“The legal decision this morning, in the Family division of the High Court, provides important clarification. It is likely to be a relief to young people with gender dysphoria and their families. In December, the High Court found that young people under 16 with gender dysphoria were highly unlikely to be able to understand the… Read More »Press Release: New Tavistock Legal Ruling on Puberty Blockers
Written By: Julian Savulescu, University of Oxford; Dominic Wilkinson, University of Oxford;
Jonathan Pugh, University of Oxford, and Margie Danchin, Murdoch Children’s Research Institute
This article is republished from The Conversation under a Creative Commons license. Read the original article.
For instance, reports of blood clots associated with the AstraZeneca vaccine led to several European countries suspending their vaccination programs recently, only to resume them once these clots were judged to be a coincidence. However, authorities couldn’t rule out increased rates of a rare brain blood clot associated with low levels of blood platelets.
There are also problems with the Pfizer and Moderna vaccines. By early February 2021, among the over 20 million people vaccinated in the United States, there have been 20 reported cases of immune thrombocytopenia, a blood disorder featuring a reduced number of platelets in the blood. Experts suspect this is probably a rare vaccine side-effect but argue vaccination should continue.
So what happens with the next safety scare, for these or other vaccines? We argue it’s best to give people the facts so they have the autonomy to make their own decisions. When governments pause vaccine rollouts while investigating apparent safety issues, this is paternalism, and can do more harm than good.Read More »Cross Post: There’s no Need to Pause Vaccine Rollouts When There’s a Safety Scare. Give the Public the Facts and Let Them Decide
By Jonathan Pugh, Dominic Wilkinson, and Julian Savulescu
The authors are working on the UK Pandemic Ethics Accelerator project – @PandemicEthics_. This project was funded by the Arts and Humanities Research Council (AHRC) as part of UKRI’s Covid-19 funding. All authors are affiliated to the University of Oxford.
Summary Points
Read More »Suspending The Astra-Zeneca Vaccine and The Ethics of Precaution
Written by Dominic Wilkinson and Jonathan Pugh
This article is republished from The Conversation under a Creative Commons license. Read the original article.
In the UK, an Oxford city councillor has been suspended after mentioning on social media that she had received a COVID vaccination from a private doctor. Meanwhile, media reports suggest that two Spanish princesses, who did not yet qualify for vaccination in Spain were vaccinated while visiting their father in the United Arab Emirates. They are among a number of ultra-wealthy people getting vaccinated in that country.
There have also been reports of people accessing vaccines early in the UK, despite not being in any of the groups prioritised for vaccination at the time.
So how concerned should we be about these cases?Read More »Cross Post: COVID vaccines: is it wrong to jump the queue?
By Dominic Wilkinson and Jonathan Pugh.
This is a crosspost from the Journal of Medical Ethics Blog.
This is an output of the UKRI Pandemic Ethics Accelerator project.
Last April, in the first wave of the COVID-19 pandemic, a number of academics, lawyers, doctors and ethicists wrote publicly about the need for national ethical guidance relating to resource allocation (e.g., see here, here, here). At the time there was concern that there would be insufficient intensive care beds to meet the needs of critically ill patients, and many thought that there needed to be clear guidance to doctors to tell them what to do if that occurred.
While a number of professional groups produced guidelines (for example, the British Medical Association, Royal College of Physicians, Intensive Care Society), no national guidance was ever produced. (A draft guideline was developed but rejected in early April 2020).
Almost 12 months and two pandemic waves later, in a legal ruling last week, Justice Swift refused the application of a number of COVID-affected families who had sought a judicial review on the absence of national guidelines. The ruling is not yet publicly available, but it appears that there were three legal arguments: that there was a statutory obligation to have contingency plans in case demand exceeded capacity, that rationing in the absence of national guidance would violate Article 8 of the Human Rights Act, and that it was “irrational” not to have a national guideline. Swift J apparently rejected all three of these claims.
We will focus here on the third of these – the most ethical of the arguments.
“iii) Rationality – it is irrational not to have a national guideline.”
By Jonathan Pugh, Dominic Wilkinson and Julian Savulescu.
This is a crosspost from the Journal of Medical Ethics Blog.
This is an output of the UKRI Pandemic Ethics Accelerator project.
A group of citizen scientists has launched a non-profit, non-commercial organisation named ‘RaDVaC’, which aims to rapidly develop, produce, and self-administer an intranasally delivered COVID-19 vaccine. As an open source project, a white paper detailing RaDVaC’s vaccine rationale, design, materials, protocols, and testing is freely available online. This information can be used by others to manufacture and self-administer their own vaccines, using commercially available materials and equipment.
Self-experimentation in science is not new; indeed, the initial development of some vaccines depended on self-experimentation. Historically, self-experimentation has led to valuable discoveries. Barry Marshall famously shared the Nobel Prize in 2005 for his work on the role of the bacterium Helicobacter pylori, and its role in gastritis –this research involved a self-experiment in 1984 that involved Marshall drinking a prepared mixture containing the bacteria, causing him to develop acute gastritis. This research, which shocked his colleagues at the time, eventually led to a fundamental change in the understanding of gastric ulcers, and they are now routinely treated with antibiotics. Today, self-experimentation is having something of a renaissance in the so-called bio-hacking community. But is self-experimentation to develop and test vaccinations ethical in the present pandemic? In this post we outline two arguments that might be invoked to defend such self-experimentation, and suggest that they are each subject to significant limitations.Read More »Cross-Post: Self-experimentation with vaccines
Written by:
Jonathan Pugh
Dominic Wilkinson
Julian Savulescu
This is an output of the UKRI Pandemic Ethics Accelerator project – it develops an earlier assessment of the English hotel quarantine policy, published by The Conversation)
The UK has announced that from 15th Feb, British and Irish nationals and others with residency rights travelling to England from ‘red list’ countries will have to quarantine in a government-sanctioned hotel for 10 days, at a personal cost of £1,750. Accommodation must be booked in advance, and individuals will be required to undergo two tests over the course of the quarantine period.
Failure to comply will carry strict penalties. Failing to quarantine in a designated hotel carries a fine of up to £10,000, and those who lie about visiting a red list country are liable to a 10-year prison sentence.
Read More »An Ethical Review of Hotel Quarantine Policies For International Arrivals
Written by
Dominic Wilkinson and Jonathan Pugh,
The UK government announced that from February 15, British and Irish residents travelling to England from “red list” countries will have to quarantine in a government-sanctioned hotel for ten days, at a personal cost of £1,750. Accommodation must be booked in advance, and people will need to have two COVID tests during the quarantine period.
Failing to quarantine in a designated hotel carries a fine of up to £10,000, and those who lie about visiting a red list country could face a ten-year prison sentence.
Other countries have already implemented mandatory hotel quarantines for travellers, including Australia, New Zealand, China and India. When are such quarantines ethical? And who should pay for them if they are?
Read More »Crosspost: Is It Ethical To Quarantine People In Hotel Rooms?
by Dominic Wilkinson @Neonatalethics
This week, the Care Quality Commission (CQC) published an interim report into resuscitation decisions during the COVID-19 pandemic. According to a number of media outlets, the report found that in the first wave of the crisis inappropriate and possibly unlawful ‘do not resuscitate’ orders were used “without the consent of patients and families” (see eg Telegraph, Sky).
There are real concerns and important questions to answer about policies and care for patients in care homes and in the community during the pandemic. However, the media stories, and the CQC report itself appear to illustrate two ethical misconceptions.
Read More »DNACPR Orders in a Pandemic: Misgivings and Misconceptions.
by Prof Dominic Wilkinson @Neonatalethics
Last month, in an emergency hearing, the High court in London heard a case that characterises a familiar problem in medical ethics. A 15 year old adolescent (known as ‘X’) with a long-standing medical condition, Sickle Cell disease, had a very low blood count and required an urgent blood transfusion. However, X is a Jehovah’s Witness and did not wish to receive blood as it was contrary to her religious beliefs. X’s doctors believed that she was at risk of very serious health consequences without a blood transfusion (a stroke, or even death).
Of no great surprise to anyone, the court authorised the emergency blood transfusion for X. Although X was “mature and wise beyond her years”, and judged to be ‘Gillick competent’ (see below), the judge made the decision in her best interests.
That decision is consistent with many previous cases that have come to the courts in the UK and overseas (see here, here, here )[1]. It is very similar to the case in Ian McEwan’s novel and film “The Children Act” (the book, had been based on real cases before the courts). The courts, in the UK at least, have always decided to over-rule under-eighteens who wish to refuse potentially life-saving treatment. Once the teenager reaches the age of eighteen, the decision is different, however. At that point, if they are judged to have “capacity”, (ie they have the ability to use, understand, and communicate the information necessary for a decision) they can refuse even if the treatment would certainly save their life.
Although the decision is unsurprising, the judge made a comment implying that future cases might not always reach the same conclusion. X’s lawyer argued that the traditional legal approach may be “in need of urgent re-analysis and review”, and the judge appeared to agree that these arguments needed careful consideration (not possible acutely given the urgency of X’s case).
Should the ethical and legal approach to adolescents who refuse treatment change?
Read More »Refusal Redux. Revisiting Debate About Adolescent Refusal of Treatment.
