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Medical ethics

Is the UK’s HPV vaccination programme unethical and/or unlawful?

A colleague recently emailed me. Her daughter, just turned
12, had come back from school bearing an information leaflet about HPV vaccination
with the Glaxo Cervarix vaccine, and a consent form for the parent to sign.

The consent form nodded inelegantly to Gillick, asserting that ‘[t]he decision to consent or refuse is
legally [the girl’s], as long as she understands the issues in giving consent.’
There was no indication given, in the consent form or the accompanying
literature, as to whether and if so how that understanding would be tested. The
reality is that it won’t be tested at all.

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When you prick me do I not cry?

A fascinating study in the Lancet this week has suggested that a very commonly used and simple analgesic in newborn infants may not actually be preventing them from experiencing pain. The study’s authors suggest that this medicine should no longer be used routinely in newborn infants. A headline in the Guardian reads “Newborn babies should not be given sugar as pain relief”. But there are scientific, philosophical and ethical reasons why this conclusion, though possibly correct, is premature.

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Enhancement – Keep the Game, Change the Basis

Paradoxically, elite sports is largely about seeking for inequality, but simultaneously trying to level the playing field in order to equalize the opponents. So, how is it possible to cultivate inequality through equality? Anti-doping activists argue that enhancing substances falsify the individual and naturally given capability to perform in a competition. As a result, there might be a lack of equal opportunities. In contrast, enhancement advocates underline that doping might be able to level the playing field by removing the effects of genetic inequality, and therefore provides equality.[1] In fact, both arguments imply the noble aspiration of equality. So then, equality must be the ultimate aim.

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Should doctors come clean? Religion makes a difference to end-of-life decisions

In a paper released today in the Journal of Medical Ethics, a large survey of UK doctors found that doctors’ religion influenced their views and practice of end-of-life care. Why does this matter? A number of headlines highlighted that atheist or agnostic doctors were more likely to report having participated in “ethically contentious end-of life actions”: ie taking part in terminal sedation or in actions that they expected or partly intended would hasten the patient’s death. But other headlines emphasised the obvious flip-side: doctors who identified themselves as ‘very religious’ or ‘extremely religious’ were about 35% less likely than non-religious doctors to report having taken this sort of step.

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Cosmetic Surgery – What is the Matter with Dr Salesman?

Written by Roman Gaehwiler

Reconstructive plastic surgery to correct ravages of disease and injuries as well as gross physical abnormalities constitutes a core medical practice. Reconstructive procedures, however, lie along a continuum, without any clear boundary between therapeutic reconstructive surgery for diagnosable problem and purely cosmetic surgery.[1]

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The NHS Should Make and Sell its own Homeopathic Remedies and Homeopaths Should be Paid the Minimum Wage

In March this year I blogged on the topic of NHS funding for homeopathic remedies. Even though I agreed with the critics of homeopathy, that there is no credible evidence for the efficacy of homeopathic remedies and that it is irrational to use these in preference to medical treatments that have actually been proven to work, I argued that the NHS should continue to subsidise the cost of homeopathic remedies. My basic line of argument was anti-paternalist. People should have the choice to be irrational if they want. What is important is that people are provided with all information relevant to their decision making. However, if they go ahead and choose to behave irrationally, then, provided that they are not harming others, their actions should not be interfered with. It is not the State’s role to prevent people from making such choices.

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Competing against Mutants

Introduction

In a recently broadcasted documentation about gene-doping, multiple award winning Swiss science journalist and author, Beat Glogger, reflected the issue of gene-doping in a sensitive and objective manner. In this Swiss-German co-production Andy Miah, a bold British Bioethicist, argued that gene-doping is supposed to be a natural friendly method of performance enhancement, whereas many other practices in the past weren’t. Simultaneously, he considered athletes no more as natural creatures by arguing: “We have to get rid of the imagination, that athletes are natural human-beings” (freely re-translated from the German version). Despite the fact that this statement is rather an anti-thesis than a substantiation for his strident position, I have to admit that the current development in gene technology tends to construct a sort of athletic hybrid. No doubt, this is a serious future issue we have to face. Nevertheless, Andy Miah’s declaration implies that athletes might kind take on a pioneer role regarding the subject of genetic enhancement. Therefore, is that an issue worth considering or even to achieving?

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Ethicists unite: you have nothing to lose but your non-citation

Yesterday Richard Ashcroft, Professor of Bioethics at Queen Mary College, London, wrote in a Facebook update: ‘I am fed up with being asked to come into science/medicine projects, add a bit of ethics fairy dust, usually without getting any share of the pie, just to shut reviewers up. I am not doing it any more. If they think we are important, treat us with respect. Otherwise, get lost.’

Lots of people liked this. So do I. Ethicists have for too long been the invisible but essential backroom boys and girls of biomedicine; patronised by the practitioners of ‘hard’ science; seen as unimaginative but powerful bureaucrats who have to be kept sweet; as despised social scientists who wield rubber stamps made essential by other zeitgeist-dictating social scientists who want to keep their woolly-headed chums in a job; as factotums who don’t deserve to have their names on the papers any more than the temp who does the photocopying. Why is this? 

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Performance Enhancement – Athletes are Victims not Delinquents

To describe the obvious power dynamic in modern sports industry from my personal point of view, I’m going to make use of a little metaphor. Therefore you have to imagine sport as a squash game played by several opponents. The competitors, hitting the ball from one corner into the other, represent the different stakeholders in elite-sports. Spectators, coaches, sponsors, national and international associations to mention a few. Of course there’s also one tiny ball incarnating the athlete himself as a kind of focal point, trying to satisfy the different demands. As a ball you’re certainly one of the most important parts of the game. But simultaneously you might be very easy to manoeuvre, because your being spherical, which could imply your lack of personal influence. Merely your ability to leave behind a little black marking on the squash court “wall of fame” is your only chance to colour your sport individually. As an elite sportsperson you’ve almost no opportunity to defend yourself against the prevailing key-players in the system. Otherwise you’re going to risk your career or even your status as a moral competitor. In the following lines, I’ll try to explain my position by disclosing the maladministration and mild coercion top-athletes are confronted with, emphasising four different issues of the “sports-system”.

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