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Medical ethics

Greeks and geeks

At Harvard Medical School someone is screaming, reports the Boston Globe. ‘Death!’, he shrieks, ‘Why after all these years have you not appeared?’ He begs for euthanasia, tormented by his pain. Medical students listen to him.

His lines were written by Sophocles, and the students are listening because they have to: it is part of their curriculum.

The remarkable thing is not that Harvard medical students are being marinated in Sophocles, but that the Globe thought it worth reporting. Most medical students in mainstream western universities will get some ethics teaching. Sophocles is just one tool in the teachers’ toolkit. It’s a very effective one, by all accounts, but no different in kind from the lectures and seminars more conventionally deployed. Ethics teaching aims to teach students some problem-solving strategies, and to help them to recognise, evaluate, criticise, cull or cultivate the values that they themselves bring to the wards. 

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Between Life and Death…

A powerful BBC documentary, “Between Life and Death”, screened this evening on BBC One. The documentary (which can be viewed online for the next week in the UK) examined the life and death decisions made for critically ill patients with severe brain injury. Neuro-intensive care provides a way to interrupt the process of dying for such patients. But it raises difficult questions for medical staff and for families about the wishes of patients, the wishes of family members, and about uncertainty. Should treatment continue at the risk of the patient surviving in a severely impaired state? Or should patients be allowed to die, with the risk that perhaps if treatment had continued they may have recovered?

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The Costs of a Right to Demand Treatment

by Bridget Williams

Who has the right to decide when life prolonging treatment
should be withdrawn? Should doctors have the right to refuse to use costly and
scarce resources to continue to treat a permanently unconscious, dying man? Is
there a limit to the medical resources we can reasonably claim for ourselves
and our families when there are others who have the potential to receive much
greater benefits from those same resources?

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Critical Care ethics series – the ethics of maxiple pregnancies

by Dominic Wilkinson Quads, Quins, Sexts, Septs, even Octs! High order multiple pregnancies such as the Suleman octuplets in California generate enormous media attention. However, they also raise some unique ethical questions. In the second of a series of seminars on critical care ethics, the neonatal grand round today looked at ethical questions arising from… Read More »Critical Care ethics series – the ethics of maxiple pregnancies

An Ethical Approach to Abortion

by Julian Savulescu

Abortion should be decriminalised. Early abortion should be freely and easily available on request. Late abortion should be freely and easily available at least for those who have a valid justification: significant fetal abnormality, threat to woman’s health or a serious social reason, for example child pregnancy or rape. Family planning, including safe, free and open abortion services, is an essential part of a civilized society.

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Special Edition: Should we allow late abortion?

There have been a number of articles in the media about abortion in the last few weeks. The British Prime Minister has suggested that the time limit for (relatively) unrestricted access to abortion should be reduced from 24 to 22 or 20 weeks. A survey published tomorrow in an Australian medical journal suggests that the public in Australia support legal access to abortion, and do not believe that doctors should be sanctioned for performing abortion in the later stages of pregnancy if there is a good reason to do so.

This blog collects together resources and media articles relevant to the debate

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Foetal pain and the abortion debate: believing what you want to believe

By Janet Radcliffe-Richards

Last Friday’s BBC morning news headlines included a report of two reviews by the Royal College of Obstetricians and Gynaecologists of evidence about foetal pain. The reviews concluded that foetuses under 24 weeks could not feel pain, because “nerve connections in the cortex, the area which processes responses to pain in the brain, does not form properly before 24 weeks”, and that even after that stage “a foetus is naturally sedated and unconscious in the womb”.

The corresponding article on the BBC website added the comment that “anti-abortion campaigners challenged the reports”. There were no details about the form these challenges took or who they came from, but as the reports were reviews of scientific evidence, it sounds as though a challenge to the reports must have been a challenge to the scientific claims. Of course scientific claims are always potentially open to challenge, so if the article had reported that scientists had come forward to challenge the methodology of key studies, for instance, or the way the reviews represented the data, we would just have known there was an ongoing scientific debate on the subject. But the implication of the BBC article was that people who were against abortion were challenging the scientific claims about foetal pain. And if this is true, it is interesting. Why should people with particular moral views (about the wrongness of abortion) or political ambitions (to prevent it) issue challenges to scientific claims? Most of these people are not scientists, and there is no reason to think they have special knowledge of nerve connections in the foetal cortex. So why are the challenging what the scientists say?

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Viability and the abortion debate – what really matters?

MPs in the House of Commons will debate tomorrow whether the cut-off for legal abortions in the UK should be reduced. Currently abortions are permitted up to the 24th week of a pregnancy, and some MPs have argued that this should be reduced to 20 weeks or below. Advocates and opponents of the change have pointed to scientific evidence about the viability of infants born extremely prematurely at 22, 23 and 24 weeks. They seem to believe that if we can answer the scientific question of whether such infants are viable, that will resolve the question about whether or not abortion is permissible at that stage.
That might be the case if there were a consensus on what viability means, and why it is important in questions about abortion time-limits. But, as this article will highlight, there is no such consensus, and it is not straightforward why viability should matter. So far in this public debate there has been little or no mention of the important questions – what is viability, and why is it important in abortion law?

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