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Medical ethics

Palmistry for the genome: genetic fundamentalism fights on

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.’

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Why Bioenhancement of Mathematical Ability Is Ethically Important

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.

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Could a ban on homebirth be justified?

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?

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Is professional integrity a futile argument?

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.

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

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?

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Anti Addict Mummy Money

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.

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Kidneys and the Ultimatum Game

Frequently in life there is some good available if you and I can agree on some split of that good between us. If we cannot agree the good never comes into existence. This fact can be modelled by what is called the ultimatum game. In the ultimatum game somebody offers us £100 to split between us just in case we agree on the split. The rule is that I propose and you dispose. If you accept we get the money split as agreed and if you reject it we both get nothing. Since you are better off whatever positive offer I make, it looks as if it is rational to accept even as little as £1.
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Is it legitimate to ask opponents of embryonic stem cell therapy whether they support IVF?

by Dominic Wilkinson

In the news this week is the first US officially-sanctioned human trial of embryonic stem cells. A patient with spinal cord injury has received an injection of embryo-derived stem cells.

Predictably, the news has not been received positively by those who are opposed to research with embryonic stem cells.

The development, however, was criticized by those with moral objections to research using the cells because days-old embryos are destroyed to obtain them.

"Geron is helping their stock price, not science and especially not patients," said David Prentice, senior fellow for life sciences at the Family Research Council.

The arguments in favour and against embryonic stem cells have been reviewed and rehearsed ad nauseam. I will not repeat them here.

 

But is it reasonable to ask or demand that those who are opposed to ES cells answer 'the question'. What are your views on IVF?

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Incidentally… avoiding the problem of incidental findings

A new study from the Mayo clinic in the United States points to a frequent problem in certain types of medical research. When healthy volunteers or patients with a given condition take part in research studies they may have brain scans, CAT scans, blood tests or genetic tests that they wouldn’t otherwise have had. These tests are not done for the benefit of the individual, they are designed to answer a research question. But sometimes, quite often according to the authors of this new study, researchers may spot something on the scan that shouldn’t be there, and that could indicate a previously undiagnosed health condition. These ‘incidental findings’ generate an ethical dilemma for researchers. Should they tell the research participant about the shadow seen on their scan? Do they have an obligation to reveal to a research participant that they have found them to carry a gene increasing their risk for breast cancer, or Alzheimer’s disease? There is much agonising by ethics committees, ethicists and researchers about the problem of incidental findings, but there is a simple way of avoiding the problem. Anonymise research databases and tests so that there is no possibility of determining which participant has the breast cancer gene, or the lump in their kidney.

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