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Ethics

Abortion and the cognitively impaired mother

It will be interesting to watch the reception of a recent Court of Protection case, as yet unreported, in which a woman with profound learning difficulties was found to have capacity to decide not to terminate her pregnancy.

As so often, the case decided nothing new. But it is a timely reminder of the trite but often overlooked principle that capacity is not an all or nothing thing. The question: ‘Does she have capacity?’ is always dangerously incomplete. The correct question is always ‘Does she have capacity to decide X?’

There was no doubt that she did not have capacity to manage many aspects of her affairs. She was in the bottom 1% of the population so far as intellectual function was concerned. Deputies were appropriately appointed. But, so far as the continuation of her pregnancy was concerned, so what?

It was decided as a matter of fact that she had capacity to decide whether or not to continue with, or to terminate, the pregnancy. And that meant that the Court of Protection had no jurisdiction to decide the matter. No best interests determination could lawfully be made.Read More »Abortion and the cognitively impaired mother

Salt in the Wound, or the Sweetest Thing? On Placing Legal Limits On the Sugar, Salt and Fat Content of the Foods We Eat.

Last week, in the light of the UK’s growing obesity problem, the shadow health secretary Andy Burnham called for a debate on the question on whether a legal limit ought to be introduced on the amount of sugar,salt and fat that manufacturers can put into the foods that we eat, particularly those foods aimed primarily at children. In calling for such a debate, Mr Burnham pointed out that the obesity epidemic can no longer be ignored, given the challenges that widespread obesity will raise for the NHS. Furthermore, he suggested that the current government’s ‘responsibility deal’ , which aims to tackle the obesity problem by collaborating with food manufacturers to improve food content and labelling,  is simply not working.Read More »Salt in the Wound, or the Sweetest Thing? On Placing Legal Limits On the Sugar, Salt and Fat Content of the Foods We Eat.

Dirty Money

I have a relative who faces the following dilemma, though he doesn’t see it as a dilemma.  But I do. 

My relative is involved in the charitable sector.  He has been approached by some representatives of a foreign foundation.  He doesn’t know anything about the foundation – those who run the foundation want to keep all substantial details about it secret, for reasons unknown (they may have honourable motives).  The foundation has a bank account in the UK, with money transferred into it from abroad: my relative assumes that the money is legally kosher (since the British bank would have had to check for money laundering and so on).  Read More »Dirty Money

The last sweet years or bad romance? Handling infidelity in the nursing home

Ulf suffers dementia and lives in a nursing home. He often interacts with Lena, who also has dementia. They seek each other out, invite each other to their rooms, hold hands and kiss. They can clearly express what they prefer (or not). The staff think they enjoy life and each other’s company. There is just one problem for the happy couple: Ulf is married, and his wife is not happy. She and their children strongly dislikes the relation between Ulf and Lena and asks the staff to keep them apart. They argue that if Ulf had been free of dementia he would not have desired contact with Lena; he might sometimes even be confused and think Lena is his wife.

The situation was posed as a question to the ethics committee of the National Board of Health and Welfare in Sweden, and it recently responded that the staff should not try to interfere in the relationship: the welfare and autonomy of Ulf is prior to the wishes of the family. An earlier question dealt with a somewhat similar case, where the cuckolded wife demanded that her husband be both separated from the other woman and medicated to “dampen” him. The committee found that it would be against the autonomy of the man to be medicated against his will, and the staff did not have a right (legally or morally) to prevent patients from seeing each other.

The interesting question is what to make of romances that come about due to dementia. Are they authentic? How do they relate to the interests expressed earlier in life?

Read More »The last sweet years or bad romance? Handling infidelity in the nursing home

Sin Taxes and Biomarkers

            For years, ‘sin taxes’ – taxes on socially undesirable and/or addictive substances/activities like smoking, alcohol and gambling – have been a source of controversy.  On the one hand, they have been seen as an effective means to raise revenue and reduce consumption of addictive (and generally unhealthy) substances.  On the other hand, sin taxes are generally regressive and are rather paternalistic.  But beyond these typical disputes, recent research has found a new and important dimension to the sin tax debate: genetics.  A study by Jason Fletcher has found that whether or not taxes reduce cigarette consumption depends on the presence of a particular genotype.  This suggests an interesting and novel policy: only apply the cigarette tax to those whose genotype indicates they will respond to the tax.  But is this a sound policy, or should we be keeping biomarkers out of policy debates over sin taxes?  Read More »Sin Taxes and Biomarkers

Turning the Camera Around: What Newtown Tells Us About Ourselves

On the morning of December 14th, 20-year old Adam Lanza opened fire within the halls of Sandy Hook Elementary School in Newtown, Connecticut, killing 20 children and six adult staff members before turning his gun on himself. In the hours that followed, journalists from every major news station in the nation inundated the tiny town, and in the days that followed, the country as a whole started down a familiar path characterized best by the plethora of ‘if only-isms’.

It began in the immediate hours following the shooting: if only we had stricter gun control laws, this wouldn’t have happened. This is perhaps an unsurprising first response in a country that represents 4.5% of the world’s population and 40% of the world’s civilian firearms.[1] Over the next few days, as a portrait of the shooter began to emerge and friends and family revealed that he was an avid gamer, a second theory surfaced in the headlines: if only our children weren’t exposed to such violent video games, this tragedy never would have occurred.[2] [3] And just in the past few days, public discourse has converged on the gunman’s mental health, the general conclusion being that if only we had better mental health services in place, this wouldn’t have happened.[4][5] (The National Rifle Association [NRA] even tried to jump on board, suggesting that “26 innocent lives might have been spared” if only we had an armed police guard in every school in America.[6] They seem to be the only ones taking themselves seriously.[7])Read More »Turning the Camera Around: What Newtown Tells Us About Ourselves

Informed consent deserves a little less respect

The conclusions of a ‘citizens’ jury’, reported recently in the British Medical Journal [1] shed light on some important weaknesses in the doctrine of ‘informed consent’. The doctrine is commonly thought of as canonical. Be careful about questioning its exalted status: you’ll be branded paternalistic at best, and the indictment may well involve unflattering comparisons with Dr. Mengele.

The ‘jury’, composed of 25 women,  commented on how a leaflet on breast cancer screening should be re-drafted. The jury preferred:

– the term ‘overtreatment’ to ‘over-diagnosis’

-to express benefits in the language of lives saved rather than deaths avoided

– to talk about ‘benefits’ and ‘risks’ rather than ‘pros’ and ‘cons’

– to begin the leaflet by an up-beat reference to the numbers of lives saved by screening, followed by the caveat that a small number of women would be over-treated.

What was the priority: reassurance or accuracy? The majority (15), wanted both; 3 thought that reassurance was most important; 7 thought that accuracy was the priority.

How should one list the benefits and harms? Four thought they should be listed together in the same sentence, 8 that they should be listed separately, and 12 for mentioning them first separately and then together.

The point of all this  is that there are innumerable different ways, all of which would be smiled on by Bolam [2], in which entirely accurate information can be conveyed. And yet tiny nuances are seen by the receivers of the information as significant.Read More »Informed consent deserves a little less respect

Prank Calls and Moral Luck

An outburst of blame, vituperation, and indignation, including death threats from all over the world, has followed the sad suicide of a nurse who fell for a ‘prank call’ from two Australian DJs and unwittingly released confidential information about a member of the British royal family.

Some criticism might well be made of any person who engages in such deception for the purposes of entertainment, and the fact that the DJs’ actions were therefore not entirely ‘innocent’ has perhaps fuelled the flames of protest. But there is little doubt that they are being subjected to significantly more blame than many others who engage in similar stunts.Read More »Prank Calls and Moral Luck