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Medical ethics

New Publication: ‘Overriding Adolescent Refusals of Treatment’

Written by Anthony Skelton, Lisa Forsberg, and Isra Black

Consider the following two cases:

Cynthia’s blood transfusion. Cynthia is 16 years of age. She is hit by a car on her way to school. She is rushed to hospital. She sustains serious, life-threatening injuries and loses a lot of blood. Her physicians conclude that she needs a blood transfusion in order to survive. Physicians ask for her consent to this course of treatment. Cynthia is intelligent and thoughtful. She considers, understands and appreciates her medical options. She is deemed to possess the capacity to decide on her medical treatment. She consents to the blood transfusion.

Nathan’s blood transfusion. Nathan is 16 years of age. He has Crohn’s disease. He is admitted to hospital with lower gastrointestinal bleeding. According to the physicians in charge of his care, the bleeding poses a significant threat to his health and to his life. His physicians conclude that a blood transfusion is his best medical option. Nathan is intelligent and thoughtful. He considers, understands and appreciates his medical options. He is deemed to possess the capacity to decide on his medical treatment. He refuses the blood transfusion.

Under English Law, Cynthia’s consent has the power to permit the blood transfusion offered by her physicians. Her consent is considered to be normatively (and legally) determinative. However, Nathan’s refusal is not normatively (or legally) determinative. Nathan’s refusal can be overridden by consent to the blood transfusion of either a parent or court. These parties share (with Nathan) the power to consent to his treatment and thereby make it lawful for his physicians to provide it.

Read More »New Publication: ‘Overriding Adolescent Refusals of Treatment’

Exercise, Population Health and Paternalism

Written by Rebecca Brown

 

The NHS is emphatic in its confidence that exercise is highly beneficial for health. From their page on the “Benefits of exercise” come statements like:

“Step right up! It’s the miracle cure we’ve all been waiting for”

“This is no snake oil. Whatever your age, there’s strong scientific evidence that being physically active can help you lead a healthier and happier life”

“Given the overwhelming evidence, it seems obvious that we should all be physically active. It’s essential if you want to live a healthy and fulfilling life into old age”.

Setting aside any queries about the causal direction of the relationship between exercise and good health, or the precise effect size of the benefits exercise offers, it at least seems that the NHS is convinced that it is a remarkably potent health promotion tool.Read More »Exercise, Population Health and Paternalism

Video Interview: Should We Vaccinate Young Children Against COVID?

Many who had no doubts whatsoever about having themselves vaccinated against COVID, are much more hesitant when it comes to vaccinating their young children. Is such hesitancy justified?  In this Thinking Out Loud interview, Katrien Devolder talks to Dominic Wilkinson, Consultant Neonatologist and Professor of Medical Ethics at the University of Oxford about the ethical… Read More »Video Interview: Should We Vaccinate Young Children Against COVID?

Your eyes will be discontinued: what are the long-term responsibilities for implants?

by Anders Sandberg

What do you do when your bionic eyes suddenly become unsupported and you go blind again? Eliza Strickland and Mark Harris have an excellent article in IEEE Spectrum about the problems caused when the bionics company Second Sight got into economic trouble. Patients with their Argus II eyes found that upgrades could not be made and broken devices not replaced. What kind of  responsibility does a company have for the continued function of devices that become part of people?

Read More »Your eyes will be discontinued: what are the long-term responsibilities for implants?

Impersonality and Non-identity: A Response to Bramble

by Roger Crisp

Consider the following case, from David Boonin:

Wilma. Wilma has decided to have a baby. She goes to her doctor for a checkup and the doctor tells her that…as things now stand, if she conceives, her child will have a disability. . . that clearly has a substantially negative impact on a person’s quality of life. . . [but is not] so serious as to render the child’s life worse than no life at all. . . .[But] Wilma can prevent this from happening. If she takes a tiny pill once a day for two months before conceiving, her child will be perfectly healthy. The pill is easy to take, has no side effects, and will be paid for by her health insurance. . . .Wilma decides that having to take a pill once a day for two months before conceiving is a bit too inconvenient and so chooses to throw the pills away and conceive at once. As a result of this choice, her child is born [with the disability].

Read More »Impersonality and Non-identity: A Response to Bramble

Cognitive snobbery: The Unacceptable Bias in Favour of the Conscious

There are many corrosive forms of discrimination. But one of the most dangerous is the bias in favour of consciousness, and the consequent denigration of the unconscious.

We see it everywhere. It’s not surprising. For when we’re unreflective – which is most of the time – we tend to suppose that we are our conscious selves, and that the unconscious is a lower, cruder part of us; a seething atavistic sea full of monsters, from which we have mercifully crawled, making our way ultimately to the sunlit uplands of the neocortex, there to gaze gratefully and dismissively back at what we once were.  It’s a picture encoded in our self-congratulatory language: ‘Higher cognitive function’; ‘She’s not to be blamed: she wasn’t fully conscious of the consequences.’: ‘In the Enlightenment we struck off the shackles of superstition and freed our minds to roam.’Read More »Cognitive snobbery: The Unacceptable Bias in Favour of the Conscious

Event Summary: Vaccine Policies and Challenge Trials: The Ethics of Relative Risk in Public Health

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St Cross Special Ethics Seminar, Presented by Dr Sarah Chan, 18 November 2021

In this St Cross Special Ethics Seminar, Dr Sarah Chan explores three key areas of risk in ‘challenge trials’ – the deliberate infection of human participants to infectious agents as a tool for vaccine development and improving our knowledge of disease biology.  Dr Chan explores a) whether some forms of challenge trials cannot be ethically justified; b) why stratifying populations for vaccine allocation by risk profile can result in unjust risk distribution; and c) how comparing these cases and the evaluation of relative risk reveals flaws in approach to pandemic public health.


Read More »Event Summary: Vaccine Policies and Challenge Trials: The Ethics of Relative Risk in Public Health

Philosophical Fiddling While the World Burns

By Charles Foster

An unprecedented editorial has just appeared in many health journals across the world. It relates to climate change.

The authors say that they are ‘united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.’

Climate change, they agree, is the major threat to public health. Here is an excerpt: there will be nothing surprising here:

‘The risks to health of increases above 1.5°C are now well established. Indeed, no temperature rise is “safe.” In the past 20 years, heat related mortality among people aged over 65 has increased by more than 50%.Hi gher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality. Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities, and those with underlying health problems.’Read More »Philosophical Fiddling While the World Burns

Healthcare, Responsibility, and Golden Opportunities

Written by Gabriel De Marco

This blog post is based on a co-authored paper (w. Tom Douglas and Julian Savulescu) recently published in Ethical Theory and Moral Practice.

 

When it comes to determining how healthcare resources should be allocated, there are many factors that could—and perhaps should—be taken into account. One such factor is a patient’s responsibility for his or her illness, or for the behavior that caused it; e.g. whether a lifetime smoker is responsible for developing his lung cancer, or whether someone is responsible for heart disease on the basis of having an unhealthy diet. Policies that take responsibility for the unhealthy lifestyle or its outcomes into account—responsibility-sensitive policies, or RSPs, for short—have been a matter of debate for some time.

Read More »Healthcare, Responsibility, and Golden Opportunities

Compromising On the Right Not to Know?

Written by Ben Davies

Personal autonomy is the guiding light of contemporary clinical and research practice, at least in the UK. Whether someone is a potential participant in a research trial, or a patient being treated by a medical professional, the gold standard, violated only in extremis, is that they should decide for themselves whether to go ahead with a particular intervention, on the basis of as much relevant information as possible.

Roger Crisp recently discussed Professor Gopal Sreenivasan’s New Cross seminar, which argued against a requirement for informational disclosure in consenting to research participation. Sreenivasan’s argument was, at least in its first part, based on a straightforward appeal to autonomy: if autonomy is what matters most, I should have the right to autonomously refuse information.

I have previously outlined a related argument in a clinical context, in which I sought to undermine arguments against a putative ‘Right Not to Know’ that are themselves based in autonomy. In brief, my argument is, firstly, that a decision can itself be autonomous without promoting the agent’s future or overall autonomy and, second, that even if there is an autonomy-based moral duty to hear relevant information (as scholars such as Rosamond Rhodes argue), we can still have a right that people not force us to hear such information.

In a recent paper, Julian Savulescu and I go further into the details of the Right Not to Know, setting out the scope for a degree of compromise between the two central camps.

Read More »Compromising On the Right Not to Know?