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Decision Making

Press Release: Tafida Raqeeb

Professor Dominic Wilkinson, Professor of Medical Ethics, University of Oxford. Consultant Neonatologist

 

This morning, the High Court judgement around medical treatment for five-year old Tafida Raqeeb was published. Tafida sustained severe brain damage from bleeding in the brain eight months ago. Her parents wish to take her to a hospital in Italy to continue life support, while the doctors at the London hospital caring for her believe that it would be best to stop life support and allow Tafida to die.

 

Justice MacDonald concluded today that life sustaining treatment for Tafida must continue and her parents should be allowed to take her to Italy.Read More »Press Release: Tafida Raqeeb

The Doctor-Knows-Best NHS Foundation Trust: a Business Proposal for the Health Secretary

By Charles Foster

Informed consent, in practice, is a bad joke. It’s a notion created by lawyers, and like many such notions it bears little relationship to the concerns that real humans have when they’re left to themselves, but it creates many artificial, lucrative, and expensive concerns.

Of course there are a few clinical situations where it is important that the patient reflects deeply and independently on the risks and benefits of the possible options, and there are a few people (I hope never to meet them: they would be icily un-Falstaffian) whose sole ethical lodestone is their own neatly and indelibly drafted life-plan. But those situations and those people are fortunately rare.Read More »The Doctor-Knows-Best NHS Foundation Trust: a Business Proposal for the Health Secretary

Press Release: Tafida Raqeeb, International Disagreement and Controversial Decisions About Life Support

by Dominic Wilkinson @Neonatalethics

 

This week the legal case around medical treatment for five-year old Tafida Raqeeb has begun in the High Court. She sustained severe brain damage from bleeding in the brain seven months ago. Her parents wish to take her to a hospital in Italy for further treatment, while the doctors at the London hospital caring for her believe that it would be best to stop life support and allow Tafida to die.

 

In a previous press release, I addressed several common questions about the case:

  • This seems to be another case like that of Charlie Gard and Alfie Evans. How common are cases of disagreement in the medical care of children?
  • Why do disagreements occur?
  • Why don’t parents have the final say about treatment?
  • Who is right in Tafida’s case, her parents, or the doctors?

 

There appear to be two central questions in her case –

  1. Is there any realistic chance of her condition improving if life-support continues?
  2. If Tafida’s condition does not improve, should treatment to keep her alive continue, or should it stop (particularly, if her parents do not give permission to withdraw treatment)?

Read More »Press Release: Tafida Raqeeb, International Disagreement and Controversial Decisions About Life Support

What the People Really Want: Narrow Mandates in Politics

Written by Ben Davies

Last week’s by-election in the Welsh constituency of Brecon and Radnorshire saw a reduction of Boris Johnson’s government majority to just one, as Liberal Democrat Jane Dodds won the seat. The result was an interesting one: more voters went for No Deal-friendly parties (mainly Johnson’s Conservatives and the Brexit Party) than for the out-and-out Remainer Lib Dems. Dodds won not because a majority of voters supported her, but arguably because the pro-Brexit vote was split, and the Lib Dem vote was boosted by Plaid Cymru and the Greens declining to field candidates (it can’t have helped that the Conservatives also simply reselected their candidate whose unseating for expenses fraud triggered the election).

The result generated two sets of comments by Conservative Chair James Cleverly. Cleverly’s first claim was that the Liberal Democrats had engineered a “back room deal” with other Remain-friendly parties – Plaid and the Greens – in a way that was, he implied, undemocratic.Read More »What the People Really Want: Narrow Mandates in Politics

Puberty-Blocking Drugs: The Difficulties of Conducting Ethical Research

The ethics of research trials for young people with gender dysphoria are complicated.
Billion Photos/Shutterstock

Dominic Wilkinson, University of Oxford and Julian Savulescu, University of Oxford

A recent Newsnight programme reported that a major UK puberty-blocking trial is under investigation. Doctors at a London clinic provided drugs to block the development of puberty in young adolescents with gender dysphoria, a condition where the person experiences discomfort or distress because of a mismatch between their biological sex and gender identity.

The trial began in 2011. A year after starting the drugs, the young people were apparently more likely to report thoughts of wanting to harm themselves. The worry is that perhaps the treatment they received was causing them to have these thoughts of self-harm and suicide.

One of the criticisms of the study, put forward on Newsnight, is the design. The study involved giving the drugs to a group of adolescents and monitoring the effects. However, there was no control group, that is, adolescents who did not receive the drugs. This makes it hard to be sure whether the rates of self-harming thoughts are related to the drugs, would have happened anyway, or perhaps were lower than they would have been without treatment.Read More »Puberty-Blocking Drugs: The Difficulties of Conducting Ethical Research

Doing More Harm Than Good? Should the Police Always Investigate Non-recent Child Sexual Abuse Cases?

Hannah Maslen, University of Oxford, @hannahmaslen_ox

Colin Paine, Thames Valley Police, @Colin_Paine

Police investigators are sometimes faced with a dilemma when deciding whether to pursue investigation of a non-recent case of child sexual abuse. Whilst it might seem obvious at first that the police should always investigate any credible report of an offence – especially a serious offence such as sexual abuse – there are some cases where there are moral reasons that weigh against investigation.

Imagine a case in which a third party agency, such as social services, reports an instance of child sexual exploitation to the police. The alleged offence is reported as having occurred 15 years ago. The victim has never approached the police and seems to be doing OK in her adult life. Although she had serious mental health problems and engaged in self-harm in the past, her mental health now appears to have improved. She does, however, remain vulnerable to setbacks. Initial intelligence gives investigators reason to believe that the suspect has not continued to offend, although there are limits to what can be known without further investigation. Should this alleged offence be investigated?

Read More »Doing More Harm Than Good? Should the Police Always Investigate Non-recent Child Sexual Abuse Cases?

Abolish Medical Ethics

Written by Charles Foster

In a recent blog post on this site Dom Wilkinson, writing about the case of Vincent Lambert, said this:

‘If, as is claimed by Vincent’s wife, Vincent would not have wished to remain alive, then the wishes of his parents, of other doctors or of the Pope, are irrelevant. My views or your views on the matter, likewise, are of no consequence. Only Vincent’s wishes matter. And so life support must stop.’

The post was (as everything Dom writes is), completely coherent and beautifully expressed. I say nothing here about my agreement or otherwise with his view – which is comfortably in accord with the zeitgeist, at least in the academy. My purpose is only to point out that if he is right, there is no conceivable justification for a department of medical ethics. Dom is arguing himself out of a job.Read More »Abolish Medical Ethics

Shamima Begum and the Public Good

Written by Steve Clarke,Wellcome Centre for Ethics and Humanities and Uehiro Centre for Practical Ethics, University of Oxford,

& School of Humanities and Social Sciences, Charles Sturt University

 

Shamima Begum, who left the UK in 2015 at age 15, to join the Islamic State, has been the subject of consistent media attention since she was discovered in the Al-Hawl refugee camp in Northern Syria, in February this year. Soon after being discovered in the refugee camp Begum was controversially stripped of her UK citizenship by Home Secretary Sajid Javid. Citizenship can be removed by the Home Secretary if doing so is deemed to be ‘conducive to the public good’. While it is illegal to render a person stateless, the Home Secretary is entitled to deprive UK citizens of their citizenship if they are also citizens of another country, or if they are eligible for citizenship in another country. Begum may be eligible for citizenship of Bangladesh, given that she has Bangladeshi ancestry, and there is a legal argument that she already is a citizen of Bangladesh.[1]

The Home Secretary’s decision has been much discussed in the media. Some commentators have argued that Begum’s interests should not be trumped by considerations of the public good. Others have questioned the legality of the decision. Still others have complained about the secretive nature of the decision-making process that led the Home Office to recommend to the Home Secretary that Begum be deprived of her citizenship. Here I will be concerned with a different issue. I will set aside considerations of Begum’s interests and I will set aside legal and procedural considerations. I will focus on the question of whether or not it is actually conducive to the public good in the UK to deprive Begum of her citizenship. Like most people, I do not have access to all of the information that the Home Secretary may have been apprised of, regarding Begum’s activities while she was living in the Islamic State, which would have informed his decision. So what I will have to say is necessarily speculative.

Read More »Shamima Begum and the Public Good

Arbitrariness as an Ethical Criticism

Written by Ben Davies

We recently saw a legal challenge to the current UK law that compels fertility clinics to destroy frozen eggs after a decade. According to campaigners, the ten-year limit may have had a rationale when it was instituted, but advances in freezing technology have rendered the limit “arbitrary”. Appeals to arbitrariness often form the basis of moral and political criticisms of policy. Still, we need to be careful in relying on appeals to arbitrariness; it is not clear that arbitrariness is always a moral ‘deal-breaker’.

On the face of it, it seems clear why arbitrary policies are ethically unacceptable. To be arbitrary is to lack basis in good reasons. An appeal against arbitrariness is an appeal to consistency, to the principle that like cases should be treated alike. Arbitrariness may therefore seem to cut against the very root of fairness.

Read More »Arbitrariness as an Ethical Criticism

In Praise Of Dementia

By Charles Foster

Statistically there is a good chance that I will ultimately develop dementia. It is one of the most feared conditions, but bring it on, I say.

It will strip me of some of my precious memories and some of my cognitive function, but it will also strip me of many of the neuroses that make life wretched. It may (but see below) make me anxious because the world takes on an unaccustomed form, but surely there are worse anxieties that are dependent on full function – such as hypochondriacal worries, or the worry that comes from watching the gradual march of a terminal illness. On balance the trade seems a good one.Read More »In Praise Of Dementia