Medical ethics

Who wants to be an abortionist?

by Lachlan de Crespigny
November 25, 2010January 7, 2011

By Lachlan de Crespigny

Dr. Evan James never wavered in his determination to become an abortion provider. But he is unusual – few trainee doctors have a driving ambition to become abortionists. The U.S. has seen a 40 per cent drop in the number of doctors who perform abortions since the early 1980s. Those in the field say there's likely a similar trend in Canada. Few Canadian hospitals provide abortions and numbers are dropping. Other countries, including Australia, have similar service provision problems.

Abortion is lawful in at least some circumstances in almost all western countries. Yet most have too few providers and current providers are aging with few replacements coming through.

Data or life? Ethical obligations to present and future patients.

by Practical Ethics
November 24, 2010January 7, 2011

By Jahel Queralt-Lange

Each year 10.9 million new cases of cancer are diagnosed worldwide, and 6.7 million people die. The good news is that better drugs are developing faster. We all want to hear about “wonder drugs” and the scientific and medical communities feel the urge (and sometimes the pressure) to provide them. However, some ethical problems might appear in our way to this breakthrough. Before being released into the market, any drug has to undergo a trial in which its benefits are tested and weighed up against its adverse effects. Of course, the desirability of increasing our knowledge in order to improve our health is beyond question. What poses problems is that those individuals who participate in the trials are the means by which we achieve that knowledge. Past experiences, like the Tuskegee Syphilis experiment that took place in the US showed that it’s morally outrageous to trade the life of some individuals for the sake of benefiting society. Nowadays the issue is regulated but moral dilemmas persist.

Unintentional contraception

by Anders Sandberg
November 20, 2010

by Anders Sandberg

The pope approves of the use of condoms to fight AIDS: according to an upcoming book he says it is acceptable when the intention is to reduce the risk of infection. While he still views abstinence as the proper way of fighting the disease, "In certain cases, where the intention is to reduce the risk of infection, it can nevertheless be a first step on the way to another, more humane sexuality." Now, how does this fit with the doctrine of double effect? According to this doctrine, it is sometimes permissible when acting towards a good result to bring about a foreseen side effect that on its own would be impermissible. Is contraception hence a permissible side effect of trying to reduce infection risk?

Lethal Ethics: When Philosophical Distinctions Kill

by Practical Ethics
November 12, 2010

by Julian Savulescu

Teresa Lewis died on the 24th of September after being a lethal injection at the Greensville Correctional Centre in Virginia. The 41-year-old was convicted of plotting to kill her husband, Julian Lewis, and her stepson, Charles Lewis. She persuaded two men to carry out the murders in return for sex and money. The two men received life sentences. The execution went ahead in spite of protests from lawyers, celebrities and others who argued that she should have been given clemency because of her low IQ. Under US law, anyone with an IQ of 70 avoids the death penalty. Lewis was judged to have an IQ of 72.

Palmistry for the genome: genetic fundamentalism fights on

by Charles Foster
November 11, 2010January 8, 2011

by Charles Foster
A recent paper in Social, Cognitive and Affective Neuroscience has the self-explanatory title Investigating the genetic basis of altruism: the role of the COMT Val158Met polymorphism. ^1. The German authors aren’t as cautious in their claims as they should have been. They should have noted, nervously, the reception given to the infamous ‘God gene’ hypothesis,² and entitled the paper something along the lines of ‘Some not very statistically significant correlations (from which we can’t begin to infer a causative relationship) between the COMT Val 158 Met polymorphism and some behaviour that might be markers of, amongst other things, being nice, whatever that means, ignoring other non-correlations with other more plausible markers of being nice.’

Why Bioenhancement of Mathematical Ability Is Ethically Important

by Practical Ethics
November 4, 2010

by Julian Savulescu

In a paper just released today, Cohen Kadosh and colleagues (Cohen Kadosh et al., Modulating Neuronal Activity Produces Specific and Long-Lasting Changes in Numerical Competence, Current Biology (2010), doi:10.1016/j.cub.2010.10.007) described how they increased the numerical ability of normal people by applying an electrical current to a part of the skull. So what? Most of us don’t do that much maths after leaving school and manage just fine.

Could a ban on homebirth be justified?

by Michelle Hutchinson
October 30, 2010

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?

Is professional integrity a futile argument?

by Practical Ethics
October 29, 2010

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.

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

by Practical Ethics
October 27, 2010

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?

Anti Addict Mummy Money

by Paul Troop
October 21, 2010

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.