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Dominic Wilkinson’s Posts

Pandemic ethics: The boy who cried ‘flu’!

The headlines in the last week have been dramatic. California has declared a state of emergency. The World Health Organisation has raised its pandemic alert status to level 5 – its second highest level. The UK government is about to post leaflets to every household providing information on how to reduce spread of an outbreak of H1N1 influenza (swine flu).

It is not clear whether the threatened pandemic will eventuate. But the response to a possible or to a real pandemic raises a number of ethical questions. This blog will hopefully address some of those questions in the coming days. But here is one to start with. How ought the government to respond to the threat of pandemic influenza?

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Tortured logic

A leaked report by the International Committee of the Red Cross (ICRC) has concluded that medical personnel were involved in interrogation and torture performed overseas by the CIA according to reports in the New York Times. The practices reported by the ICRC have been known about for some time. The way that this has been reported in the media seems to imply that there is something especially bad about the involvement of medics in torture, that this makes it even worse. But why should this be?

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Life or no-life on the ventilator: the argument from parental freedom

In the High Court this week, parents of nine-month old infant OT are fighting a request by doctors to turn off the infant’s life support. The infant has been on a breathing machine since 3 weeks of age, and apparently has severe brain damage. This case has obvious echoes with the highly publicised case of Charlotte Wyatt, and the earlier case of baby MB. In both those instances courts ruled in the parents’ favour and life support was continued.

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Brain training and cognitive enhancement

If you were offered a treatment that claimed to be able to improve your memory and creativity, enhance neuroplasticity and increase cognitive ability, and prevent later cognitive decline would you take it? Many people would – at least if the recent popularity of computer-based brain-training exercises is anything to go by. Programs claiming to be able to do some or all of the above have been at the top of software charts for the last couple of years, and have sold millions of copies. Research published today in the consumer magazine ‘Which?’ pours cold water on the claims of the brain trainer manufacturers. The research concludes that there is very weak evidence that these exercises actually work.

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

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.

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Universal AIDS testing: should we save the many at the cost of harm to the few?

In a paper published in the Lancet yesterday, a group of WHO scientists
have suggested that a radical change to HIV testing would be necessary
to combat the epidemic. The authors published details of a mathematical
model of “universal voluntary testing” and early drug treatment of all
those found to have HIV in a country with HIV levels similar to those
present in Southern Africa. They present striking and provocative
evidence that this approach could reduce dramatically the incidence and
mortality from HIV within a fairly short period. The major ethical
question raised in response to their proposal is whether such a
strategy would violate the rights of individuals, and impose harms on
them in order to secure greater benefits for others.

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Status quo bias and presumed consent for organ donation

Yesterday the UK organ donation taskforce released its report on a
presumed consent (opt-out) system for organ donation. To the
consternation of the chief medical officer and the Prime Minister the
taskforce advised against the introduction into the UK of such a system.

In an editorial in today’s Guardian, it was observed that both the low
rates of consent in the UK – and the taskforce’s response to the
question of presumed consent may represent an irrational preference for
the default position. They may both be examples of the status quo bias.

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