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The Tragedy of Moral Mistakes

A tragic case was recently reported of a man who died following botched care via the NHS’ telephone helpline. Suffering from blood poisoning, a series of errors, mis-recording and failure to listen meant that he was told simply to take the remedy ‘Gaviscon’. He died shortly afterwards.  This was rightly widely reported in the press as a major failing of the health system. Many such catastrophic errors in medicine are reported in the press, and wherever possible safeguards put in place to prevent their re-occurrence.

However, we seem to accept deaths that occur not through medical mistakes but through what I will call moral mistakes. For example, each day 3 people die on the waiting list to receive organ transplants. Many of those could be saved if all those eligible and consenting to give organs did so. But instead, organs are withheld even when those who have opted in to organ donation die, because their families decide against it. Others are withheld because we have failed to introduce an opt out system of consent, meaning that those who simply never got around to signing up are excluded from bringing life to another person.

This is just one example of how mistakes in medical ethics can kill people. There are many more.

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US Congress shutsdown CDC, also other unimportant agencies

So the US government is likely being shutdown, which will suspend the work of many government agencies, including the Center for Disease Control (CDC). But, fair citizens, I reassure you – in its wisdom, the US Congress has decided that the military’s salaries will be excluded from the shutdown. With all due respect to military personnel, this… Read More »US Congress shutsdown CDC, also other unimportant agencies

Stress Influences Our Moral Behaviour

All of us are stressed, every now and then. Acute stress can have a profound impact on the human body and mind: both physical and psychological stressors affect the autonomic nervous system and the hypothalamic–pituitary–adrenal axis, leading to changes in cardiovascular and neuroendocrine measures. Stress also is shown to affect cognitive functions like memory and attention. Just recently, however, research discovered that acute stress also can influence our moral behaviour.

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Is compassion a necessary component of healthcare?

Last week, the Daily Mail reported on Dr Anna Smajdor’s paper in which she argues that compassion ‘is not a necessary component’ of healthcare. This claim contrasts interestingly with Jeremy Hunt’s recent proposal that all student nurses should have to prove that they are capable of caring by spending a year on wards carrying out basic tasks. This proposal, along with the suggestion that pay be linked to levels of kindness would, according to Hunt, go some way to improving the standard of NHS care.  The motivating idea behind Hunt’s proposals is that lack of compassion amongst NHS staff is partly responsible for poor care and, in some cases, for cultivating a ‘culture of cruelty’.

So is compassion a necessary component of healthcare? Is an adequate standard of care necessarily unattainable when compassion amongst staff is absent? In considering these questions I do not intend to embark on a detailed critique of Dr Smajdor’s paper. Instead, I will begin from her main ideas and use them to motivate a general discussion of the role of compassion in healthcare. According to the report, Dr Smajdor argues for two main claims: 1) that compassion is not a necessary component of healthcare – that acceptable standards can be attained without it – and 2) that compassion can actually be dangerous for healthcare workers, possibly resulting in impaired standards of care. Read More »Is compassion a necessary component of healthcare?

Is unwanted pregnancy a medical disorder?

by Rebecca Roache

Follow Rebecca on Twitter

Abortion is often in the news. Yesterday, The Atlantic Wire reported a poll of Americans’ moral views, which found just under half of Americans believe abortion is morally wrong. Today, The Sun is running an article on the devastating effects on women of having abortions. And, a couple of weeks ago, the law in Ireland was changed to allow abortion under certain circumstances.

Whether (and under what circumstances) abortion is ethical, and whether (and under what circumstances) it should be permitted by law, are two of the most well known and fiercely debated issues of our age. I do not wish to engage with them here. Instead, I will argue as follows:

  1. Abortions cause suffering, and neither permitting them nor banning them is likely to reduce this suffering to an acceptable level.
  2. The best way of reducing the suffering caused by abortion is to reduce unwanted pregnancies.
  3. Current attempts to reduce unwanted pregnancies in the UK do not work well enough.
  4. Viewing unwanted pregnancy as more like a medical disorder and less like a social problem is likely to enable more effective measures to address it.

I then propose such a measure, and defend it against some possible objections.

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Let’s Talk About Death: Millennials and Advance Directives

Sarah Riad, College of Nursing and Health Sciences, University of Massachusetts Boston

Melissa Hickey, School of Nursing, Avila University 

Kyle Edwards, Uehiro Centre for Practical Ethics, University of Oxford

As advances in medical technology have greatly increased our ability to extend life, the conversation on end-of-life care ethics has become exceedingly complex. With greater options both to end life early and extend it artificially, advance directives have arisen in an effort to preserve patient autonomy in situations in which he or she becomes incapable of making a medical decision. However, most people—especially young adults—do not think to plan for such moments of incapacity and the potentiality of an untimely death. With a youthful sense of invincibility comes a lack of foresight that prevents us from confronting these issues. The reality is that unexpected events happen. When they do, it is often very difficult to imagine what a person would have wanted and make medical decisions accordingly on his or her behalf. In this post, we suggest both a transition from action-based to value-based advance directives and an interactive website that would make the contemplation of these issues and the construction of a value-based advance directive appealing to and accessible for Millennials, the 20-somethings of today. Read More »Let’s Talk About Death: Millennials and Advance Directives

Not all philosophers are equal

Not all ethical issues are equally important. Many ethicists spend their professional lives performing in sideshows.

However entertaining the sideshow, sideshow performers do not deserve the same recognition or remuneration as those performing on our philosophical Broadways.

What really matters now is not the nuance of our approach to mitochondrial manipulation for glycogen storage diseases, or yet another set of footnotes to footnotes to footnotes in the debate about the naturalistic fallacy. It is: (a) Whether or not we should be allowed to destroy our planet (and if not, how to stop it happening); and (b) Whether or not it is fine to allow 20,000 children in the developing world to die daily of hunger and entirely avoidable disease  (and if not, how to stop it happening). My concern in this post is mainly with (a). A habitable planet is a prerequisite for all the rest of our ethical cogitation. If we can’t live here at all, it’s pointless trying to draft the small print of living.Read More »Not all philosophers are equal

The Ethics of Private Payment for Health Care: The Example of Vaccination

30  July. This blog is an extended version of the post ‘Vaccines: All or Nothing’ (posted 29 July). 

A vaccine which would protect children from Meningitis B has been rejected by the Joint Committee on Vaccination and Immunisation (JCVI) as not cost effective, despite the fact the cost is not yet known.

The Department of Health’s director of immunization explained:

“This is a very difficult situation where we have a new vaccine against meningitis B but we lack important evidence. We need to know how well it will protect, how long it will protect and if it will stop the bacteria from spreading from person to person.

“We need to work with the scientific community and the manufacturer to find ways to resolve these uncertainties so that we can come to a clear answer.”

A call for more research is a standard answer to many dilemmas in healthcare, though perhaps one which is easy to ignore. As far as we know there are no current plans to ensure that this research takes place but the vaccine has already been found to be safe, and according to the BBC, “tests have suggested the vaccine is effective against 73% of the different strains of the disease”.

Resource allocation is an inevitable part of any health care system, and perhaps especially so in the NHS. Whilst we would like to provide all available treatments, prioritizing according to effectiveness and cost is necessary, though the exact method of calculating this (currently Quality Adjusted Life Years, or QALYs) is of course under intense debate and scrutiny.

In the meantime, children continue to suffer avoidable, lifelong disability due to infection with Meningitis B. I argue with Lach de Crespigny in a forthcoming paper on homebirth that actions (or failures to act) taken today which cause harm in the future are as wrong as if that harm were realized today. The plight of these children and adolescents should not be ignored.

Put simply, if you could prevent a child from getting brain damage, now or in the future, at little cost to you, you ought to perform that act.

One possible way forward would be to allow parents to pay for the vaccination of their child, at whatever price the company sets, just as holiday vaccinations can be provided by the NHS at a cost to the patient. Vaccinated children could be monitored and their data recorded. Not only would this generate the data that would establish how high up funding agendas this vaccine should be, but some individual children would be prevented from suffering this deadly and debilitating disease. To increase take up, the company would be under market pressure to keep the price as low as possible.

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I’ve warned you! But I shouldn’t have

Among close friends, or even within the family, the use of SSRI’s (selective serotonin reuptake inhibitors) can be a delicate topic, it may come with connotations of depression, suicidal behaviour, and can be emotionally marginalizing. A new scientific review may further entangle this already vexing situation, in the study (Isacsson, G. & Alhner, J. 2013)… Read More »I’ve warned you! But I shouldn’t have

How do you want to die?

How do you want to die? Quickly, painlessly, peacefully lying in your own bed?

Most people say that. But then, people seem to cling to their lives, even if that could mean a less peaceful end. When asked whether they would want physicians to perform certain interventions to prolong their lives like CPR (cardiopulmonary resuscitation) or mechanical ventilation (‘breathing machine’), people say ‘yes’.

Interestingly, a study discussed in a Radiolab podcast from earlier this year reveals that contrary to lay people, physicians do not want these life-saving interventions they perform on their patients performed on themselves.Read More »How do you want to die?