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Could a ban on homebirth be justified?

Agnes Gereb, a midwife in Hungary, has been imprisoned for performing home births http://www.guardian.co.uk/world/2010/oct/22/hungary-midwife-agnes-gereb-home-birth. She faces various charges, including negligent malpractice and manslaughter (relating to a homebirth in which the baby died after a difficult labour). While home birth is theoretically legal in Hungary, in practice independent Hungarian midwives are not certified as being able to ensure safe conditions for home birth.

Media commentary in this country has on the whole been very sympathetic towards Gereb (for example http://www.bbc.co.uk/programmes/b00vhfg2), implying that the rules which prevent women from giving birth at home are unwarranted restrictions on their freedom. Although in most developed countries home births are the exception rather than the rule, they are generally felt to be something women have a right to choose to have. A plausible reason for this is that birth is seen as a very important, as well as personal, experience which the mother should have control over. Is Hungary justified in challenging the existence of such a right?

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Is professional integrity a futile argument?

by Dominic Wilkinson

In an earlier post this week I argued that there are only two substantive reasons for doctors not to provide treatment that they judge futile – either on the basis of a judgement that treatment would harm the patient (a form of paternalism), or on the basis that providing treatment would harm others (on the basis of distributive justice). I rejected the idea that professional integrity provided an additional reason to withhold or withdraw treatment.

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Break my bones, but don’t let me die! Should doctors provide ‘futile’ CPR?

by Dominic Wilkinson

Two recent cases in a Toronto hospital illustrate a dilemma that hospital doctors face all too frequently. What should they do if patients or their representatives insist on treatment that the doctor believes would be futile? Should they just go along with the patient despite their misgivings? Alternatively, should they unilaterally withhold treatment if they feel it would be inappropriate to provide it?

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Counterfeit Placebos

Last week it was reported that police in Bangladesh had made a major bust at a factory that was producing counterfeit homeopathic drugs. The counterfeiters were attaching the labels of other drug producers to the remedies they were producing in their own factory. Dhaka's Daily Star reported the bust with the rather ironic headline "Fake Medicine Factory Busted".

Of course, even homeopathic remedies need to be guaranteed safe if they are sold in stores, and counterfeiters are not bound by the same safety controls as other more reputable sources. There are also 'intellectual property' issues concerning the use of other company's labels and trademarks. So I am not here to tell you that this drug bust was unnecessary or ridiculous. In fact I want to challenge The Star's implicit suggestion that homeopathic remedies are by their nature counterfeit therapies.

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Anti Addict Mummy Money

A US group that pays drug addicts to undergo sterilisation visits the UK this week, having recently paid its first British client for undergoing a vasectomy. “Project Prevention” claims that its goal is to make addicts and alcoholics use long-term birth control until they can care for the children they conceive. Founder Barbara Harris has said: “We don’t allow dogs to breed. We spay them. We neuter them. We try to keep them from having unwanted puppies, and yet these women are literally having litters of children.”

The visit has provoked strong responses. Some have compared the group to eugenicists, while supporters point to the cost to the children and society of conception by addicted parents. Dominic Wilkinson has controversially suggested on this blog that a version of the programme could be offered on the National Health Service.

This ethical debate is on the level that Mackie (1977) identifies as first order. However, the issue also highlights second order moral issues about the nature of morality. What are we doing when we express a moral view and how do we know that our views are reliable? One approach to answering these sorts of questions is to understand human morality as an adaptation that contributed to our ancestors’ evolutionary fitness. Without addressing the strengths and weaknesses of such an approach here, if correct, it has the potential to illuminate second, and by implication first, order questions.

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Should we force parents to vaccinate their children? No: let’s just scare them instead

by Rebecca Roache

The BBC recently reported that some homeopaths are offering their patients homeopathic remedies designed to replace the MMR vaccine.  Given that the efficacy of homeopathic remedies is notoriously unproven, this points to the worrying conclusion that some parents who have chosen a homeopathic alternative to the MMR vaccine believe that their children are immune to measles, mumps, and rubella, when in fact they are unprotected against these diseases.

This development marks another blow for the ongoing campaign to ensure that children receive the recommended vaccinations.  Sir Sandy Macara, ex-chairman of the British Medical Association, has claimed that the UK has lower immunisation rates than some developing countries in which people have poor access to healthcare.  The percentage of the UK population currently vaccinated against MMR falls well below the level needed to achieve ‘herd immunity’ – where the number of immune individuals in the population prevents the spread of disease, thereby protecting those who are not immune – and recent outbreaks of measles in Wales has led the Welsh Assembly to consider making the MMR vaccine compulsory.  Such a move would be highly controversial, but is this a price worth paying to protect public health?

Read More »Should we force parents to vaccinate their children? No: let’s just scare them instead

Is the UK’s HPV vaccination programme unethical and/or unlawful?

A colleague recently emailed me. Her daughter, just turned
12, had come back from school bearing an information leaflet about HPV vaccination
with the Glaxo Cervarix vaccine, and a consent form for the parent to sign.

The consent form nodded inelegantly to Gillick, asserting that ‘[t]he decision to consent or refuse is
legally [the girl’s], as long as she understands the issues in giving consent.’
There was no indication given, in the consent form or the accompanying
literature, as to whether and if so how that understanding would be tested. The
reality is that it won’t be tested at all.

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Should doctors come clean? Religion makes a difference to end-of-life decisions

In a paper released today in the Journal of Medical Ethics, a large survey of UK doctors found that doctors’ religion influenced their views and practice of end-of-life care. Why does this matter? A number of headlines highlighted that atheist or agnostic doctors were more likely to report having participated in “ethically contentious end-of life actions”: ie taking part in terminal sedation or in actions that they expected or partly intended would hasten the patient’s death. But other headlines emphasised the obvious flip-side: doctors who identified themselves as ‘very religious’ or ‘extremely religious’ were about 35% less likely than non-religious doctors to report having taken this sort of step.

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Cosmetic Surgery – What is the Matter with Dr Salesman?

Written by Roman Gaehwiler

Reconstructive plastic surgery to correct ravages of disease and injuries as well as gross physical abnormalities constitutes a core medical practice. Reconstructive procedures, however, lie along a continuum, without any clear boundary between therapeutic reconstructive surgery for diagnosable problem and purely cosmetic surgery.[1]

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The NHS Should Make and Sell its own Homeopathic Remedies and Homeopaths Should be Paid the Minimum Wage

In March this year I blogged on the topic of NHS funding for homeopathic remedies. Even though I agreed with the critics of homeopathy, that there is no credible evidence for the efficacy of homeopathic remedies and that it is irrational to use these in preference to medical treatments that have actually been proven to work, I argued that the NHS should continue to subsidise the cost of homeopathic remedies. My basic line of argument was anti-paternalist. People should have the choice to be irrational if they want. What is important is that people are provided with all information relevant to their decision making. However, if they go ahead and choose to behave irrationally, then, provided that they are not harming others, their actions should not be interfered with. It is not the State’s role to prevent people from making such choices.

Read More »The NHS Should Make and Sell its own Homeopathic Remedies and Homeopaths Should be Paid the Minimum Wage