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Is it criminal not to breastfeed?

by Rebecca Roache

The Brazilian
model Gisele Bundchen recently—and controversially—claimed that mothers should
be required by law to breastfeed their babies for the first six months of their
lives. 
A few days later, she partially retracted the claim on her blog, insisting that her talk of a breastfeeding law should
not be taken literally.  It was simply a way of expressing her belief in the
importance of doing the best for her child. 
After all, legally enforcing breastfeeding would be madness, right?

Not
according to the Indonesian government. 
It recently passed a law giving babies the right to six months of
exclusive breastfeeding,
except in cases where medical problems prevent their mothers from breastfeeding.  Mothers who do not comply face a year in
prison or a fine of 100,000,000 Rupiahs (around £7,100), and those who prevent
mothers from fulfilling their breastfeeding obligations also face punishments.  Scientists and health professionals generally
agree that breastfeeding is healthier for babies than the alternatives (see,
for example, here),
that not enough mothers do it (see here),
and governments around the world invest huge sums trying to get mothers to
breastfeed.  But is criminalising non-breastfeeding mothers a good idea?

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The ethics of prescribing antibiotics

Antibiotics are overprescribed. That is, they are given out in many cases where they will achieve little or nothing for the patient. On its own, this would merely be wasteful, but usage of antibiotics increases the development of antibiotic resistant organisms and this is bad for everyone. Today's Guardian has an article suggesting that antibiotic resistance could become a *very* big problem, with all major antibiotics becoming ineffective within a couple of generations (see also the original research in the Lancet). This leads to some very interesting questions concerning the ethics of prescribing antibiotics.

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Ethicists unite: you have nothing to lose but your non-citation

Yesterday Richard Ashcroft, Professor of Bioethics at Queen Mary College, London, wrote in a Facebook update: ‘I am fed up with being asked to come into science/medicine projects, add a bit of ethics fairy dust, usually without getting any share of the pie, just to shut reviewers up. I am not doing it any more. If they think we are important, treat us with respect. Otherwise, get lost.’

Lots of people liked this. So do I. Ethicists have for too long been the invisible but essential backroom boys and girls of biomedicine; patronised by the practitioners of ‘hard’ science; seen as unimaginative but powerful bureaucrats who have to be kept sweet; as despised social scientists who wield rubber stamps made essential by other zeitgeist-dictating social scientists who want to keep their woolly-headed chums in a job; as factotums who don’t deserve to have their names on the papers any more than the temp who does the photocopying. Why is this? 

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Why public health campaigns should not promote enhancement

by Rebecca Roache

Human
enhancement is a hot topic in bioethics. 
Typically conceived as the use of technology to raise human capacities
above what is merely healthy or normal, it attracts questions such as, Is it
ethical?  Is it desirable?  Is it cheating? and, Should the state
subsidise it?  A common view is that,
whilst therapy—which aims to restore human capacities to what is healthy or
normal, but not to raise them above this level—is desirable; enhancement is at
best unnecessary [1], and at worst unethical [2].  Human enhancement, one might be tempted to
think, is for oddballs only: the average person is content merely to be
healthy.

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Facilitating, Condoning, and Preventing HIV

The Eighteenth International AIDS Conference is currently underway in Vienna, and one of the issues that has been under discussion is how to reduce HIV transmission within the various at-risk groups. One such group is the prison population, among whom HIV transmission occurs due to both illicit sexual activity and intravenous drug abuse. But prison authorities have often resisted putting in place public health measures such as condom or needle distribution that have been shown to be effective, because they regard sexual activity and drug use as prohibited in their prisons, and do not want to to be seen as condoning these activities. Is this concern a reasonable one?

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Greeks and geeks

At Harvard Medical School someone is screaming, reports the Boston Globe. ‘Death!’, he shrieks, ‘Why after all these years have you not appeared?’ He begs for euthanasia, tormented by his pain. Medical students listen to him.

His lines were written by Sophocles, and the students are listening because they have to: it is part of their curriculum.

The remarkable thing is not that Harvard medical students are being marinated in Sophocles, but that the Globe thought it worth reporting. Most medical students in mainstream western universities will get some ethics teaching. Sophocles is just one tool in the teachers’ toolkit. It’s a very effective one, by all accounts, but no different in kind from the lectures and seminars more conventionally deployed. Ethics teaching aims to teach students some problem-solving strategies, and to help them to recognise, evaluate, criticise, cull or cultivate the values that they themselves bring to the wards. 

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Foetal pain and the abortion debate: believing what you want to believe

By Janet Radcliffe-Richards

Last Friday’s BBC morning news headlines included a report of two reviews by the Royal College of Obstetricians and Gynaecologists of evidence about foetal pain. The reviews concluded that foetuses under 24 weeks could not feel pain, because “nerve connections in the cortex, the area which processes responses to pain in the brain, does not form properly before 24 weeks”, and that even after that stage “a foetus is naturally sedated and unconscious in the womb”.

The corresponding article on the BBC website added the comment that “anti-abortion campaigners challenged the reports”. There were no details about the form these challenges took or who they came from, but as the reports were reviews of scientific evidence, it sounds as though a challenge to the reports must have been a challenge to the scientific claims. Of course scientific claims are always potentially open to challenge, so if the article had reported that scientists had come forward to challenge the methodology of key studies, for instance, or the way the reviews represented the data, we would just have known there was an ongoing scientific debate on the subject. But the implication of the BBC article was that people who were against abortion were challenging the scientific claims about foetal pain. And if this is true, it is interesting. Why should people with particular moral views (about the wrongness of abortion) or political ambitions (to prevent it) issue challenges to scientific claims? Most of these people are not scientists, and there is no reason to think they have special knowledge of nerve connections in the foetal cortex. So why are the challenging what the scientists say?

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The Cost of Non-Cash Incentives for Organs

The Times newspaper featured an editorial proposing changes in the organ procurement system last week by Sally Satel, a scholar from the American Enterprise Institute, a conservative think tank. I thought the first few lines were especially revealing about Satel’s attitude to market transactions – she reports that she desperately needed a kidney herself, but dreaded “the constricting obligation that would surely come with accepting” an altruistic donation. She therefore “wished [she] could buy a kidney just to avert the emotional debt.”

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Critical Care ethics grand round

by Dominic Wilkinson

Today I gave a talk at the John Radcliffe Medical Grand Round on Advance Directives and treatment withdrawal decisions in intensive care – based on a case I was involved in last year.

A middle-aged patient presents with acute respiratory failure, and is intubated and transferred to the intensive care unit. After admission he improves, but it transpires that he has a progressive neurodegenerative disorder and has previously expressed a wish not to have intensive life support measures provided.

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Oxford Debates — Performance-Enhancing Drugs Should be Allowed in Sport — Moderator’s Opening Statement

Oxford Online Debates

by Roger Crisp

Taking drugs to improve one’s sporting performance seems, on the face of it, a paradigmatic example of a wrong action. It combines two activities usually considered shameful: the use of banned substances, and cheating.

But on closer inspection the issue is more complicated. The use of some drugs, such as nicotine or caffeine (both of which might enhance performance in some cases), carries little or no stigma, and the charge of cheating would be inappropriate were the drugs in question explicitly permitted.

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