/04/18/vtech.shooting/index.html . This came to mind again as I was listening to Radio 4’s Any Questions last Friday, when a questioner referring to the terrorist attacks in Mumbai asked whether we could ever put a stop to extremist violence. In the subsequent debate difference of opinion began to appear between the panellists who spoke about the need for security and intelligence gathering and military operation, and Caroline Lucas of the Green Party who insisted that terrorism could never be ended by these means, and said several times that we needed to get to the root cause of the problem. In starting to identify these root causes she mentioned the Palestinian situation, and the widespread feeling among Muslims that the so-called war on terror was really a war of the West against Islam. (You can check the detail by going to the BBC i-player: http://www.bbc.co.uk/iplayer/ .)