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Banks: Liberty or Regulation

Banks: Liberty or Regulation

Gordon Brown has just said that he made a big mistake about financial regulation. His remarks are in line with many politicians on the financial crisis: regulation failed therefore we need more regulation. But do we?

Frideswide Square is a notorious traffic junction in Oxford, and it’s a nightmare. It has about 20 sets of traffic lights and small problems here lead to long tailbacks in many directions, tripling journey times for many otherwise short trips. So you can imagine how awful it was when the traffic lights all broke down recently.

Except it wasn’t.Read More »Banks: Liberty or Regulation

Stop bullfighting but carry on bullrunning, really?

“The only place where you could see life and death, i. e., violent death now that the wars were over, was in the bull ring and I wanted very much to go to Spain where I could study it” wrote Ernest Hemingway. These days he couldn’t go to Catalunya to find some inspiration because bullfighting is banned. The decision was very controversial and it came as a result of a petition signed by 180.000 people who think that torturing animals just for the sake of fun is morally outrageous.

Bullfighting supporters adduced several reasons for maintaining the “spectacle”. Firstly, they gave what we can call a conservative argument. They said that bullfighting is a rooted tradition, like flamenco or paella, and there is value in keeping meaningful traditions alive. Secondly, they put forward an aesthetic argument. There is beauty in a corrida (a bullfight): the outfit, the risk of death, the bravery of the matador. The work of great artists like Hemingway, Almodovar or Garcia Lorca has been inspired by the ritual. A third and more twisted reason was the animalist argument. It was claimed that bullfighting is a good means to preserve the animals. The kind of bulls that are used in bullfighting are of a particular kind (toros de lidia). They are raised only for the ritual and they have a very good life until “their day arrives”– they enjoy better conditions than farmed animals so they can be brave enough. Finally, bullfighting supporters denounced that the interest behind the abolitionist campaign was not moral but political. For them, the popular initiative was not the result of a genuine concern for the animals but of the separatists’ strategy to dissociate Catalunya from anything considered as quintessentially Spanish. We can call this reasoning the political argument.

Read More »Stop bullfighting but carry on bullrunning, really?

Knowing is half the battle: preconception screening

In a recently released report the UK Human Genetics Commission said there are “no specific social, ethical or legal principles” against preconception screening. If a couple may benefit from it, testing should be available so they can make informed choices. Information about this kind of testing should also be made widely available in the health system (and in school). The responses in the news have been along predictable lines, with critics warning that this is a modern version of eugenics or that it would lead to some people being stigmatized.

Read More »Knowing is half the battle: preconception screening

The Second Coming of the Placebo Treatment

The German Medical Association has recommended that doctors should sometimes make use of deceptive placebo treatments when those treatments may be more effective than pharmacologically active alternatives. This recommendation stands at odds with the position of nearly every other international medical association, including the British Medical Association and the American Medical Association, which ruled in 2007 that it would always be unethical for doctors to prescribe placebos without informing their patients.

There is a gathering controversy on the placebo issue; for a long time it has been assumed that placebo treatments are both unethical and/or ineffective, and that widespread use of placebo treatments would grievously undermine the trust between doctors and patients. But a series of recent studies has been undermining the orthodox opinion:

Read More »The Second Coming of the Placebo Treatment

Autonomy: amorphous or just impossible?

By Charles Foster

I have just finished writing a book about dignity in bioethics. Much of it was a defence against the allegation that dignity is hopelessly amorphous; feel-good philosophical window-dressing; the name we give to whatever principle gives us the answer to a bioethical conundrum that we think is right.

This allegation usually comes from the thoroughgoing autonomists – people who think that autonomy is the only principle we need. There aren’t many of them in academic ethics, but there are lots of them in the ranks of the professional guideline drafters, (look, for instance, at the GMC’s guidelines on consenting patients) and so they have an unhealthy influence on the zeitgeist.

The allegation is ironic. The idea of autonomy is hardly less amorphous. To give it any sort of backbone you have to adopt an icy, unattractive, Millian, absolutist version of autonomy. I suspect that the widespread adoption of this account is a consequence not of a reasoned conviction that this version is correct, but of a need, rooted in cognitive dissonance, to maintain faith with the fundamentalist notions that there is a single principle in bioethics, and that that principle must keep us safe from the well-documented evils of paternalism. Autonomy-worship is primarily a reaction against paternalism. Reaction is not a good way to philosophise.Read More »Autonomy: amorphous or just impossible?

Above and Beyond …?

After the tsunami of 11 March, many thousands of people in northern Japan have lost their homes or are in dire need of medical and other supplies. The Oxfam website has a special page on the disaster through which you can donate using a debit or credit card. Other pages enable you to help Ivory… Read More »Above and Beyond …?

Suicide for sale in Oregon: a “valuable service”?

Oregon is currently the scene of a controversy about the sale of so-called “suicide kits” or “helium hoods” (see here and here). These kits are sold by mail by a two-person company called The Gladd Group; one of its owners is reported to be a 91-year-old San Diego County woman who has been selling the kits for four years. The device is now receiving increased media attention following the suicide, with the help of the helium hood kit, of 29-year old Nick Klonoski, who had health-related issues that had brought him into depression, but was not terminally ill. His tragic death has now sparked a movement to outlaw the sale of those kits in Oregon. However, the woman selling the kits protests that she is providing a valuable service, and is quoted as saying that “[i]t is not my intention to hurt anybody, but to offer people comfort when they die”. Is the sale of those suicide kits a legitimate form of business, or should it be banned?

Read More »Suicide for sale in Oregon: a “valuable service”?

Should surgeons other than cardiac surgeons publicise performance information?

Mortality rates for common forms of cardiac surgery have been made public in the United Kingdom for several years now. This information is individualised. If you are considering having a particular surgeon perform a common form of cardiac operation on you, you can make a better-informed decision by getting on the internet and finding out how many times that cardiac surgeon has conducted that operation, how many of his or her previous patients have survived such operations and how often they have not survived. You can also find out how your prospective surgeon compares to other surgeons performing similar operations. Although the publicising of cardiac surgeons’ performance information was controversial when it was first introduced, it has attained a broad level of acceptance in areas in which it has been introduced, in large part because this form of transparency has been effective in reducing mortality (see Justin Oakley and Steve Clarke ‘Surgeon Report Cards’, in Patient Safety First: Responsive Regulation in Health Care, edited by Judith Healy and Paul Dugdale, Sydney, Allen and Unwin, 2009, pp. 221-236). For discussion of a range of ethical issues related to the disclosure of surgeons’ performance information see Informed Consent and Clinician Accountability: the Ethics of Report Cards on Surgeon Performance, edited by Steve Clarke and Justin Oakley, Cambridge, Cambridge University Press, July 2007.

 Read More »Should surgeons other than cardiac surgeons publicise performance information?

Catholic bishops condemn France’s first ‘bebe medicament’

Last month, doctors in France announced the arrival of the country’s first so-called ‘saviour sibling’. Born to parents of Turkish origin, Umut Talha (Turkish for ‘our hope’) was conceived through in vitro fertilisation (IVF) using preimplantation genetic diagnosis (PGD). This technique, in conjunction with Human Leukocyte Antigen (HLA) typing, commonly known as ‘tissue-typing’, has enabled families to have a child – a ‘saviour sibling’ – that is capable of donating life-saving tissue (usually umbilical cord material) to an existing sick sibling. Umut’s parents approached the hospital in Clamart a year ago requesting tissue-typing PGD. Their two existing children had beta thalassaemia, an inherited blood disorder that requires monthly blood transfusions.

An embryo was screened and genetically selected from an original group of twelve embryos to ensure that it was both free of the disorder and a tissue match for one of the existing siblings. The resulting saviour sibling, Umut, did not have thalassaemia, and cells from his discarded umbilical cord will be used to cure his older sister, now aged two, and her monthly blood transfusions will be discontinued. Umut’s parents plan to return to Clamart to undergo the same procedure to cure their other child, Umut’s four-year-old brother.  

Saviour sibling selection is nothing new. Read More »Catholic bishops condemn France’s first ‘bebe medicament’

The patient vanishes

by Dominic Wilkinson

If a patient’s family refuse to allow withdrawal of breathing machines should doctors provide long-term support in an intensive care unit for a patient who is clinically brain dead? Should doctors provide heart-lung bypass (ECMO) for a child with anencephaly? Should doctors perform a tracheostomy and provide a long-term breathing machine for a patient in a documented persistent vegetative state?Read More »The patient vanishes