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Medical ethics

Can forced sterilization ever be ethical?

A British court still needs to decide whether to authorize the sterilization, at her mother’s own request, of a mentally disabled woman (see e.g. here and here). Reading only the headlines and initial paragraphs of the news entries devoted to the case, one might become worried that we are seeing here a resurgence of an abhorrent practice that gained much favour in the first half of the 20th-Century, in countries like Germany or the United States: i.e. the compulsory sterilization of the mentally retarded for eugenic purposes. However, it is important to look at the particulars of this case in order not to be misled. The 21-year old woman, referred to as P, is pregnant with her second child, and her mother (“Mrs. P”) says that they “can’t carry on supporting more and more children”. She also said that after the birth of her second child her daughter would have “a complete family” (a girl and a boy). But her mother is worried that she will soon fall pregnant again, in which case the child will have to be given away for adoption – something that her daughter, she says, is unable to understand, yet an outcome that would cause her much distress were it to happen.

Reacting to the case, bioethicist George Annas, from Boston University, commented that “this is eugenics if they are doing this because she’s mentally disabled. This decision needs to be made based on the person’s best interests, not the best interests of society or her caregivers.”

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Herbal Placebos

The seven-year period within which member states must implement the EU directive on herbal medicine ends next month. In the UK, the government last week announced that herbalists will now be regulated by the Health Professionals Council (HPC). The HPC is the body that currently supervises a number of health professions including paramedics and physiotherapists. The effect of the decision has been to trigger concerns, particularly from medical professionals, that the move will confer legitimacy on treatments with no proven benefit. But if the government is going to permit herbal medicine, then there are in fact grounds to make it as plausibly medical as possible.

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Moralism and Reproduction: Ten Infringements of Liberty

One of the great success stories of British science in the last 30 years was the introduction of In Vitro Fertilisation by Steptoe and Edwards in 1978. They should have won the Nobel Prize. Around 3% of babies are now born after IVF. Testing of and experimentation on early human embryos offers great prospects for improving not only the health of the next generation but how well their lives go. Today, a wide variety of genes which cause or contribute significantly to disease can be tested. Soon, it will be possible to test for all the genes an embryo has and choose embryos which start life with the least prospects of disease and greatest range of talents, abilities and capacities. And IVF has allowed individuals and couples to have children in new ways, expanding procreative liberty. Experimentation on embryos is yielding important knowledge of human development and contributing to the development of regenerative medicine, or stem cell therapies.

Assisted reproduction, including embryo testing, and research involving the embryo has been controlled by the Human Fertlisation and Embryology Authority (HFEA). I recently wrote an evaluation of the performance of the HFEA. I argued that the HFEA was set up on the wrong premise: the embryo was said to have a special moral status. Regulation should be set up on the basis of preventing real, tangible and direct harm. Destroying some embryos but not others is not an example of preventing harm. Secondly, it has operated to enforce public morality, imposing moralism not preventing harm. This was kind of objectionable moralism that was employed by Lord Devlin to justify a ban on homosexuality. Thankfully, HLA famously disposed of that bad justification, at least in the case of homosexuality. Moralism, however, has been alive and well in the case of reproduction.Read More »Moralism and Reproduction: Ten Infringements of Liberty

You want to publish? Let’s hear all your dirty secrets

By Charles Foster

Most scientific journals require contributors to declare any conflict of interest.

But what about ethicists? We are much more ambitious and presumptuous in our aims than most scientists. We purport to tell our readers not which drug will reduce their blood cholesterol, or which type of plate is best for their radial fracture, but how best to live: how to make right decisions about things that matter far more than cholesterol; how to be the right sort of people. If we write good papers, amounting to more than newspaper opinion pieces, the papers support their conclusions with supposedly objective reasoning. We try to look scientific. And yet, try as we might, we can’t escape from our own histories and tendencies. If an ethicist has been sexually abused as a boy by a paedophilic priest, or forced to watch US evangelical TV, he’ll never be able to think that religion is anything but evil or ridiculous, and his articles will argue, with apparent but wholly fake objectivity, towards that conclusion. If the Jesuits got him before the age of 7, and etched the catechism into his subconscious rather than buggering him, the man they made out of the boy will be theirs for ever, in the Journal of Medical Ethics just as devoutly as in the confessional. And yet there’ll be not a whisper of a warning next to their papers. Those influences are likely to be far more determinative of the views expressed than any financial conflict of interest in a drug trial ever was. Everything about an ethicist’s life raises a potential conflict of interest.Read More »You want to publish? Let’s hear all your dirty secrets

Hypothetically donated organs

Every day three people die in the UK while waiting in the transplant queue. In the face of the urgency to increase the organs available, some propose introducing economic incentives. A more moderate solution consists in choosing a public policy with an appropriate default option, that is, a condition that is imposed on individuals when they fail to make a decision. A default option influences policy-outcomes in two ways: a) it can have a direct impact on people’s choices because they might interpret it as the option recommended by society; b) the effort involved in making a decision as opposed to accepting one –e.g. filling a form, having to think about one’s death, etc.- nudges people towards the default option.

Regarding organ transplantation, legal systems are divided between opt-out systems in which everybody is an organ donor unless she has registered not to be, and the so called opt-in systems that consider that nobody is an organ donor unless they have registered to be one. Countries with an opt-out system like Austria, Belgium or Spain tend to have higher organ donation rates. This fact is often used as a strong argument in favour of taking consent as the default option. Unlike the countries mentioned, UK has an opt-in policy. However, the Welsh are trying to pass a piece of legislation that would allow them to establish an opt-out system. Their initiative reopens the debate about the pros and cons of the two systems. Those who oppose introducing an opt-out system in the UK make the following claims:

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DIY enhancement: morphological freedom or self-harm?

by Anders Sandberg

Lepht Anonym is a DIY biohacker, extending her body and senses through implantation of home-made cybernetics in her own kitchen. (YouTube video of her lecture) Most of her work is about extending the sense of touch, using implanted magnets to acquire “magnetic vision” and (hopefully) an implanted version of the northpaw magnetic sense system besides the “usual stuff” of RFID implants.

She is critical of regular transhumanism, which she thinks is all talk. This is the real deal: “You just have to get deep enough to open a hole and put something in,” she says. “It’s that simple.” Of course, she has ended up in the hospital a few times. A new kind of self-harm all right-thinking people ought to save her from, or a valid form of self-expression that should be protected?
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Trading Organs for Freedom

In Mississippi, sisters Jamie and Gladys Scott are to be let out of prison on the condition that Gladys donates a kidney to Jamie. (See also an article in the Guardian) They are both serving life sentences for being accessories to armed robbery, and would otherwise not be eligible for parole until 2014. Jamie Scott is severely ill with diabetes and high blood pressure, and requires frequent dialysis. She has been given parole on medical grounds, while Gladys has been granted parole on the condition that she give one of her kidneys to Jamie within a year. Receiving payment in exchange for organs is illegal in the US. But is there a relevant moral difference between trading one of your kidneys for money, and trading it for your freedom?

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Is Discounted Therapy Fair?

by David Shipley

A friend of mine is a therapist. She faced the following dilemma.

My friend specialises in enhancing fertility and was approached by a prospective patient who wished to become pregnant but could not afford to pay the standard fee of £45 per treatment as she was on benefits. The woman was aged 40 and had no children. What should my friend the therapist have done?

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Is it ethical to force-feed prisoners on a hunger strike?

by Alexandre Erler

The question, which generated debate a few years ago in the context of the US detention camp at Guantanamo Bay, is now arising again in Switzerland, where imprisoned cannabis farmer Bernard Rappaz has been on hunger strike for about three months now, in protest against a prison sentence he considers excessive. Rappaz was sentenced to five years and eight months behind bars for trading in cannabis and various other offenses. The Federal Court, Switzerland’s highest instance, has ruled that Rappaz should be force-fed if necessary, but doctors in charge of him have refused to obey those orders. A criminal law Professor has argued that according to the Swiss Penal Code, these doctors should be prosecuted, as their refusal amounts to civil disobedience. How should we regard such a legal implication? Is it ethically acceptable, perhaps even required, to force feed someone like Bernard Rappaz?

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