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Ethics

Abortion is No Place for the Law

Victorian politicians are debating how to reform law on abortion. In Victoria, as in other states, abortion remains a crime. This is inconsistent with what happens. There are nearly 100 000 abortions every year in Australia.

The Victorian government will decide between 2 Models. According to Model B, abortion will be available on request until 24 weeks of pregnancy, but after that point 2 doctors must agree that it is indicated. Doctors who fail to comply with the law would receive professional and other sanctions. On Model C, abortion is available on request all through pregnancy. Premier Brumby and a majority of politicians support Model B.

Why is the imposition of sanctions on doctors who provide abortions so attractive? Firstly, abortion is an undesirable means of birth control. Most people would prefer to find other ways of not having unwanted children. Secondly, many people believe that as the fetus grows, and looks more like a baby, its moral status increases. After 24 weeks, some fetuses are even capable of living in intensive care units, outside the womb, as extremely premature newborns.

Despite its superficial attractiveness, Model B is deeply morally flawed. According to Model B, the moral status of the fetus, and whether it is kept alive or aborted, depends on the judgement of 2 doctors. Their decisions will usually be based on whether there is a disease or disability present. But this implies that fetuses with disabilities have less of a right to life than those which do not have disabilities. This is discrimination against the disabled and those with diseases. We would not allow 2 doctors to kill a child just because it had spina bifida. Why would we think the presence of spina bifida should change the moral standing of a fetus? Doctors can withdraw medical treatment leading to the deaths of their patients, but only when the patient’s life is no longer worth living. This is not the case in virtually all abortions.

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Doctors or Resource Allocators?

A recent survey by Myeloma UK, and reported on the BBC website, suggests that many doctors do not tell patients about drugs that may be beneficial and which are licensed in the UK. The trouble is that the drugs have not yet been approved by NICE and so may be difficult to obtain on the NHS. This seems to suggest that something is wrong with the way in which NICE functions with respect to licensing and that doctors are in some way complicit.

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When the heart stops: harvesting organs from the newly (nearly) dead

In the New England Journal of Medicine yesterday, doctors from Denver reported on three controversial cases of heart transplantation from newborn infants. These cases are striking for several reasons. They were examples of so-called ‘donation after cardiac death’ (DCD), an increasingly frequent source of organs for transplantation, but done very rarely in newborns. They are controversial because the transplanted organs were hearts that were ‘restarted’ in recipients after they had stopped in the donor. Transplant surgeons waited only a relatively short period after the donor’s heart had stopped (75 seconds) before starting the organ retrieval process. These transplants raise serious questions about the diagnosis and definition of death.

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Would you rather be invisible or be able to fly? (Or: are you a sneaky superhero?)

If, like
me, you were one of the kids whose preferred superpower was invisibility, you
may soon be in luck. The BBC reports
today that US scientists have
created a material that could one day be used to make people and objects invisible. The material, which has so far been created
only on a microscopic scale, neither absorbs nor reflects light,
meaning that anyone looking at an object covered in it would see what
lies behind the object rather than the object itself. It’s likely that such technology will be
snapped up first by the military, but perhaps, in years to come, invisibility
cloaks will be available to all.

For some,
the idea of being invisible is distasteful. Being invisible means being able to get away with anything – and
why bother to act morally when you can be sure that you’ll never be caught
out? In this case, would a world full of
people who can turn invisible at the drop of a hat be a world full of thieves,
cheats, and sneaks?

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The point of death

The Guardian yesterday reported the death of the man who had been so tragically shot in Antigua, with his wife, three weeks after their wedding. It began like this:

"Ben Mullany, the newlywed who was shot on honeymoon in Antigua in an attack that killed his wife, Catherine, died in hospital in Wales yesterday after his life support machine was switched off.  The 31-year-old trainee physiotherapist, who had suffered a fractured skull and had a bullet lodged in the back of his head, was flown back to Britain while in a coma on Saturday. Tests carried out when his condition stabilised after the 24-hour journey established he was brain dead." 

This is a familiar way of describing such happenings, even among clinical professionals.   Brain death is pronounced, so the life support machine is switched off, and the patient dies.   The clear implication is that brain death is not death.  The machine is still keeping the patient alive, and it is switching off the machine that causes real death. 

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Slaves to consent?

Nature reports that in response to analysis done by bioethicist Robert Streiffer (and published in the Hastings Center Report), Stanford University may withdraw the use for research of several of its publicly funded stem cell lines because of concerns about consent. In 2001 President Bush decreed that only lines already in existence would be eligible for federal funding – 21 lines were subsequently approved by the NIH.

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Saving the planet by reducing birth rates

Climate change will impact the well-being of future
generations, directly by, for
example, increased intensity and frequency of extreme weather events such as
heavy storms. It will have also indirect
impacts on human heath – via cardiovascular diseases or by a rise in epidemics as emerging disease leave
the tropic and go North.

 
The beginning of this year, the British Medical Journal
declared that since climate change impacts public health, doctors have to deal
with it. And in tackling the problem, John Guillebaud, emeritus professor of
family planning and reproductive health at University College London , and GP
Pip Hayes from Exeter suggest that doctors should talk to their patients about
climate change and encourage them to think about the environmental impacts of
having a big family: see for example the Editorial
or an article
in the Daily Telegraph, or the Guardian.
After all, “each UK birth
will be responsible for 160 times more greenhouse ags emissions […] than a new
birth in Ethiopia.”

 
Fair enough, the world is
interconnected: environmental changes involve impacts on the population, and
changes in the population impact the environment. But is it sensible to treat
environmental problems not primarily as such, but making them problems of
family planning?

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Care for the Dying and Cost-effectiveness

Yesterday’s news reports the launch of the Government’s End of Life Care Strategy for England. This strategy will dedicate in excess of £250 million allowing patients who are dying to decide, as the Times puts it, “where and how to die.” This is part of a programme to provide better care for the dying. According to the BBC, only one in five deaths takes place at home despite a comfortable majority expressing a preference for such familiar surroundings. This prioritisation raises some interesting ethical issues particularly in the light of cost-effectiveness considerations.

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Activists and acts of mercy

In Germany this week, and in Australia recently, there has been public
concern and significant media attention about the actions of euthanasia
activists. A former government official and lawyer, Roger Kusch, went
public in Germany with a video of an elderly woman who he had helped to
die. In Australia, Phillip Nitschke has been criticised for his
involvement and subsequent comments about the death of Graeme Wylie a
man suffering from Alzheimer’s disease whose partner and close friend
have been found guilty of manslaughter.

Opponents of euthanasia have used these cases to argue against liberalisation of laws on assisted suicide or euthanasia.

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Education and the Fairness of Capital Punishment

Regardless of their views on capital punishment most people desire it to be centred on due process and fairness. But a software experiment, by showing that the likelihood of execution of people on death row can be predicted to high accuracy, paradoxically suggests a great degree of arbitrariness in how the death penalty is applied in the US. A death sentence is essentially a lottery ticket: the condemned will be executed with a certain probability and otherwise suffer a long and uncertain imprisonment. But different convicts get different probability tickets, even when the legal system and all criminal circumstances are the same.

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