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Oxford Debates – The NHS should not treat self-inflicted illness (Moderator’s Introduction)

Moderator: Dr Paula Boddington

Should the NHS treat self-inflicted illness? This question raises a plethora of different issues, about science, society, social policy, as well as philosophical questions about human nature and individual freedom.

The best use of health care resources will always be debated. How much money should be spent on health? How efficiently can it be spent? How should it be divided within the healthcare system? These can never simply be questions of economics but also raise vitally important questions about values. This debate about what treatments the NHS should offer is taking place in an economic climate where there is a call to curtail public spending. Would refusing to treat self-inflicted illnesses be a fair place to start to save money?

But money is only one aspect of this debate.

Read More »Oxford Debates – The NHS should not treat self-inflicted illness (Moderator’s Introduction)

More on drugs…

In a recent
entry on this weblog, Roger Crisp discusses the recent and controversial
“Release” advertising campaign on drugs (and its slogan “Nice People Take
Drugs”),
and rightly highlights the need for serious and widespread debate on drug
legislation. My home country, Switzerland, precisely had a debate on this issue
a few months ago, when we were called to vote on a popular initiative
purporting to decriminalize the use, purchase, consumption and possession of
cannabis (not of other drugs) – which would have meant placing the consumption
of this drug on a similar plane with that of tobacco or alcohol. This measure
was supposed to be accompanied by others, notably destined to protect young
people. On the 30th of November 2008, however, the Swiss people
rejected the initiative by quite a large majority.

Read More »More on drugs…

Coercion, compulsion and immunisation

The former head of the British Medical Association, Sir Sandy Macara, has called for the Measles Mumps and Rubella immunisation (MMR) to be a compulsory requirement prior to school entry. The UK has seen a surge in cases of measles over the last couple of years because of a fall in the immunisation rate. Many parents have chosen not to immunise their children as a result of the supposed (and now completely discredited) link between MMR and autism. Immunisation rates have fallen to 70% in some parts of the country. Is compulsory immunisation the answer, and if so, what degree of compulsion should we adopt?

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Shining monkey, sadistic conclusion?

Japanese researchers have genetically modified marmoset monkeys, and demonstrated that the modification can be inherited by their offspring. The modification was the standard green fluorescent protein making the monkey's glow green under UV light, a marker to demonstrate that the modification worked (BBC shows a picture of their feet glowing "an eerie green", while the picture in Nature's News and Views shows the cute monkeys in normal light and the original paper shows both). The long-term aim is to be able to produce transgenic primates that could act as disease models for humans – many conditions do not map well onto mice and rats. But is it acceptable to introduce heritable illness conditions into animals?

Read More »Shining monkey, sadistic conclusion?

The flu paradox: is the WHO focusing too little on flu?

The WHO is in the news these days thanks to the H1N1 epidemic (alias the swine flu, or the Colbert flu), and it is doing an admirable job coordinating various national agencies in fighting a pandemic. Historically it has been at the forefront of fighting epidemic disease, whether tuberculosis or AIDS. However, since Gro Harlem Brundtland's director-generalship 1998-2003 there has been an increased emphasis on public health, in particular fighting alcohol and tobacco use but also traffic accidents. Has the WHO aimed at the right or wrong problems?

Read More »The flu paradox: is the WHO focusing too little on flu?

Pandemic ethics: The boy who cried ‘flu’!

The headlines in the last week have been dramatic. California has declared a state of emergency. The World Health Organisation has raised its pandemic alert status to level 5 – its second highest level. The UK government is about to post leaflets to every household providing information on how to reduce spread of an outbreak of H1N1 influenza (swine flu).

It is not clear whether the threatened pandemic will eventuate. But the response to a possible or to a real pandemic raises a number of ethical questions. This blog will hopefully address some of those questions in the coming days. But here is one to start with. How ought the government to respond to the threat of pandemic influenza?

Read More »Pandemic ethics: The boy who cried ‘flu’!

Just lose it?

A recent
study by researchers from the Harvard Medical School concludes that getting
angry at work, contrary to common opinion, may not be a bad thing, but may
actually be beneficial to your career and your overall happiness (as reported by BBC News and the Guardian among others). The researchers nevertheless issue a few caveats: in order for anger to be
beneficial, one ought to remain in control when expressing it and be able to
“positively channel” it. On the other hand, they advise against outright fury,
which they describe as “destructive”. There is indeed an important lesson contained in these statements; one might have wished, however, that the researchers had been a little more specific in the provisos they add to their main idea.

Read More »Just lose it?

Educating children on matters of food

As evidenced by recent declarations by the Children’s Secretary (see here and here),
the British government is determined to fight childhood obesity and to initiate
nothing less than a “lifestyle revolution”, resulting in more children leading
a healthy and active life. With this aim in view, a free cookbook was recently distributed to 11
year-olds by the Department for Children, Schools and Families. In
addition to that, from 2011
cookery lessons will be compulsory in England's secondary schools for children
aged 11 to 14, and £3.3 million will be invested in order to
recruit and train people capable of teaching cooking skills to children.
Parents are also urged to teach their children how to prepare meals from
scratch.

These are certainly sensible steps to take. With nine out of 10 British adults
and two-thirds of children expected to be overweight or obese by the year 2050
unless action is taken (http://www.guardian.co.uk/society/2008/jul/30/obesity),
we are clearly dealing with an important public health issue. And given the
significance of the link between excess weight and an unhealthy diet (lack of
exercise being another major contributing factor), it seems clear that we should
teach children what a healthy diet consists in and equip them not to be dependent on
the local fast-food chain when the time of the next meal comes. We can hope
that the government’s scheme will help to achieve this, and that parents will
follow the lead – though it is also necessary that the meals provided in school
canteens be in keeping with those aims. However, I would like to suggest that
these steps should form part of a wider project meant to educate children on
matters of food. We want our children to be healthy, but we should also want
them to become autonomous and ethically responsible eaters (and, more
generally, consumers).

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Stem Cell Trials – Should They Go Ahead? Why Harm to Patients Is Not a Reason to Stop Them

Professor Savulescu comments:

Professor Julian Savulescu is Uehiro Chair in Practical Ethics and Director of the Uehiro Centre for Practical Ethics at Oxford, Director of the Oxford Centre for Neuroethics, and Director of the Program on the Ethics of the New Biosciences. He was also recently awarded a major Arts and Humanities Research Council grant on Cognitive Science and Religious Conflict.


THE FDA has approved for the first time a clinical trial of embryonic stem cells to treat spinal injury patients. The trial will be conducted by Geron. A similar trial by Reneuron has been approved recently in the UK (The Scotsman, and the BBC). The research in the UK to treat stroke patients has already attracted stern criticism from “ethical campaigners.” The first wave predictably objected on the ground that it involved abortion "It involves cannibalising an unborn child.” But no child was aborted for the purposes of providing stem cells. These would have involved abortions that would anyway have occurred for a variety of reasons. Such opponents predictably object to anything involving destruction of embryos and fetuses – abortion, IVF, prenatal testing, contraception – so it is hardly surprising that they would object to this form of medical treatment.

The second wave of ethical campaigners, not clearly distinct from the first, claim now that the treatment is too risky. But is it too risky?

Read More »Stem Cell Trials – Should They Go Ahead? Why Harm to Patients Is Not a Reason to Stop Them