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Telling porkies: should the doctor tell her patient where the medicine comes from?

Telling porkies: should the doctor tell her patient where the medicine comes from?

In a column in the New York Times this week Randy Cohen fields a question from an anaesthetist. Should the doctor ask a devoutly religious patient whether he minds that his anticoagulant (heparin) is derived from pigs? In reply Cohen suggests that the doctrine of informed consent requires the doctor to consider the non-medical preferences of the patient and make sure Muslims, Jews and vegetarians know where their medicine is coming from.

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Should NHS Medical Services be Rated Like TripAdvisor?

The website TripAdvisor (See: http://www.tripadvisor.co.uk/ ) allows viewers to access (and contributed to) popular ratings of hotels, restaurants and other travel related facilities all over the world. The NHS is now operating a website – NHS Choices – that performs a similar service in respect of NHS medical services: www.nhs.uk. It contains a mix of hard data, such as information about mortality rates at hospitals and the performance of GPs across a range of different aspects of performance, as well as soft data including patients’ impressions of their stay at particular hospitals and their experience of being treated by particular GPs. The rating of hospitals, GPs and other specialisations in medicine follows on from the successful UK experience of publicising cardiac surgeons’ mortality and survival rates, a Government initiative to restore public confidence in cardiac surgery following the Bristol Royal Infirmary Scandal. According to a recent article in the Guardian this has lead to a 21% drop in mortality rates for coronary artery surgery over the last five years: http://www.guardian.co.uk/lifeandstyle/2009/jul/30/heart-surgery-death-rates-fall.

 


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Non-lethal, yet dangerous: neuroactive agents

An article and editorial in Nature warns about the militarization of agents that alter mental states. While traditional chemical weapons are intended to hurt or kill people, these agents are intended to disable. For example, they might induce confusion, sleepiness or calm. The Chemical Weapons Convention contain a loophole for using biochemical agents for law enforcement including domestic riot control, and there is a push from some quarters to amend it to allow novel incapacitating agents. Is disabling agents just an extension of other forms of non-lethal force, or is this a slippery path we should avoid?

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How not to criticize the NHS

The British National Health Service (the NHS) has been in news a lot recently. First it was the Investor's Business Daily in the US, which claimed that:

'People such as scientist Stephen Hawking wouldn’t have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.'

This is a particularly ridiculous claim as Stephen Hawking of course has lived in the UK all of his life! He responded saying:

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Should early non invasive prenatal testing be opposed?

It is now possible to detect fetal problems with just a sample of the pregnant woman’s blood. Women will probably be offered this test routinely in the first trimester. But the breakthroughs are said to raise serious ethical questions.

In 2008 Fan et al. (Proc. Natl Acad. Sci.USA 2008; 105:16266–16271) non-invasively diagnosed fetal chromosome abnormality from cell-free DNA in maternal blood. Recently, at least two companies have announced plans to introduce non-invasive prenatal diagnosis (NIPD) into health care.

The clinical role of NIPD is unclear. It could be used either as a screening test (with CVS or amniocentesis still required as a follow up diagnostic test) or it might replace invasive tests. Less likely, it might be interposed between current screening and invasive tests.

The most exciting, and potentially controversial, role of NIPD is if it can replace current invasive tests. Prenatal (cyto)genetic diagnosis could be achieved much earlier in pregnancy.

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The party line and the flu-line

It has emerged over the weekend that the UK government ignored the advice of a key panel of scientific advisors in the formulation of its pandemic response. The panel advised against the mass prescription of antivirals (Tamiflu) because of the fear that this would accelerate resistance of the virus (see also this previous post in the pandemic ethics series). An expert in influenza, Hugh Pennington, has even called for the national flu hotline to be shut down. It appears that the government may have been influenced in its pandemic response by political sensitivities.

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Symposium Announcement: Human Enhancement: What should be permitted?

The Brocher Foundation, and the Universities of Oxford and Geneva are pleased to announce the Symposium: Human Enhancement: What should be permitted? 20-21 October 2009, Brocher Centre, Geneva, Switzerland Biomedical science is increasingly yielding technologies that can be used to enhance the capacities of healthy people, as well as to treat disease. This two-day workshop… Read More »Symposium Announcement: Human Enhancement: What should be permitted?

Should we forget about organic food?

A recent
report by the Food Standards Agency argues that organic food doesn’t bring any
substantial nutritional benefits compared to conventionally produced food.
This contradicts the conclusions of previous studies suggesting organic food to
be nutritionally superior. As one might have expected, supporters of organic
farming have been critical of the report, yet it is unfortunate that the media
coverage on this issue often gives the impression that organic food has been
shown to be a sham (some consumer groups thus expect shoppers to now “think
twice before buying organic”)
and that its advocates are now reduced to using any bad argument they can think
of to prove the contrary. This impression is understandable but misleading.

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Artificial Brains and Personal Identity

Professor Henry Markram, Director of the Blue Brain Project in Switzerland, has told a conference in Oxford that an artificial human brain is achievable within a decade: http://www.telegraph.co.uk/technology/news/5894875/Artificial-human-brain-could-be-built-in-next-decade.html What would count as a ‘human brain’ is debatable, of course, but the prospect of an artificial grounding for cognitive and other mental functions raises many fundamental… Read More »Artificial Brains and Personal Identity

Four… three… two… one… I am now authorized to use physical force!

Noel Sharkey, Professor of Artificial
Intelligence and Robotics at the University of Sheffield, warns that we are well on our way to get military killer robots that have great autonomy in applying deadly force. Current military "robots" such as UAVs have limited autonomy. They are
remotely controlled by humans, but increasingly given ability to
patrol, find targets and attack on their own. It would be a natural
progression to give them increasingly free reign, with the humans
merely granting permission – but in an active situation human reactions
might be too slow. Will the current convention that a properly trained
military human operator has to make the final decision still hold true
in the future?

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