Ethics

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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Lessons for Philosophers and Scientists from Sherlock Holmes and Father Brown

By Charles Foster

Arthur Conan Doyle’s estate has issued proceedings, complaining that Enola Holmes,  a recently released film about Sherlock Holmes’ sister, portrays the great detective as too emotional.

Sherlock Holmes was famously suspicious of emotions. 1 ‘ [L]ove is an emotional thing’, he icily observed, ‘and whatever is emotional is opposed to that true cold reason which I place above all things. ‘2  “I am a brain’, he told Watson. ‘The rest of me is a mere appendix’.3

I can imagine that many professional scientists and philosophers would feel affronted if they were accused of being emotional animals. Holmes is a model for them. He’s rigorous, empirical, and relies on induction.

But here’s the thing. He’s not actually very good. Mere brains might be good at anticipating the behaviour of mere brains, but they’re not good for much else. In particular Holmes is not a patch on his rival, Chesterton’s Father Brown, a Roman Catholic priest. Gramsci writes that Brown ‘totally defeats Sherlock Holmes, makes him look like a pretentious little boy, shows up his narrowness and pettiness.’ 4 Brown is faster, more efficient, and, for the criminal, deadlier. This is because, not despite, his use of his emotions. Continue reading

This Machine Kills Viruses

Written by Stephen Rainey

If we had a machine that could eradicate coronavirus at the press of a button, there would likely be a queue to do the honours. Rather than having such a device, we have a science-policy interface, and a general context of democratic legitimacy. This isn’t a push-button, but a complex of socio-political liberties and privations. We can’t push the button, but we can learn how to use the technology we do have – by collectively following policies like staying inside, wearing masks outside, and keeping distance from others.

Because of the coronavirus pandemic a novel form of this scientific research, technological application, and influence or control of nature (including humans) is emerging. In this case, the application is public policy, as based on multitudes of scientific advice. That over which control is sought is twofold: the virus, and people. Control of the virus is not really possible without some control over the people. Likewise, control of the people becomes harder where the virus is not controlled. Public trust in tough policies wanes if there is no end in sight, or no clear rationale in place. Continue reading

Selectively Saving Christmas?

Written by Ben Davies and Gabriel De Marco

The UK governments in Westminster and the devolved nations (Northern Ireland, Scotland and Wales) have made a recent about-turn regarding Christmas. Where there were previously plans to relax Covid-related restrictions for five days, they will now be relaxed for only Christmas itself, and not at all in some parts of the country.

The planned relaxations were extensive. And even following the recent changes, Christmas is being treated in a way that is considerably different to other major religious festivals: no relaxation of lockdown was seen for Sikh festival Vaisakhi, Muslim celebration Eid (where more extensive lockdowns were announced just the day before), Jewish Hanukkah, or Hindu Diwali.

Although it has not explicitly been posed as such, it seems reasonable to think that saving Christmas has been a long-term plan.  The timing of the recent ‘second lockdown’ in England is also suggestive. In order to avoid many going into Christmas with infections, and many leaving with new infections, the thought may have been that we needed this “circuit-breaker”; indeed, when Johnson announced the lockdown at the end of October, one hope he expressed was that “taking action” at that point would make Christmas gatherings more likely. And even amid the recent reversal, communal worship can continue even in the new ‘Tier 4’ locations.

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Consent Without Alternatives

Written by Ben Davies and Joshua Parker

“COVID-19: Do not resuscitate orders might have been put in place without consent, watchdog says”. This recent headline followed an investigation by the Care Quality Commission into Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions early in the pandemic. In a recent post, Dominic Wilkinson highlights two misconceptions in the coverage of this report, one of which is the ‘consent misconception’.

Dominic’s view is that “there is no ethical requirement…to seek the agreement of patients not to offer or provide a treatment” which a medical professional judges inappropriate. Of course, his position is not that consultation and discussion around CPR is inappropriate, only that consent is not necessary. This is the standard view on consent in this context and, due in part to the Tracey judgment, reflects doctors’ practice. Thus, an important distinction emerges between consenting to the withholding of some treatment, and discussion of that decision. Doctors may be ethically required to discuss a decision without also having an obligation to seek the patient’s consent. The absence of consent, then, does not signal that the DNACPR was unethical, whereas a failure to consult probably will.

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Could vaccine requirements for entering pubs be wrong, while closing pubs altogether is OK?

By Tom Douglas

Suppose that, before you could enter a pub, you had to produce a ‘vaccine passport’ showing that you had been vaccinated against the new coronavirus. 

Vaccine requirements like this are controversial. In the UK, the government has been keen to deny that it is even considering their use. This is in some ways puzzling, for closing pubs altogether has not been that controversial, and preventing people from entering pubs without exception seems, at first sight, to be a greater imposition on liberty than preventing people from entering pubs without first being vaccinated. As my colleagues Julian Savulescu and Alberto Giubilini recently noted, it seems better, in terms of liberty, to have some choice than none. 

This raises the question, could a vaccination requirement for entering pubs be wrong, while closing pubs altogether is not?

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DNACPR Orders in a Pandemic: Misgivings and Misconceptions.

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.

 

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Antenatal Care During The COVID-19 Pandemic: Couples As Dyads

Written by Rebecca Brown

 

During the pandemic, many healthcare services have been reduced. One instance of this is the antenatal care of expectant mothers. Ordinarily, partners of pregnant women are permitted to attend appointments. This includes the 12 week scan: typically the first opportunity expectant parents get to see the developing foetus, to discover whether it has a heartbeat and is growing in the right place. This can be very exciting and, if there’s bad news, devastating. It also includes scans in mid pregnancy and (for first-time mothers) at 36 weeks, as well as the entirety of labour.

During the pandemic, many healthcare providers have restricted attendance at antenatal appointments as well as labour and postnatal care. Even when lockdown restrictions were eased, with pubs, zoos and swimming pools re-opening and diners in England being encouraged to Eat Out to Help Out, some hospitals continued to exclude partners from all antenatal appointments and all but the final stage of labour, requiring them to leave shortly after birth. This included cases where mother and newborn had to remain on wards for days following delivery. With covid cases rising, it seems likely that partners will once again be absent from much antenatal, labour, and postnatal care across the country. Continue reading

The Duty To Ignore Covid-19

By Charles Foster

This is a plea for a self-denying ordinance on the part of philosophers. Ignore Covid-19. It was important that you said what you have said about it, but the job is done. There is nothing more to say. And there are great dangers in continuing to comment. It gives the impression that there is only one issue in the world. But there are many others, and they need your attention. Just as cancer patients were left untreated because Covid closed hospitals, so important philosophical problems are left unaddressed, or viewed only through the distorting lens of Covid. Continue reading

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