Guest Post: Frances Kamm- Harms, Wrongs, and Meaning in a Pandemic
Written by F M Kamm
This post originally appeared in The Philosophers’ Magazine
When the number of people who have died of COVID-19 in the U.S. reached 500,000 special notice was taken of this great tragedy. As a way of helping people appreciate how enormous an event this was, some commentators thought it would help to compare it to other events that involved a comparable number of people losing their lives. For example, it was compared to all the U.S lives lost on the battlefield in World Wars 1 and II and the Vietnam War (or World War II, the Korean War, and Vietnam). Such comparisons raise questions, concerning dimensions of comparison, some of which are about degrees of harm, wrong, and meaningfulness which are considered in this essay. (Since the focus in the comparison was on the number of soldiers who died rather the number of other people affected by their deaths, this discussion will also focus on the people who die in a pandemic rather than those affected by their deaths.)
Is Life-Sustaining Treatment Being Lawfully Withdrawn From Patients In Prolonged Disorders Of Consciousness? Nobody Seems To Know
By Charles Foster
From the time of the decision of the House of Lords in Airedale NHS Trust v Bland (1993) until the decision of the Supreme Court in An NHS Trust v Y (2018) (which I will refer to here as ‘Y”) it had been understood that the withdrawal of life-sustaining treatment (typically clinically assisted nutrition and hydration – ‘CANH’) from patients in a vegetative state should be endorsed by the court. Over the years, this practice had been extended to cover such withdrawals in Minimally Conscious States too.
In Y, the Supreme Court held that there was no requirement for court review or endorsement. Why? Continue reading
Lockdown Erodes Agency
By Charles Foster
A couple of lockdown conversations:
- The other day I met a friend in the street. We hadn’t seen one another for over a year. We mimed the hugs that we would have given in a saner age, and started to talk. ‘There’s nothing to tell you’, she said. ‘Nothing’s happened since we last saw you. And that’s just as well, because, as you’ll find, I’ve forgotten how to talk, how to relate, and how to read ordinary cues. We’ve not been out. We’ve not changed anything. I wonder if we’ve been changed?’
- Another friend. ‘Zoom’s great, isn’t it? You switch off your camera and your microphone, and the meeting just goes on perfectly happily without you. Everyone thinks you’re there. Your name’s up on their screen. But you are just getting on with your own business.’
And a lockdown fact: Lockdown has been great for book sales. 2020 saw an estimated rise of 5.2% in volume sales of print books in the UK compared with 2019 sales. This was the biggest annual rise since 2007: Continue reading
Cross-Post: The Moral Status of Human-Monkey Chimeras
Written by Julian Savulescu and Julian Koplin
This article was first published on Pursuit. Read the original article.
The 1968 classic Planet of the Apes tells the story of the Earth after a nuclear war destroys human civilisation. When three astronauts return to our planet after a long space voyage, they discover that humans have lost the power of verbal communication and live much like apes currently do.
Meanwhile, non-human primates have evolved speech and other human-like abilities, and are now running the earth with little regard for human life.
The astronaut George Taylor, played by Charlton Heston, is rendered temporarily mute when he is shot in the throat and captured. In one scene he is brought before the Apes, as he appears more intelligent than other humans.
He regains the power of speech, and his first words are: “Take your stinking paws off me, you damned dirty ape.”
Planet of the Apes may be fiction, but this month the world’s first human-monkey lifeforms were created by Juan Carlos Belmonte at the Salk Institute for Biological Studies in the US, using private funding. Professor Belmonte and his group injected stem cells from the skin of a human foetus into a monkey embryo.
This part-human lifeform is called a chimera.
If implanted into a monkey uterus, the chimera could theoretically develop into a live-born animal that has cells from both a monkey and a human.
While it has been possible to make chimeras for more than 20 years using a different technique that involves fusing the embryos of two animals together, this technique has not been used in humans. It has been used to create novel animals like the geep – a fusion of a sheep and goat embryo.
Professor Belmonte used a different technique– called “blastocyst complementation” – which is more refined. It enables greater control over the number of human cells in the chimera.
But why is this research being done?
Crosspost: Learning to live with COVID – the tough choices ahead
By Jonathan Pugh, Dominic Wilkinson and Julian Savulescu
This work was supported by the UKRI/ AHRC funded UK Ethics Accelerator project, grant number AH/V013947/1. The UK Ethics Accelerator project can be found at https://ukpandemicethics.org/
As mass vaccination continues to be rolled out, the UK is beginning to see encouraging signs that the number of COVID deaths is reducing, and that the vaccines may be reducing the transmission of coronavirus.
While this is very welcome news, a mass vaccination programme is unlikely to be enough to eliminate the virus, so we need to turn our thoughts towards the ethics of the long-term management of COVID-19.
One strategy would be to aim for the elimination of the virus within the UK. New Zealand successfully implemented an elimination strategy earlier in the pandemic and is now in a post-elimination stage.
An elimination strategy in the UK would require combining the mass vaccination programme with severe restrictions on international travel to stop new cases and variants of the virus being imported. However, the government has been reluctant to endorse an elimination strategy, given the importance of international trade to the UK economy.
One of the main alternatives to the elimination strategy is to treat coronavirus as endemic to the UK and to aim for long-term suppression of the virus to acceptable levels. But adopting a suppression strategy for the long term will require us to make a societal decision about the harms we are and are not willing to accept.
Mandating COVID-19 Vaccination for Children
Written by Lisa Forsberg and Anthony Skelton
In many countries vaccine rollouts are now well underway. Vaccine programmes in Israel, the United Kingdom, Chile, United Arab Emirates, Bahrain and the United States have been particularly successful. Mass vaccination is vital to ending the pandemic. However, at present, vaccines are typically not approved for children under the age of 16. Full protection from COVID-19 at a population level will not be achieved until most children and adolescents are inoculated against the deadly disease. A number of pharmaceutical companies have started or will soon start clinical trials to test the safety and efficacy of COVID-19 vaccinations in children and adolescents. Initial results of clinical trials seem promising (see also here and here).
There are strong reasons to inoculate children. COVID-19 may harm or kill them. It disproportionately affects already disadvantaged populations. For example, a CDC study published in August 2020 found the hospitalisation rate to be five times higher for Black children and eight times higher for Latino children than it is for white children. In addition, inoculating children is necessary for establishing herd immunity and (perhaps more importantly), as Jeremy Samuel Faust and Angela L. Rasmussen explained in the New York Times, preventing the virus from spreading and mutating ‘into more dangerous variants, including ones that could harm both children and adults’. Continue reading
It’s Only a Game
Written by Stephen Rainey
Footballers are increasingly prominent in speaking against social and political ills. They can draw attention to serious issues, given their public profile. If more of us followed their example, beyond supporting their causes, we could make a world less accommodating for moral complacency.
Press Release: Majority of UK public want choice at the end of life – survey
Most people in the UK would like the option of being heavily sedated, having a general anaesthestic or to having euthanasia, if they were dying, according to Oxford research published today in the medical journal PLOS One.
Professor Dominic Wilkinson, Professor Julian Savulescu and colleagues from the Oxford Uehiro Centre for Practical Ethics, surveyed more than 500 adults in August 2020 on their views about the care of a patient who had one week to live.
The study found a high level of support for access to deep sedation in dying patients.
Some 88% said they would like the option of a general anaesthetic if they were dying. Meanwhile, 79% of those surveyed said they would like to have the option of euthanasia.
But just 64% said they would personally choose anaesthetic at the end of life and nearly half said they would not choose euthanasia for themselves or a family member.
The report maintains, ‘This study indicates that a substantial proportion of the general community support a range of options at the end of life, including some that are not currently offered in the UK.’
According to Professor Wilkinson, ‘Previous surveys have shown that a large proportion of the UK public wish to have the option of euthanasia. This study shows an even larger number wish to have the choice of being heavily sedated or even receiving a general anaesthetic if they were dying.’
He continues, ‘Currently, in the UK it is legal for doctors to provide pain relief to dying patients, and to use sedatives if that is not enough to keep a patient comfortable. Heavy sedation is used as an option of last resort. General anaesthesia is not currently considered. But members of the general public value the option of deep sleep and complete relief from pain if they were dying. They believe that patients should be given this choice.’
Meanwhile, Professor Savulescu adds, ‘Patients have a right to be unconscious if they are dying. This survey shows that the general public want to have greater choice at the end of life.’
ENDS
Notes for Editors
For more information, please contact news.office@admin.ox.ac.uk
1. The survey is based on two anonymous online surveys of members of the UK public, sampled to be representative. They were given a scenario of a hypothetical terminally ill patient with one week to live and asked about the acceptability of providing titrated analgesia, gradual sedation, terminal anaesthesia, and euthanasia.
2. Across both surveys, a majority had undertaken higher education, with seven in 10 having A levels or higher qualifications. Meanwhile, just 2.4% overall had no qualifications.
3. Just over half of all respondents said they were religious with 13.8% describing themselves as very religious.
Ethics Doesn’t Rule, OK?
By Charles Foster
Ethics and law are different. Or they should be.
Law has the power to coerce. That is a frightening power. There should be as little law as possible. But there should be more ethics than there is.
The boundary between the two domains is not absolute. Clinicians are probably more frightened of being struck off by the General Medical Council (GMC) (after an adjudication on their ethics by the Medical Practitioners’ Tribunal Service) than they are about an order by a civil court that compels their insurers to pay damages for clinical negligence. The exercise of the GMC’s statutory powers can be draconian: the existence of those powers, and the associated sanctions, is certainly coercive.
But although the boundary is sometimes blurred, it is still real. It is the job of the law to keep it from becoming dangerously permeable. In a recent case the law was caught napping. Continue reading
Priority Vaccination for Prison and Homeless Populations
Written by Ben Davies
Last week brought the news that an additional 1.7m people in the UK had been asked to take additional ‘shielding’ measures against COVID-19, following new modelling which considered previously ignored factors such as ethnicity, weight and deprivation. Since many of this group have not yet been vaccinated, they were bumped up the priority list for vaccine access, moving into group 4 of the government’s vaccine plan.
Two other groups, however, have not yet been incorporated into this plan despite appeals from some quarters that they should be. First, new figures reinforced the sense that the virus is disproportionately affecting prisoners, with one in eight of the prison population having had COVID-19, compared with roughly one in twenty in the wider population (in the United States, the prison figure has been estimated to be one in five).
Second, some GP groups and local councils have offered priority vaccination to homeless residents, despite their not officially qualifying for prioritisation on the government’s plan. There have also been calls for the government to incorporate this into national plans, rather than being left to more local decision-making.
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